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A rare heart condition often triggered by extreme stress may be more deadly for men than women, according to a new study published in the Journal of the American Heart Association.
Medically known as takotsubo cardiomyopathy, or “broken heart syndrome,” the condition is characterized by symptoms such as chest pain, palpitations, and shortness of breath. It occurs when a sudden surge of stress hormones temporarily stuns the heart muscle, mimicking the symptoms of a heart attack.
Although takotsubo cardiomyopathy is more commonly diagnosed in women, researchers analyzing nearly 200,000 U.S. hospital cases from 2016 to 2020 found that men—who comprised just 17% of cases—had a mortality rate of 11.2%, more than double that of women.
“This gender gap in outcomes is striking,” said Dr. Mohammad Reza Movahed, coauthor of the study and clinical professor of medicine at the University of Arizona. “It raises new questions that deserve further investigation.”
The condition is typically triggered by sudden emotional or physical stress—such as the loss of a loved one, intense physical exertion, or even an unexpected event like winning the lottery. During such events, the heart’s left ventricle can weaken, impairing its ability to pump blood effectively.
Researchers believe that hormonal differences may contribute to the disparity. Men generally produce higher levels of catecholamines, the stress hormones responsible for the condition, potentially leading to more severe cardiac effects. Meanwhile, estrogen, which is present at higher levels in women, may have protective effects on the cardiovascular system.
Social and medical factors may also play a role. Physicians may overlook takotsubo cardiomyopathy in men due to its stronger association with women, potentially leading to delays in diagnosis and treatment. Additionally, men may be more likely to postpone seeking medical care, assuming their symptoms will resolve on their own.
“Most physicians are aware of takotsubo, but many still think of it as a woman’s disease,” said Dr. Deepak Bhatt, director of Mount Sinai Fuster Heart Hospital. “That misconception can result in misdiagnosis and worse outcomes.”
If not promptly treated, the condition can lead to serious complications, including blood clots, stroke, heart failure, and cardiac arrest. However, with early diagnosis and appropriate medication, takotsubo cardiomyopathy is often fully reversible within a few weeks.
The study adjusted for key variables such as age, race, and pre-existing conditions like diabetes and lung disease. However, it did not account for outpatient data or deaths occurring after hospital discharge, suggesting the condition’s true impact may be even greater.
Dr. Louis Vincent, a cardiology research fellow at the University of Miami, emphasized the need for more comprehensive research into the gender disparity. “Big datasets help reveal population-level trends,” he said. “This one makes it clear: broken heart syndrome may be more dangerous for men than we thought.”
Experts stress that sudden chest pain or difficulty breathing should always be treated as a medical emergency.
“Don’t try to tough it out or wait it out,” said Bhatt. “Every second counts in protecting your heart from long-term damage.”
While broken heart syndrome is often triggered by unexpected emotional shocks, doctors recommend managing daily stress through regular exercise, mindfulness, and therapy to build resilience.
“Developing healthy coping strategies gives your body the tools to better withstand the unexpected,” added Movahed.
