Heart 411

The guide to a healthy heart

Can You Really Die of a Broken Heart?

Negative emotions can hurt the heart.

By Marc Gillinov, M.D., and Steven Nissen, M.D.

Shakespeare knew it. Seventeenth-century poet John Donne wrote about it. Country and Western stars sing about it. And anybody who has experienced the pain of deep loss or the joy of unconditional love has felt it. The strong connection between your emotions and your heart has been a central theme in art and literature for centuries. Both in literature and in life, negative emotions can hurt the heart. In Shakespeare's thirty-nine plays, ten characters die as a result of strong emotion. In one of theater's most memorable scenes, King Lear, nearly mad with grief after the death of his daughter Cordelia, suffers from symptoms that seem remarkably like those of a heart attack and literally dies of a broken heart.

Among life events, loss of a loved one ranks as one of life's greatest stresses. Unfortunately, virtually every one of us will have to work though this at some point, and for some this event poses special health dangers. We have long known that death of a husband or wife is sometimes followed within a few months by death of the surviving spouse. The common explanation is almost a cliche—"He died of a broken heart after he lost his wife." In fact, this statement is often correct.

Today, we understand the relationship between emotional health and heart health. And when it comes to grief-one of our strongest emotional responses-we have scientific data and real medical studies that help us to understand the medical risks of a "broken heart."

Grief can cause two different cardiac problems: a reversible condition called "stress cardiomyopathy" or, more commonly, a standard heart attack.

Stress cardiomyopathy

Recognized by Japanese doctors long ago, stress cardiomyopathy tends to occur in middle-aged women after a sudden emotional shock. While the most common precipitating event is death of a loved one, even a surprise birthday party can trigger the response.

In affected people, sudden, massive release of stress hormones causes temporary changes in the heart's blood vessels, leading to reduced heart function, change in the heart's shape and acute heart failure. The Japanese call this condition "Takotsubo's cardiomyopathy," referring to the observation that the heart assumes the shape of a Japanese lobster trap, which is called a "tako tsubo." The patients develop chest pain and shortness of breath. The good news for these patients is that the condition is usually reversible with proper medical care.

Heart attacks

Grief can also precipitate a heart attack. A recent study from Harvard Medical School made headlines with its examination of the risk of a heart attack after death of a significant person in one's life. The most alarming finding: the risk of a heart attack was increased a shocking twenty-one fold during the first twenty-four hours after the death of a loved one. The risk was greatest among those who had common risk factors for heart disease, including high blood pressure, smoking, diabetes and elevated cholesterol.

How does grief precipitate a heart attack? Strong emotions can activate our stress or "fight-or-flight" response. This causes increases in heart rate and blood pressure. In the person with coronary heart disease, the increased blood pressure can cause rupture of a plaque inside of one of the heart's arteries. Plaque rupture leads to a blood clot inside the artery, cutting off blood flow to a portion of the heart and causing a heart attack. The increased heart rate can make the situation even worse because the heart muscle needs more energy (and greater blood flow) when the heart rate is high.

During times of grief, take care of yourself and your family

After loss of a loved one, we naturally focus on the person who died. But don't forget about the living. Pay particular attention to the grieving person who either already has coronary heart disease or who has substantial risk factors. Make sure that these individuals take care of themselves. This means taking their medicines (don't miss that dose of aspirin or beta-blocker), getting adequate rest, maintaining a good diet and continuing to exercise. And don't ignore symptoms or warning signs that could signal stress cardiomyopathy or a heart attack. While chest pain is the most common symptom, neck, arm and back pain, new onset of shortness of breath, extreme fatigue, nausea and sweating should set off alarm bells.

The message—we must take care of the living as we honor and remember those who have departed.

Marc Gillinov, M.D., is a staff cardiac surgeon at the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic. He is the co-author of Heart 411.

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