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Woman cuddling with a brown miniature poodle

The grief that comes with losing a beloved pet can be all-consuming. In fact, the pain can actually manifest with physical symptoms that mimic a heart attack.

A recent article in The New England Journal of Medicine detailed the case of a Texas woman who reported symptoms of a heart attack. But at the hospital, diagnostic X-rays showed unblocked arteries. The patient, Joanie Simpson, told doctors that, among other stressors, she had recently lost her 9-year-old Yorkshire Terrier, Maya, who had been suffering from heart failure, the Washington Post reported. “I was close to inconsolable,” she told the Post.

Simpson was diagnosed with “broken-heart syndrome,” formally called takotsubo cardiomyopathy, a medical disorder in which the left ventricular of the heart temporarily balloons (the name “takotsubo” is after a type of octopus trap shaped similarly to the enlarged ventricular). Symptoms include shortness of breath, chest pain, and irregular heartbeats, according to the American Heart Association. It’s often caused by extreme stress and is more common in post-menopausal women.

In the journal article, Simpson’s doctor, Abhishek Maiti, wrote that Simpson has fully recovered in the year since the incident. Simpson is planning to get another dog in the future‚Äîand if her heart breaks again, it will be worth it to her, the Post reported.

Simpson’s case is extreme, but the sentiment is common. Owners of recently deceased pets can expect feelings of extreme sadness, aloneness, confusion, and guilt, explains Joy Dias, director of client counseling and support services for the University of Florida College of Veterinary Medicine, in an article for the AKC Canine Health Foundation. “In fact, any emotions that we feel when a person we love dies are very likely to occur when a pet dies,” she adds.

“Dogs don’t disappoint us the way people sometimes can in relationships,” says Roxanne Hawn, a columnist for AKC Family Dog and author of the book Heart Dog: Surviving the Loss of Your Canine Soul Mate. “Dogs also bear witness to all the ups and downs in our lives in a way that human friends don’t because dogs are with us all the time.”

This isn’t only a “pet person” thing. Psychiatrists in the human realm likewise acknowledge the impact the death of a family pet can have on an owner’s physical and mental health. “The loss or death of a cherished pet creates a grief reaction that is in many ways comparable to that of the loss of a family member,” wrote Paul Clements, a psychiatric clinical specialist at Drexel University, and his colleagues in an article on Perspectives in Psychiatric Care.

Click here for AKC’s tips on grieving the loss of a pet.