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Recent Newspaper & Online Columns by Kate Scannell MD

Dying of a Broken Heart

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 01/22/12

In the early 1970s, my friend's father died on stage while receiving a golden watch from his boss to mark his retirement. Grasping the watch in one hand, he reportedly clutched his chest with the other and collapsed. He could not be revived. His sudden death had been completely unexpected, and his family was devastated. His death was officially attributed to a heart attack.

Afterward, my grieving friend speculated that her father's death had been triggered by the stress and heightened emotions he'd been experiencing over the unwelcome prospect of retirement. He'd been a dedicated "company man" his entire adult life, someone who had found meaning and personal fulfillment through his job at the auto plant. He couldn't imagine living without the satisfying daily routine of his work and the companionship of co-workers.

I knew nothing at the time about cardiology, the heart's autonomic neural regulation or the body's powerful, smoldering brew of stress hormones. However, I was convinced by what had happened to my friend's father that a heart could be broken by grief and loss. That it could shatter under the unbearable weight of despair.

Years later, after becoming a physician, I often was reminded of my friend's father. Over time, I cared for patients who suffered heart attacks or died unexpectedly while experiencing intense emotional states. I knew patients who developed chest pain and heart problems on the anniversary date of a divorce or a loved one's death. While once providing phone-line duty for a hospital on New Year's Eve, I handled a call from an elderly woman who wanted to know if she might be having a heart attack -- or, as she speculated, whether it was "just my widowed heart breaking" on this first turn of a new year without her husband.

Over time, the medical profession has increasingly -- and sometimes begrudgingly -- acknowledged a powerful mind-body connection that profoundly affects how humans mentally experience and physically express health and disease. In this regard, it recognized the "broken heart syndrome" in the mid-1980s as a legitimate medical condition in which heart attacks could be caused by intense emotional or physical stress -- not blocked arteries or the "coronary artery disease" we usually expect to find during cardiac testing.

Experts think broken heart syndrome is caused by adrenaline surges triggered during physical trauma or acute emotional states such as bereavement, anxiety and anger. Analogous to a deer "frozen in the headlights," the heart is "stunned" and immobilized in a brisk wash of adrenaline. Severe heart muscle weakness (cardiomyopathy) ensues, accompanied by typical symptoms of a heart attack -- such as chest pain or shortness of breath.

In the '90s, Japanese researchers noted that the actual physical appearance of someone's heart could change if their heart attack had been preceded by intense emotional or physical stress. Using modern radiographic techniques, they demonstrated that a segment of stunned heart muscle would balloon out and assume a flask-like shape resembling a Japanese octopus trap or pot -- that is, a "tako-tsubo." The term "takotsubo cardiomyopathy" was coined to describe this phenomenon.

This storied background now leads us to a noteworthy report published this month in the journal Circulation. Finally -- after many scattered tales in the medical literature documenting the reality of stress-induced heart attacks -- someone has methodically and systematically examined whether a heart attack might in fact be triggered by a loved one's death.

In the new study, researchers asked 1,985 patients who had suffered a heart attack whether in the prior six months they had experienced the death of a "significant person." Intriguingly, 270 patients answered "yes," including 19 who had suffered a heart attack within a day of that significant person's death. From these and other data, the researchers calculated that the risk of a heart attack was 21 times higher within the first 24 hours of loss, and six times higher within the first week.

Unfortunately, researchers did not distinguish broken heart syndrome from coronary artery disease as the underlying cause for the heart attacks. However, it is generally thought that about 2 percent of heart attack patients who undergo emergency evaluation will be found to be suffering a broken heart.

It's important to be aware of the broken heart syndrome because you can choose to be vigilant about its possible occurrence during episodes of great emotional or physical stress -- for yourself and others. You can support someone suffering bereavement, especially within the first week of a loved one's death. If a broken heart is diagnosed as the cause for your heart attack, your doctor will not treat you with useless -- and risky -- standard heart attack treatments, such as blood thinners and clot busters.

In 1966, singer Jimmy Ruffin famously asked, "What becomes of the broken hearted, who had love that's now departed?" While his soulful question cannot be fully satisfied with mere medical data, the new study helps us to get closer to a more heartfelt understanding about minding the body during stress, loss and bereavement.

It helps us appreciate that "dying from a broken heart" is no mere metaphor. In newly articulating another secret of the heart, it echoes resonantly in this 21st century with Shakespeare's sage advice:
Give sorrow words.
The grief that does not speak,
whispers the o'er fraught heart
and bids it break.


Kate Scannell is a Bay Area physician and syndicated columnist. She is the author of "Death of the Good Doctor" and "Flood Stage."

Copyright 2012, Kate Scannell