By Kevin G. Tayon, MD, and Bryan J. Taylor, PhD, FAACVPR

The year is 1983; the place is Hiroshima, Japan. Dr. Hikaru Soto, a pioneer of Japanese reperfusion therapy for acute myocardial infarction, encountered a puzzling case. An ostensibly healthy 64-year-old woman arrived at the hospital with sudden-onset chest pain and evidence of severe heart failure. The team was concerned for a heart attack; however, when doctors imaged her heart arteries, they found no blockages or plaque. Two weeks later, something unexpected happened — her heart function had spontaneously and completely recovered.

An enthusiast in studying heart attack patients, Dr. Soto was intrigued by the fact that his patient’s heart function was severely reduced at its tip but normal at its base. To Dr. Soto, the shape of her heart resembled a traditional Japanese octopus trap, known as a “takotsubo.” Hence, he named this condition “Takotsubo syndrome.” At the time, the case was considered a medical curiosity; and for many years, similar cases were rarely recognized or reported.

In 2004, this changed. A powerful earthquake struck the Chūetsu region of Japan. In the days following the disaster, doctors diagnosed a surge of patients with the same strange heart findings as the woman from Hiroshima in 1983. Indeed, almost as many cases of Takotsubo syndrome were reported in the week following the Chūetsu earthquake as had been reported in the two previous decades combined.

The question was, why? After the 2004 Chūetsu earthquake, the link between emotional stress and Takotsubo syndrome was evaluated extensively. It was found that patients with Takotsubo syndrome were typically presenting after a period of intense emotional or physical stress; think grief, fear, acute illness, or trauma. The evidence was now mounting that intense emotional and physical stress could temporarily overwhelm the heart, and Takotsubo syndrome was ultimately given a new name: the “broken-heart syndrome.”

Metaphorically, a broken heart is synonymous with the intense emotional stress or pain a person feels at experiencing great loss or deep longing. Clinically, however, Takotsubo syndrome is not always linked to sadness. In fact, in rare cases, it has occurred after joyful events such as weddings, surprise parties, or other emotionally enjoyable but charged celebrations. So even if your Valentine’s Day is full of love and happiness, even those strong positive emotions could lead to the development of a “broken heart” from Takotsubo syndrome.

While one-third of Takotsubo syndrome cases are triggered by emotional stress, another one-third are triggered by physical stress. Most physically triggered cases occur during acute medical illnesses, like infections, but Takotsubo syndrome has also been reported during strenuous exercise and exercise stress testing. Some researchers have even suggested that “broken-heart syndrome” may help explain other exercise-related heart dysfunction, such as swimming-induced pulmonary edema.

The association between “broken-heart syndrome” and physical stress is particularly relevant for cardiac rehabilitation professionals, who guide patients as they safely return to exercise after cardiac events and may encounter individuals with sudden, unexplained chest pain or shortness of breath during activity. As Cardiac Rehabilitation Week and Valentine’s Day intersect in 2026, increasing awareness of the “broken-heart syndrome” is especially important, because we may care for patients who have experienced it or who develop it during exercise testing and training.

Why Takotsubo Patients Often Miss Out on Cardiac Rehabilitation

Despite being a form of heart failure, Takotsubo syndrome is not currently a Centers for Medicare & Medicaid Services (CMS) covered indication for cardiac rehabilitation. Some patients qualify initially because they are treated as having a heart attack or heart failure with low ejection fraction; but by the time they are referred, their heart function often has recovered and they no longer meet eligibility criteria.

As a result, many Takotsubo syndrome patients fall into a gap. Many are still symptomatic — especially during exercise — and may benefit from structured rehabilitation, but do not have access. This is especially challenging given the emotional and stress-related nature of the condition, which makes engaging in exercise unsupervised and without assistance challenging, both mentally and physically.

Interest in this gap has grown. A small but increasing body of research has examined whether cardiac rehabilitation benefits patients with Takotsubo syndrome. These studies, including from our research group at Mayo Clinic Florida, suggest that cardiac rehabilitation may improve exercise capacity, symptoms, and quality of life in Takotsubo syndrome. While Takotsubo-specific rehabilitation research remains limited, these findings reinforce a familiar message for rehabilitation professionals: recovery is not defined by improvements in imaging or lab tests alone. Indeed, physical conditioning, mental health, education, and social support are all cornerstones of recovery from serious medical events like a “broken heart.”

A Broader Message for Cardiac Rehabilitation Week

The lack of reimbursement for cardiac rehabilitation for patients with Takotsubo syndrome highlights a larger issue in cardiovascular care. Cardiac rehabilitation is one of the most effective tools in cardiovascular disease management, yet it remains underutilized. Many eligible patients are never referred, never enroll, or face barriers related to coverage, transportation, or program availability.

Takotsubo syndrome also reminds us how deeply our physical health is connected to life’s stresses and emotions. Cardiac rehabilitation professionals certainly would agree that cardiac rehabilitation is more than exercise training. It includes education, risk-factor management, stress reduction, and social support. This is why it is well positioned to benefit patients recovering from a sudden and frightening condition like Takotsubo syndrome, where the psychosocial components of rehabilitation may be just as important as the physical ones.

As Cardiac Rehabilitation Week coincides with Valentine’s Day this year, it offers a timely opportunity for reflection. It is a moment for rehabilitation teams, clinicians, and administrators to discuss how programs can better serve patients who fall outside traditional diagnostic categories but clearly stand to benefit. The call to action is simple: work together to expand the reach of cardiac rehabilitation. By strengthening collaboration and advocacy, more patients can access the support they need so they can return to living fully and enjoy Valentine’s Day without breaking their hearts.

Dr. Kevin Tayon is a cardiologist and advanced cardiac imaging fellow at Mayo Clinic Florida. He is actively involved in clinical research and education focused on the cardiovascular responses to exercise and cardiac rehabilitation.

Dr. Bryan Taylor is a clinical-translational exercise physiologist at Mayo Clinic Florida, where he is program director of cardiopulmonary rehabilitation. He is also principal investigator of the Clinical & Cardiopulmonary Exercise Research Lab and a fellow of AACVPR.