We see it in the movies (The Notebook), we hear about cases of sudden passing without any medical reason or cause typically after a death of a spouse…so what is it ? and what’s the medical term for a broken heart ?

Takotsubo cardiomyopathy

Takotsubo cardiomyopathy is a weakening of the left ventricle, the heart’s main pumping chamber, usually as the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, a serious accident, or a natural disaster such as an earthquake. That’s why the condition is also called stress-induced cardiomyopathy, or broken-heart syndrome.

Grief Reaction and Broken Heart Syndrome


Grief is a natural and universal response to the loss of a loved one. The grief experience is not a state but a process. Most individuals recover adequately within in a year after the loss; however, some individuals experience an extension of the standard grieving process. This condition has been identified as complicated grief or prolonged grief disorder, and it results from failure to transition from acute to integrated grief. Symptoms of acute grief include tearfulness, sadness and insomnia and typically require no treatment. Intense grief over the loss of a significant person may trigger the acute onset of myocardial infarction (MI). The impact may be higher with cardiovascular risk. Complicated grief has prolonged symptoms of painful emotions and sorrow for more than one year. Patients show a preoccupation with the deceased and feel inner emptiness, no interest in life, and sleep poorly. There is a correlation between complicated grief and acute coronary syndrome (ACS).  There is now a new consensus that 7% to 10 % of bereaved individuals experience intense and chronic reactions called prolonged grief.  The terms grief, mourning, and bereavement have slightly different meanings: Grief is a person’s emotional response to loss. Mourning is an outward expression of that grief, including cultural and religious customs surrounding death. It is also the process of adapting to life after loss. Bereavement is a period of grief and mourning after a loss. Anticipatory Grief is a response to an expected loss. It affects both the person diagnosed with a terminal illness as well as their families.  Takosubo Cardiomyopathy (Broken Heart Syndrome): is a weakening of left ventricle caused by severe emotional or physical stress such as loss of a loved one, sudden illness, a serious accident, or a natural diaster (e.g., earthquake).

Mughal S, Siddiqui WJ. Grief Reaction. 2018 Jun 29. StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from

Atrial arrhythmias in Takotsubo cardiomyopathy: incidence, predictive factors, and prognosis.


Takotsubo cardiomyopathy (TTC) is a stress-related transient cardiomyopathy. It is unclear whether TTC is associated with poorer prognosis when atrial arrhythmia (AA), atrial fibrillation or flutter, occurs. The purpose of this study was to assess the incidence of AA in patients with TTC, predictive factors of AA, and its association with mortality.


We studied 214 consecutive cases of TTC over 8?years. The study cohort was divided into two groups-those with newly diagnosed AA (AA-group) and those without (non-AA group). AA occurred in 24.8% of the patients. The AA group presented with lower left ventricular ejection fraction (LVEF) on admission and higher cardiac arrest rate. Admission and peak levels of troponin, B-type natriuretic peptide (BNP), C-reactive protein (CRP), and leucocytes were higher in the AA group. In-hospital, 30-day, cardiovascular, and all-cause mortality were significantly higher in the AA group. Independent predictors of newly diagnosed AA were troponin peak [odds ratio (OR) 1.03 (1.003-1.06); P?=?0.029], CRP peak [OR 1.006 (1.001-1.01); P?=?0.026], and LVEF on admission [OR 0.96 (0.93-0.99); P?=?0.01]. Newly diagnosed AA was not predictive of mortality. The BNP peak [OR 1.00 (1.000-1.001); P?=?0.022] and leucocytes peak [OR 1.095 (1.034-1.16); P?=?0.002] were predictive factors of in-hospital mortality. LVEF upon discharge [OR 0.935 (0.899-0.972); P?=?0.001] and leucocytes peak [OR 1.068 (1.000-1.139); P?=?0.049] were predictive of cardiovascular death.


Newly diagnosed AA is frequently observed in patients presenting with TTC and is associated with poorer short- and long-term prognosis. Inflammation, myocardial damage, and LVEF are predictors of AA onset and cardiovascular mortality.

Jesel L, Berthon C, Messas N, Lim HS, Girardey M, Marzak H, Marchandot B,
Trinh A, Ohlmann P, Morel O. Atrial arrhythmias in Takotsubo cardiomyopathy:
incidence, predictive factors, and prognosis. Europace. 2018 Jul 10. doi:
10.1093/europace/euy147. [Epub ahead of print] PubMed PMID: 30007327.


About the author: Dr. Mordy Levy


Dr. Mordy Levy, BSc, ND, DC, HOM, IMG, Graduated from three first professional degrees in separate and distinct health care professions. As a Doctor of Chiropractic (DC) in 1997 from the National College of Chiropractic, Chicago, Illinois, as a Doctor of Medicine (MD) in 2006 from the University of Health Sciences Antigua, School of Medicine and as a Doctor of Naturopathic Medicine (ND) in 2011, graduated Summa Cum Laude, from the National University of Health Sciences and was the valedictorian of his graduating class.

Dr Levy's first undergraduate degree (BSc) was in Biology and Psychology from York University and his second undergraduate degree (BSc) was in Human Biology and Biomedical sciences from National University of Health Sciences (Chicago, IL)

Dr. Levy is a registered member in good standing with three distinct health professions in Ontario, namely the College of Chiropractors of Ontario, the College of Naturopaths of Ontario, in addition to the College of Homeopaths of Ontario.

Dr. Levy is a professional member of the Institute of Functional Medicine, the Canadian Society of Orthomolecular Medicine, American College of Nutrition, in addition to the Ontario Association of Naturopathic Doctors, the Ontario Chiropractic Association and the Ontario Homeopathic Association.

Always an avid lifelong learner, Dr. Levy completed numerous postgraduate courses in Functional Medicine, Clinical Nutrition, Acupuncture and Homeopathy. His clinical interests are in digestive, autoimmune, fertility, chronic pain and hormonal health.

On a personal noted: Dr. Levy enjoys spending time with his three boys, practicing TaeKwonDo and reviewing research articles.

Website: http://www.DrLevy.ca