It’s been said that time heals a broken heart, but a small new study suggests that may not be true — at least for those with broken heart syndrome.

The syndrome, also known as tako-tsubo cardiomyopathy or stress-induced cardiomyopathy, is an acute heart condition typically brought on by an episode of intense emotional stress, such as the death of a loved one, job loss or a divorce. Because its symptoms may include shortness of breath and chest pain, it is sometimes mistaken for a heart attack.

Though broken heart syndrome is serious — even potentially life-threatening — cardiologists have tended to regard it as temporary, generally improving relatively quickly.

But the findings of the new study suggest hearts that are “broken” by a major emotional stressor may not necessarily fully heal with time.

Researchers with the University of Aberdeen in the United Kingdom enrolled a group of 26 patients who had been given a clear diagnosis of broken heart syndrome, as well as a control group of 11 healthy patients. They then tested their heart function after four months using more sophisticated imaging tools than are typical.

“The usual test for heart function is an echocardiogram (Echo) test, and when we conduct this, it shows that the heart is back to normal,” study researcher Dr. Dana Dawson, senior lecturer in cardiovascular medicine at the University of Aberdeen, explained in a university press release. “However, when talking to the patients, they report that they are still not feeling themselves, cannot take part in strenuous activity and many have been unable to return to work.”

Dawson’s study — which used cardiac magnetic resonance as well as other more sophisticated tools to look at the patients’ hearts — found that four months out, the sections of the heart that were the most affected by the stressful event were still swollen. Although the patients’ hearts had recovered slightly, they still were not back to normal.

“The general belief was this condition was recovering itself very rapidly, but this was obviously not the case when we investigated in greater detail,” Dawson said in the press release.

“The heart muscle becomes like a sponge when it has absorbed water and it swells significantly,” she continued. “We also observed that the ability of the heart to generate the energy it needs to produce a pumping action was very much reduced.”

Dawson believes her findings, which she summarized in a letter to the editor published in the Journal of the American College Of Cardiology: Cardiovascular Imaging. She believes they call for further research into how broken heart syndrome unfolds and how it is best treated.

Dr. Amir Darki, an interventional cardiologist at Loyola University Medical Center who did not work on the study, but who had read Dawson’s summary, told The Huffington Post that there is a lot cardiologists don’t understand about broken heart syndrome.

“We don’t know why it’s more common in women; we don’t know why it affects certain parts of the heart,” he said. “We do know it’s usually triggered by something emotionally traumatic — some kind of devastating stimulus that leads to this — but we don’t know what, exactly causes it.”

There are no specific guidelines for treating broken heart syndrome, and cardiologists typically address it with many of the same medications used for heart failure patients, Darki explained.

“We have very good medical therapies that we know work,” he said.

Additionally, in the last five or so years, Darki estimated, a growing number of cardiologists have begun to focus on the physical toll that emotional trauma and stress can take on the heart, asking patients whether they’ve experienced potential triggers such as a loss or divorce, in order to ensure their treatment also includes any necessary psychological support.

“Cardiologists have become much more in tune with this, and I think the vast majority are asking about emotional health,” he said, “as well as diet and exercise.”

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