The Bee Gees famously warned us about about how difficult it is to mend a broken heart, and now some German scientists have made clear the dire consequences that await us if we don't.

A broken heart is a Real Thing. Science knows it as Takotsubo cardiomyopathy (which is considerably more difficult to rhyme against if you're writing a pop song). It can be caused by loss of a loved one, an argument with a neighbor – even by physical triggers, such asa fall or certain infections.

Broken heart syndrome presents many of the same symptoms as a heart attack – shortness of breath, chest pains, parts of the heart beating poorly – without any occlusion of coronary vessels. It occurs most commonly in women of post-menopausal age. There are known (non-lyrical) reasons as to why it occurs. When it does occur in men, the source is usually traceable to physical stress caused by accidents or infections; in women, the trigger is almost always emotional. Takotsubo cardiomyopathy from a physical trigger is worse, according to the new study from the German Center for Cardiovascular Research.

“For a long time, it was thought that the disease was harmless, since the heart function usually recovered again after three months at the latest”, explains Dr. Ibrahim El-Battrawy, the principle investigator of the study. “Yet serious secondary diseases can indeed still occur months later and up to four percent of patients even die following a Takotsubo cardiomyopathy.”

El-Battrawy's team reviewed the records of 84 patients who were monitored for over four years and examined how the different triggers affected the long-term progress of the disease. The patients had been asked whether they had experienced high emotional or acute physical stress in the previous couple of weeks. The researchers discovered that the group with emotional stress complained more about chest pains, whereas the group with physically-sourced stress was more likely to suffer from shortness of breath. The key takeaway, however, was that life-threatening cardiac arrhythmias, repeat heart failure, stroke, and heart attack occurred more frequently if physical stress was the trigger of the broken heart syndrome.

“Our study shows that physical stress is a risk factor for a poor disease progress and it contributes to further limiting the high-risk patient group”, concluded El-Battrawy. “The study also emphasizes how important it is to monitor patients over the short and long term. No matter what the trigger, patients should be monitored just as closely as heart attack patients and should have regular check-ups following discharge from the hospital.”

The research has been published in Frontiers of Psychology.