Depression

Why the Pain of a Broken Heart Mimics a Heart Attack

The profound pain of a broken heart often means a visit to the emergency room.

Posted March 14, 2013

For every woman who hugged a Valentine this year, there was a woman whose heart was breaking, literally. While we often hear of someone who dies of a broken heart, it appeared to be poignantly depicted in Season Two of “Downton Abbey,” the PBS Masterpiece Classic. In a memorable scene, Matthew Crawley, the heir presumptive to the estate, and his former love found themselves locked in a kiss.

After learning that his bride-to-be witnessed his indiscretion,Crawley became convinced that -- despite being felled by the Spanish flu -- his fiancée gave up her will to live and died of a broken heart.

Although this was good theater and we often read about people who die of a broken heart, in fact a broken heart is not considered life-threatening. Stress cardiomyopathy, the broken-heart syndrome, primarily affects middle-age women. The interrelationship between the depression of lost love and extreme emotional distress triggers painful symptoms that mimic a heart attack.

The research on heart break

According to Harvard Medical School instructor and clinical psychologist Craig Malkin, Ph.D., "The research shows that heart break registers in the same areas of the brain as physical pain. Given that pain is notoriously linked with both depression and weakened immune functioning, is it any wonder that, for example, widowers have higher mortality rates after losing their spouse? Could it be that heartbreak is as damaging as any physical suffering?”

The heartbreak pain is triggered by a hormone rush that a woman, or sometimes a man, experiences after the loss of a loved one, a traumatic ending to a love affair, or divorce.

This adrenaline surge interferes with the heart’s pumping ability, sending it into a freeze mode and leaving the left ventricle enlarged. The pain is often so severe that it sends a person to the emergency room. Despite its name, however, the broken-heart syndrome is not considered life-threatening. Acute Stress Cardiomyopathy - Johns Hopkins Medical Institutions

Heart ache and bereavement

What about all of those stories we read of a spouse who dies within weeks or months after losing a husband or wife? This type of heartache seems to be unique to bereavement, particularly among elderly couples who have lived a long married life together.

Dr. Elizabeth Mostofsky is a postdoctoral fellow in the cardiovascular epidemiology research unit at Beth Israel Deaconess Medical Center in Boston. She explained to me during earlier interviews that after the death of a loved one, the heart-attack risk is 21 times higher within 24 hours.

Although the risk diminishes each day thereafter, it remains elevated over several months. Mostofsky and her team reached their conclusions after interviewing almost 2,000 patients who suffered myocardial infarctions over five years and reported their findings last year in Circulation, the Journal of the American Heart Association.

Dr. Mostofsky says signs of bereavement involve “increased feelings of depression, anxiety and anger, and those have been shown to be associated with increases in heart rate, blood pressure and a tendency for blood clotting — all of which can lead to a heart attack.”

While social support and medication may mitigate serious consequences of a heart attack after bereavement, can stress cardiomyopathy be alleviated?

Can you protect yourself?

If there is any way to avoid the broken-heart syndrome, it might be for a woman to surround herself with supportive friends. A preventive approach might include coming to terms with the relationship, understanding the symptoms of depression and seeking professional help.

In an over-ambitious society, it is important for couples to step back from work, social media and even socializing to focus on the bond that they share. With a goal of helping couples, Dr. Malkin shares his insights in Romance Redux | Psychology Today.

While many women in difficult relationships believe they can “work things out,”depression must be taken seriously. Finding help in a counselor’s office rather than the emergency room is an option worth considering.