It sounds like a scene from a soap opera: someone loses their soul mate, then passes away in the night, seemingly from a broken heart.

But it’s not just a trope of fiction—broken heart syndrome is real, and in very rare cases, it can even be fatal. Broken heart syndrome, aka stress-induced cardiomyopathy, is a weakening of the heart that can cause similar symptoms to regular cardiomyopathy, or heart muscle disease: chest pain, shortness of breath, and sometimes changes in heart rhythm.

It’s so similar, in fact, that the syndrome wasn’t identified until the 1990s. But there’s one key difference. In stress-induced cardiomyopathy, patients don’t have blocked arteries the most common cause of heart disease.

And when you X-ray the heart, it looks a little bit like a takotsubo, a type of pot used as an octopus trap in Japan. Which is why the syndrome is also sometimes called Takotsubo cardiomyopathy. The shape comes from a temporary enlargement of the heart, especially the left ventricle, the largest and strongest of the four chambers in your heart.

Normally, bigger might sound better, but in this case the left ventricle becomes enlarged because the muscle tissue isn’t working as well. It’s become less elastic and weaker, so it can’t pump with as much force as normal. We still don’t know exactly how this enlargement happens, but the leading hypothesis is the sudden release of catecholamines, things like adrenaline, what’s often called the “fight or flight” response to stress.

Catecholamines increase blood flow to the muscles and raise the heart rate and blood pressure to prepare your body to react to potential threats. But in cases of broken heart syndrome, these catecholamines go overboard for some reason, interfering with the muscles’ ability to contract. It’s typically provoked by a profound emotional event or trauma, like the death of a loved one, getting fired, or abuse hence the name “broken heart syndrome.” That said, it can happen after any type of stress, even if it seems mild, like locking yourself out of your house.

And the event doesn’t even have to be bad. Takotsubo cardiomyopathy can happen after happy moments, too, like being surprised at a birthday party or hitting a jackpot at the casino. There’s still a lot we don’t know about broken heart syndrome, but one thing researchers have learned is that it mostly happens in older women.

We’re not totally sure why, but it may have something to do with lower levels of the hormone estrogen, which helps regulate stress. As women get older, their estrogen levels drop off. So they’re more likely to be deeply affected by a stressful event, and to experience stress-induced side effects like broken heart syndrome.

But that doesn’t explain why it rarely happens in men, who also have very low levels of the hormone. So estrogen is just one piece of the puzzle. If all this talk of death by broken heart is freaking you out a little bit, just know that it’s super rare, and life-threatening cases are even rarer.

Most cases resolve on their own in a few weeks, though doctors usually monitor people just to be safe. So, as the saying goes, time does heal a broken heart. Or at least, it usually heals broken heart syndrome.

Thanks for asking, and thanks especially to our patrons on Patreon, who always have a special place in our non-broken hearts. You have helped to keep our hearts whole! If you want to propose questions for us to answer or get other rewards like access to a monthly blooper reel— which, this episode had a whole thing about getting stuck in a bathtub that we cut out— you can get it!

You’ve got to go to patreon.com/scishow though.