Dr Irengbam Mohendra Singh
Everything is hunky-dory with love in the air, but love has casualties. A broken heart isn’t just a figure of speech. It causes actual physical pain. That you may die of a broken heart has become a scientific reality. It’s happening despite increasing digitalisation of romance with significant changes in “falling in love” in this post-modern age of “loving you by not falling in love”.
How exciting it was? when as a young teenager I received extravagant, rumbling and joyous hand-written love-letters, a kind of scrolling mental thoughts of emotions from a sweet sixteen-year old girl from Ukhrul. Thanks goodness: my heart had never been broken into pieces. Once, I did feel a kind of “pity-pat”, a curious sensation, which is difficult to describe. It ended with no physical damage. Now, as a doctor I can guess what it was. A momentary racing of heart beats.
A ‘broken heart’ does kill someone by actually damaging his heart muscles. A preposterous complexity. An article in the Journal of the American Society of Echocardiography on June 19 2017, has confirmed that people do die from a broken heart and “not even the clock can always mend a broken heart.” It’s true that an extremely stressful event can have a very deleterious impact on your heart, leading to severe short term damage to your heart muscle, causing heart failure – a treatable condition.
It’s common that many young people do feel a ‘flutter’ in their heart (a temporary abnormal fast heart beats) as a reaction to an acute stress caused by a betrayal or romantic rejection. It’s due to a surge of stress hormones, such as adrenaline, but not to the extent that it could kill you.
For centuries, playwrights had been writing about broken-heart tragedies. Various poets like Byron and Coleridge had been doing the rounds. Shakespeare’s plays are ridden with unrequited love and death that makes for good reading. Juliet couldn’t live after finding her paramour Romeo died. “She perished in grief” as Shakespeare put it. King Lear perishes with a broken heart, shortly after discovering the murder of his wife Cordelia.
In Manipur, we have the legend of Mainu Pemcha hanging herself for Borachaoba. In the Persian love story, Leila died alone in her home from not being able to see Majnu. Nat King Cole sang about Mona Lisa: “Do you smile to tempt a lover, Mona Lisa? Or is this your way to hide a broken heart?”
In his long-winded poem, The Lady of Shalott [island], Lord Tennyson describes how Knight Lancelot discovered his love damsel laid down in a boat to die as the stream carried her to Camelot: “For ere she reach’d upon the tide/ The first house by the water-side,/ Singing in her song she died,/ The Lady of Shalott.”
Even the Bible mentions “broken heart”. “The Lord is nigh unto them that are of broken heart; and saveth such as be of a contrite spirit “(Psalm 34:18, King James Bible).
Broken-heart has a sanctioned place in popular culture worldwide. It has now become a public health problem and thus a subject in Life Science. Dying of broken-heart is no more hyperbole. You can really die of broken-heart. It’s no more just a romance. There is some actual science behind this phenomenon.
Many people simply recover after suffering a broken heart when the stress goes away, while many others die from broken-heart. Scientists are now increasingly realising that there is a great link between mind and heart.
According to British Heart Foundation, broken-heart is a temporary condition where your heart muscle in the left ventricle [one of the heart’s four chambers] suddenly becomes weakened or stunned. it’s brought on by a shock. About three quarters of people diagnosed with ‘broken heart syndrome’ (BHS) have experienced significant emotional or physical stress prior to becoming unwell.
Research published in the journal JAMA Internal Medicine, a couple of years ago, found that, while the stress rarely caused cardiomyopathy (thickening of muscle walls of heart), the number of people who had a heart attack or a stroke in the month after a loved one died was double that of a matched group who were not grieving.
Former British prime minister James Callaghan (93) died of heart and kidney failure in March 2005, just 11 days after his wife died. The adopted son of Zsa Zsa Gabor, the Hollywood actress, died just a few days after she died. Johnny Case (71), the American country singer died in 2003, just four months after his wife died.
More recently, Hollywood icon Debbie Reynolds died of broken-heart in December 2016 just hours after her daughter Carrie’s death, saying: “I want to be with Carrie.” She had a stroke, probably due to prolonged flutter of the heart – ‘atrial fibrillation’. Dr Derek Connolly, consultant cardiologist at Birmingham City Hospital, says Debbie Reynolds was a prime candidate for “Takotsubo Cardiomyopathy” or ‘Broken Heart Syndrome’, a more recent cause of cardiac death.
In the past, some experts considered whether atrial fibrillation (AF), a form of fast irregular heartbeats could be the cause of BHS, as it is known to be common among people whose partner died suddenly or unexpectedly. Atrial Fibrillation has become a significant cause of people dying with stroke. It has become an important public health problem in Western countries with increasing health care costs.
Some researchers in Denmark looked at the national registry of 88,600 people, who were diagnosed with AF in the first month after losing their partner, compared to people who hadn’t. A higher risk of the condition continued for a year. They also found that the risk was especially high for young people. It was thought that surges in hormones that facilitate inflammation and imbalance in the uncontrollable parts of the nervous system may be the cause. The exact cause that triggers AF is still unsolved. It may have genetic or environmental factors.
Harmony Reynolds, a cardiologist at Langone Medical Centre, New York, has studied the relationship between stress and the heart. He says the link between stress and the heart is well recognised in the medical communities, but it’s still under investigation.
That many elderly couples died within a week of each other was once thought coincidence. Not anymore. They died of broken-heart. It’s 25 years since it was identified but only now is the condition more widely diagnosed. Studies by Imperial College, London, have estimated 2% of the 30,000 ‘heart attacks’ each year in the UK are caused by the BHS.
Some elderly European couples can still lay claim to fulfil their Christian wedding vow of “till death do us part” as some couple die together with broken-heart. When elderly couple die it’s seen as sweet while young people die together it’s a tragedy. Old people die more easily as they are frail and their hearts are weak.
An ‘acute broken heart syndrome’ is now called ‘acute stress induced cardiomyopathy’ or ‘apical ballooning syndrome’. It was first reported in Japan in 1990 as ‘Takotsubo syndrome’. Tako tsubo in Japanese means ‘octopus pot’ as the left ventricle of the heart changes into the shape of the pot, developing a narrow neck and a round bottom. It can develop at any age and is reversible. It’s more common in women than men.
BHS has recently been increasingly diagnosed in the US and in Western Europe, following its description in detail in the Japanese medical literature. It seems the syndrome went undiagnosed in these countries. BHS could be misdiagnosed as a heart attack. But in this condition, there is no blockage of arteries in the heart. Blood tests show no sign of heart damage. But a cadiogenic shock that is usually the cause of death after a heart attack when the heart suddenly can’t pump enough blood to the body, may happen.
Researchers have discovered that some patients do develop the syndrome after an emotional stress and without a preceding clinical stressor like an acute asthma attack. It’s more common in winter, which may be attributed to spasms of coronary microvessels. It’s likely according to cardiologists, due to multiple factors at play, such as coronary microvascular spasm, abnormal release to epinephrine or norepinephrine as a response to stress.
Cardiologist Dr Ilan Wittstein of John Hopkins Hospital in Maryland, US, who has treated hundreds of these broken heart people beginning in 1999, says when stress hormones like adrenaline surges after a severe stress, adrenaline and calcium go to your heart cells to make the heart beat faster and squeeze it stronger to give the body energy for “fight or flight” situation.
Takotsubo cardiomyopathy is found in 1.7 – 2.2% of patients. It’s an acute presentation with chest pain after an extreme emotional and physical stress. ECG results and blood tests are negative. Coronary angiography shows no signs of blockages of coronary arteries. Diagnosis can be made with an echocardiogram and cardiac MRI.
As yet, there is no proven therapy to prevent an acute or additional attack of broken heart syndrome, it’s good to have supportive people with whom you can share your feelings an worries. That will help to ease your stress. Some kind of physical activity to occupy your mind, taking some medications or having relaxation therapy can help. Love should be like merry-go-round fun.
(The writer is based in the UK. Email:firstname.lastname@example.org. Website: www.drimsingh.co.uk)
Dr Irengbam Mohendra Singh