When you think of a broken heart, you may imagine cheesy movie tropes that accompany a bad breakup, like eating entire tubs of ice cream or crying until you’ve made yourself sick. But a real-life broken heart can actually lead to serious cardiac damage, and patients with “broken heart syndrome” may need vigorous medical follow-up.

New research presented at the annual European Society of Cardiology meeting on Tuesday shows that patients with broken heart syndrome who have a previous or current cancer diagnosis are even more frail than other patients with the same syndrome. Having had cancer increased patients’ risk of being readmitted to hospitals with heart failure and even increased their risk of death.

Broken heart syndrome, which is also referred to as takotsubo cardiomyopathy or stress-induced cardiomyopathy, is a rare condition that was first noticed in Japan in 1990. Physicians there discovered that some people who appeared to have had a heart attack actually didn’t have any constriction of their coronary arteries. Unlike other heart attack patients, people with broken heart syndrome had a sudden and mysterious swelling of their left ventricle. (The swollen ventricle looks a lot like tako tsubo, the balloon-shaped traps used to catch octopus in Japan).

tako tsubo
Tako tsubo, the Japanese octopus traps that resemble the heart's enlarged ventricle.

Since then, researchers have found that emotional and mental stressors do seem to precede broken heart syndrome. “Triggers include intensely stressful events, such as the loss of a loved one, severe pain, serious illness, a surprise party, car accident, financial loss, fierce argument etcetera,” Dr. Jennifer Haythe, a cardiologist at Columbia University, tells Inverse.

People who have broken heart syndrome experience symptoms very similar to a heart attack. These include sudden chest pain, low blood pressure, and shortness of breath. But the condition is extremely rare. Only about 2 to 3 percent of people presenting with a heart attack in the United States actually have broken heart syndrome, Haythe says. It can strike healthy people too, although it is more common in postmenopausal women. And the condition usually resolves within a few days or weeks with medical care.

Cancer may be one more stressor that puts people at high risk. To understand exactly how the disease affects cardiac health, scientists at the University of Foggia in Italy conducted a meta-analysis of three previous studies published on people with broken heart syndrome. They looked at hospital admittance rates and adverse events among 554 people with takotsubo cardiomyopathy, nearly 20 percent of whom also had a previous or current cancer.

The researchers found that the risk of events like blood clots, cardiogenic shock, and life threatening arrhythmias was twice as high in the cancer group compared to the cancer-free group.

“Whether it is the cancer itself, an increase in stress hormones secondary to the malignancy, or the chemotherapy used to treat that predisposes the cardiac muscle to this condition needs to be determined,” Haythe says. But based on this new information, doctors may consider giving patients with broken heart syndrome specialized therapy, such as medication for heart failure, if they develop other chronic conditions like cancer. Alternatively, patients with a history of cancer could also be screened for takotsubo cardiomyopathy, Haythe says.

If anything, we’re learning that the link between our hearts and our overall health is much more literal than we realized.