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The broken heart syndrome.

T hroughout history, mankind has had an intuitive understanding of the connection between emotional stress and the heart. Descriptions of “heartache” and “dying from a broken heart” have appeared in the literary works of diverse cultures for centuries. Similarly, the medical literature is replete with descriptions of sudden death and myocardial infarction (MI) in the setting of fear, anxiety, and bereavement. In the modern era, reports of sudden death and MI have been well documented in populations subjected to emotionally traumatic events such as natural disasters and acts of war, but the direct effect of acute emotional stress on cardiac contractile function has remained obscure. Recently, a novel syndrome of transient left ventricular (LV) systolic dysfunction precipitated by acute emotional or physical stress has appeared in the medical literature. For years this syndrome has been underrecognized and misdiagnosed, and only now are physicians beginning to appreciate the constellation of clinical features that characterize it. This brief review will highlight those distinguishing features, provide some historical background of this relatively new syndrome, and review what is known about its possible pathophysiologic mechanisms.