The condition was first described by Dr. Hikaru Sato and colleagues in Japan.  It has a lot of medically appropriate names which clinicians would easily recognize, such as apical ballooning syndrome, left ventricular dysfunction or Takotsubo Cardiomyopathy. The very first case managed was at Hiroshima City Hospital in 1983, where a 64-year-old woman presented with symptoms mimicking a heart attack but had clear coronary arteries and an unusual "octopus pot" heart shape... Other cases only began to be reported later on in places like the United States and Europe in the late 1990s, with the first U.S. report emerging in 1998. The syndrome then gained major international attention and began to be more frequently diagnosed after a key study was published in the New England Journal of Medicine in 2005. The American Heart Association officially recognized it as a unique form of cardiomyopathy in 2006.

We are currently in February 2026 and it is a month formally recognized as The Heart Month where by organizations like the CDC and AHA raise awareness about heart disease, the leading cause of death, and encourage healthy lifestyle changes. Ironically February is also widely considered the "month of love" globally, largely due to Valentine's Day on February 14th. It is a time focused on romance, affection, and celebrating relationships with partners, friends, and family. The tradition, rooted in ancient Roman and Christian history, emphasizes expressing love through gifts, cards, and special gestures. We all know that love, especially romantic love, comes with its fair share of emotional turmoil. That turmoil can range from the highest highs to the lowest lows.

Welcome to Ndlalane Health newsletter, your one stop shop for all your health and wellness know how. Today in our 6 minutes read we will get to understand “why people normally say, “I love you with all my heart”. I am your host, DocSakhi and as always, we will walk through this topic together in a way that we don’t loose each other in medical jargon in the process. First lets look at how the heart works and how hormones affect it.

It is common knowledge that the heart pumps blood. Some of us might not know how it does it, and I hope I can use, just three lines to explain in the simplest way possible.

The heart is a two in one pump. The right side of the heart is interested in receiving blood from the whole body then pumping it to the lungs to be given oxygen. The right side of the heart is interested in receiving the blood from the lungs, then pumping it back to the rest of the body. The two pumps, work in a beautiful, synchronized way, in such that, they pump at the same time, giving each other turns. The pump that receives blood from the body on the right and that which receives blood from the lungs, pump at the same time, then followed by the pumps, that pump to the lungs on the right and that which pumps to the rest of the body on the left which also pump at the same time.  That is why you can hear your heart making two rhythms “goo goo” “goo goo”. usually referred to as the “lub dub” sounds.

This is all that the heart does, every day, all day without stopping, making sure that we get all the oxygen and nutrients we need, delivered on time everywhere. Since the blood is moving around all the time, it is used as transport for every other thing from other parts of the body to the next. The stomach puts its food in there (nutrients), the brain also puts its chemicals (hormones) in there to send signals and commands where they are needed. 

The heart itself also needs oxygen and nutrients, that is why it also has its own blood vessels (coronary vessels) on its body to feed itself to continue pumping.. This is where our interest will lie today, the things that can be found in the blood, that find themselves in the body of the heart, not in the pump but in the blood vessels which feed the heart itself. Things like medications and hormones and how it affects the workings of the heart.

What is a heart attack then Dr?  In simple language, this is when the heart fails to continue to pump due to many reasons, but the most common one is when, the blood vessels that feed the heart are blocked and the heart stops getting oxygen and nutrients and the muscles, responsible for running the pump start dying. There are many things that can cause those blood vessels to be blocked.. Some causes are sudden(acute), while others take a period of time to happen(chronic), for example, someone who smokes, the toxins in the cigarette, spoil the inside of the blood vessels, making the blood vessels to narrow and make pumping blood difficult. Another example would be someone with high cholesterol (fats in the blood), the fats can stick on to the sides of the blood vessels and block the blood from flowing smoothly. The cells that are on the other side of the blockage, start to die of starvation due to reduced flow quantity. In some cases, a person can have a piece of broken fat or blood clot from another part of the blood vessels, most of the the time from the legs, which can travel and find itself on the heart blood vessels which are smaller in size and block it. In such cases the heart attack happen all of a sudden.

That was quite a mouthful, and I hope it has given you a big picture at what we are about to discuss.  Then how is the heart broken in Broken heart syndrome?  

In simple language as I mentioned above, the person experiences pain in the heart, and all the symptoms of a heart attack, but when they are put in the heart monitor, all the blood vessels are clear (no blockage) and when other tests are done, the pump seems to be working fine. So then how are they having a heart attack?

The culprit here is… well, you guessed it.. hormones..

All humans experience emotions through the availability of hormones, some hormones even influence how we look, behave and so on. For example, estrogen, makes a person look feminine, and testosterone makes a person look, muscular.. Adrenaline makes a person become hyper, oxytocin makes a person feel connected to someone. Just to mention a few of the hormones. These hormones, since they travel through the blood, they find themselves in the heart too. In the heart, they either make it pump slow or fast or not affect it at all.

Lets say, you see a person you like, or wish to be in a romantic relationship with. Your crush in short. The eyes will see that person then tell the brain, “oh gosh! Its him! Or Her!.  The brain will get excited at this news and release a number of hormones, into the blood which we normally refer to as the "Chemical Cocktail" of Attraction

The first one is Adrenaline (Epinephrine): This is the "fight or flight" hormone. It is responsible for the immediate physical jolt you feel. The second one is norepinephrine: This focuses your attention, making you "tunnel vision" on the person. You see only this person in your world, temporarily. Both these hormones will increase your heart pumping rate. Why? Because your brain is excited and needs more energy to work, so it tells the heart to bring more oxygen rich blood faster. The muscles are also are preparing for whatever might happen so it starts taking in more energy at this point.

The third hormone is dopamine: This is the "reward" chemical. It creates the feeling of euphoria and intense craving to be near the person you are affectionate about. It is the same chemical released by addictive drugs. The last hormone is Phenylethylamine (PEA): Often called the "molecule of love," this is a natural amphetamine that causes the "butterflies" and light-headedness.

At this point the heart reacts to this chemical surge in very specific, measurable ways, it beats very fast and forcefully. This is why people say that, their heart "skipped a beat" or is "racing.” You can often feel your heart "thumping" against your chest wall (palpitations). The Adrenaline causes blood vessels in the skin to dilate (causing blushing) while constricting vessels in the gut (causing the "butterflies" or a nervous stomach).All this increase in cardiac output causes a temporary acute rise in blood pressure.

Lets go back now and talk about the Broken Heart syndrome. I am sure you have an idea, where the conversation is going at this point i would assume?

The difference between a "crush" and a broken heart syndrome event is that the volume of the hormones involved, together with the duration of the event ends up putting the life of the person at risk of dying.

The "Crush" Response is a controlled, manageable surge. The heart is stimulated, but it is not "stunned." The body quickly reabsorbs the adrenaline once the interaction ends but the Broken heart syndrome on the other hand is an overwhelming flood. Instead of a "jolt," the heart receives a "tidal wave" of adrenaline. The receptors in the heart become so overwhelmed that they "shut down" the muscle to protect it from being worked to death. We call this "stunning" or ballooning effect. In 96% of the cases, this happen when the person experiences negative emotions, and the 4% being positive emotions. It is fascinating how much we have learned about the connection between our brains and our hearts through this syndrome.

The connection is normally termed, The "Brain-Heart Axis"

When you experience shock, the amygdala (the brain's emotional centre) overreacts and signals the adrenal glands to dump massive amounts of adrenaline and noradrenaline into the bloodstream in an attempt to bring you mood back up from shock. I have mentioned above that, these hormones don't just make the heartbeat faster; they actually stun the heart muscle cells. The base of the heart continues to contract, but the apex (the bottom) stops moving and balloons out, creating the "octopus pot" shape. The adrenaline causes the tiny, microscopic blood vessels to spasm, temporarily cutting off the oxygen supply to the muscle without a major clot being present.

Research has shown that triggers of the broken heart syndrome are much broader:

Doctors often cannot tell the difference between a real heart attack and a broken heart syndrome based on symptoms alone, as both cause chest pain and shortness of breath. Key clinical differentiators used in the hospital include:

Unlike a heart attack, which leaves permanent scar tissue, broken heart syndrome is generally reversible. Most patients see their heart's pumping function return to normal within 2 to 8 weeks. During the acute phase, patients are treated with standard heart failure medications (e.g., beta-blockers, ACE inhibitors, and diuretics) to reduce the load on the heart.

A few years ago, this syndrome was considered not to have long term considerations but these days, due to our lifestyle it is no longer considered "harmless." Long-term mortality rates can be similar to heart attack patients, often due to underlying health issues. There is a roughly 1% to 3.5% annual risk that the syndrome will happen again and there are certain people who are at a higher risk than others.

Over 90% of cases occur in women, specifically those over the age of 40. The primary reason is the drop in estrogen levels. Estrogen helps keep blood vessels flexible and healthy. It also helps dampen the heart's response to stress hormones (catecholamines). After menopause, the loss of estrogen makes the heart’s small blood vessels (microvasculature) more sensitive to "surges" of adrenaline. Without that hormonal shield, a stressful event can more easily overwhelm the heart muscle.

 Since the trigger is often a "surge," the goal is to keep the sympathetic nervous system (the "fight or flight" response) in check because there is a high correlation between broken heart syndrome and pre-existing anxiety or depression, treating the underlying mental health condition is considered a primary preventive measure.

Techniques like deep diaphragmatic breathing can activate the parasympathetic nervous system (the "rest and digest" system), which acts as a natural brake on the adrenaline response.

Young people are affected too and their common triggers are emotional grief, physical illness or if they have neurological conditions like seizures or brain injury, drug use (stimulants), and  extreme physical stress.

For every 1 young person (under 45) diagnosed with broken heart syndrome there are roughly 20 to 30 postmenopausal women diagnosed. When young people do get it, it is more likely to be triggered by an intense emotional or physical pain stressors

The syndrome is increasingly recognized in younger populations, men, and individuals with specific metabolic or hormonal profiles. The nature of the "stress" that triggers broken heart syndrome has evolved with our digital and sedentary environment. The constant influx of high-stress news and social media comparisons can lead to chronic activation of the sympathetic nervous system. A baseline of chronic stress from modern life may lower the threshold for a major event to trigger a "broken heart" episode. Things like obesity and a lack of physical activity are linked to metabolic syndrome, which increases inflammation and vascular dysfunction. This makes the heart's microcirculation more "brittle" and reactive to adrenaline surges.

Hormonal balance is a key factor in heart health, and shifts in this balance can impact broken heart syndrome risk. Since estrogen is cardioprotective, any sudden drop or significant fluctuation can increase risk as well.

Men are increasingly represented in the syndrome’s registries (rising from 10% to 15% of cases recently). Interestingly, men often have physical triggers (like a severe illness) rather than emotional ones and face higher in-hospital mortality rates.

One More Interesting Fact: "The Happy Heart". We usually focus on stress for the most part when we speak about the broken heart syndrome but about 4% of cases are triggered by positive events (weddings, births, sports wins). Interestingly, "Happy Heart" cases often show a different ballooning pattern in the heart than "Broken Heart" cases.

In closing, I’d like to say that, issues of the heart are high up there in the medical list of dangerous things to experience in a lifetime. Its 2026 and as a society we are currently in a "medical transition" period where we are manipulating hormones more than ever (HRT for menopause, gender-affirming care, or fertility treatments). We are using powerful metabolic drugs (GLP-1s) to combat the sedentary lifestyle. Read our previous article on Diabetes drugs for my weight, if you missed it. .

This creates a complex chemical environment in the body. In most cases these treatments are often life-saving or life-enhancing, they change how the heart responds to the "Adrenaline Storm." A person on a weight-loss drug that increases heart rate, who is also under high digital-media stress and experiencing early hormonal shifts, has a much different "cardiac threshold" than a woman who lived in the early 1990s.

Doctors are evolving their screening and diagnostic protocols to address the "modern" patient profile, moving beyond the 1990s stereotype of the postmenopausal woman to include younger adults, men, and those on specific hormone or metabolic therapies. Because both gender-affirming care and early hormone replacement therapy (HRT) can alter vascular sensitivity, we are implementing a more proactive monitoring:

Guidelines now suggest detailed medical and family history screening before initiating any hormone therapy to identify pre-existing cardiac risks. Annual "Vascular Check-ups": For those on long-term hormones, annual monitoring of blood pressure, lipid profiles, and blood glucose is recommended to catch the metabolic shifts that can prime the heart for a Takotsubo event.

In emergency settings, doctors are learning to use sex-at-birth reference ranges for high-sensitivity cardiac troponin tests (e.g., using the female range for a transgender man) to avoid missing the subtle enzyme elevations typical of the broken heart syndrome.

Since the broken heart syndrome in younger people is heavily linked to anxiety and substance use disorders, some centres are integrating psychiatric screening and "psych cardiology" interventions into the recovery protocol to prevent recurrences.

For women experiencing menopause in their early 40s, we are shifting their risk assessment. Doctors are being taught that early-onset hot flashes (before age 42) can be a clinical marker for poorer endothelial function, signaling a heart that may be more vulnerable to stress-induced "stunning".

Thank you for reading all the way through to the end of the article. Stay informed, remain in the know. Learning is a life long journey.

Until next time.

Cheers by for now.

References

_{American Heart Association. (2006). Heart disease and stroke statistics—2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 113(6), e85–e151.}

_{Dote, K., Sato, H., Tateishi, H., Uchida, T., & Ishihara, M. (1991). Myocardial stunning due to multivessel coronary spasm: A rare cause of cardiogenic shock with reversible left ventricular dysfunction. Japanese Circulation Journal, 55(10), 995–1000.}

_{Ghadri, J. R., Wittstein, I. S., Prasad, A., Sharkey, S., Dote, K., Akashi, Y. J., ... & Templin, C. (2018). International expert consensus document on Takotsubo syndrome (Part I): Clinical characteristics, diagnostic criteria, and pathophysiology. European Heart Journal, 39(22), 2032–2046.}

_{Sato, H., Tateishi, H., Uchida, T., Dote, K., & Ishihara, M. (1990). Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In K. Kodama, K. Haze, & M. Hori (Eds.),}

_{Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure (pp. 56–64). Kagakuhyouronsha Publishing.}

_{Sharkey, S. W., Lesser, J. R., Zenovich, A. G., Maron, M. S., Lindberg, J., Longe, T. F., & Maron, B. J. (2005). Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation, 111(4), 472–479.}

_{Wittstein, I. S., Thiemann, D. R., Lima, J. A., Baughman, K. L., Schulman, S. P., Gerstenblith, G., ... & Champion, H. C. (2005). Neurohumoral features of myocardial stunning due to sudden emotional stress. The New England Journal of Medicine, 352(6), 539–548}