STRONG EMOTIONS COULD LITERALLY BREAK YOUR HEART

Sun 07 January 2024:

The Lord is near to the brokenhearted and saves the crushed in spirit.
∼ Hebrew Bible and Holy Bible, Psalm 34:18

You have to keep breaking your heart, until it opens.
∼ Rumi (1207–1273)

The heart was made to be broken.
∼ Oscar Wilde (1854–1900)

Blessed are the hearts that can bend; they shall never be broken.
∼ Albert Camus (1913–1960)

Hearts will never be practical until they can be made unbreakable.
∼ Tin Man in The Wizard of Oz

What is stronger than the human heart which shatters over and over, and still lives?
∼ Rupi Kaur (b. 1992)

These quotes, dating back three thousand years, demonstrate the repeated use throughout human history of the metaphoric broken heart in literature, philosophy, and religion. Even today the concept of breaking one’s heart remains one of the most known and used metaphors. But can strong emotions truly break a heart? Well, yes, they can.

If a tiger chases you, a number of changes will happen in your body; this is referred to as the fight or flight response. The amygdala in your brain triggers a signal telling your body to run. That signal travels to the adrenal glands, where the adrenal medullae release adrenaline. The adrenaline quickly makes its way to your heart’s pacemaker cells and speeds up your heart rate. It also causes heart muscle cells to let in more calcium, which makes them contract harder. This provides oxygenated blood to your leg muscles so you can run. However, on occasion, the body’s stress system can run amok and damage the heart, causing a stress-induced heart attack.

Stress-related heart attacks are also referred to as “broken heart” or takotsubo syndrome. Takotsubo is Japanese for “octopus pot.” First described in 1990, Japanese physicians were observing patients, mostly women, who suffered a heart attack after experiencing acute severe emotional grief or stress. Their heart dysfunction made their left ventricle look like an octopus pot—a pot with a wide bottom and a narrow neck. These patients had classic signs and symptoms of a heart attack: chest pain, elevated heart enzymes, EKG changes, and regional heart wall motion abnormalities. But on cardiac catheterization their coronary arteries were found to be free of atherosclerotic disease.

Vincent M. Figueredo The Curious History of the Heart Bloomsbury, 2023.

In the majority of broken heart syndrome cases, heart function recovers. We know that the resulting abnormal shape of the Takotsubo heart reflects the distribution of adrena- line receptors in the normal heart muscle, but we don’t know exactly why stress-induced heart attacks happen. A sudden surge of adrenaline can damage heart cells. Studies after earthquakes—1994 in Northridge, California, and 1995 in Kobe, Japan—found that the incidence of heart attacks was much higher on the day of the earthquake than on the same day the previous year. In addition, during and immediately after World Cup penalty shoot outs and Super Bowls, a surge in stress-induced heart attacks occurs.

Sudden severe emotions, or acute stress, can cause a heart to literally break. Fortunately, in many cases that broken heart recovers and the patient survives. As the seventeenth-century English poet Lord Byron wrote, “The heart will break, but broken live on.” Under no other conditions do the metaphorical heart and the biological heart intersect more closely.

Are we surprised that lifelong couples tend to die within months of each other? Johnny Cash and June Carter Cash died within four months of each other. The theory is that death of the surviving spouse follows quickly during bereavement because of the intense physical stress of grief—and a broken heart.

The single saddest moment of my career occurred when I was a cardiology fellow. Stepping out of a patient’s room, I had to inform her husband of over sixty years that his wife had passed away. He knew, as well as we did, that she was not going to survive. But as I told him the news, I watched his face melt into such anguish and fear. He looked up at me and asked, “What do I do without her?” The sorrow in his eyes hurts me to this day. He grabbed my shoulders for support and kept looking at me for an answer. I held this small man in my arms and cried with him for a long time that day. He passed away five months later in hospice care.

Despite all of our science and the disillusionment of the heart as nothing more than a pump, these cases seem to describe moments when the emotional and physiological parts of our heart become one. The sixteenth-century anatomist Gabriele Falloppio stated, “Man cannot live with a broken heart.”

The emotions we feel in our brain reverberate in our heart, and the resulting physical sensations are manifestations of the heart’s response. This interdependence, the heart-brain connection, is vital to our health. It’s what led humans over thousands of years to place our emotions, reasoning, and very soul in this hot, pumping organ that signifies we’re alive. Ancient societies taught that a happy heart meant a happy body and a long, healthy life. Modern science and medicine are now suggesting that our ancestors may have been more insightful than once thought. It may be that the heart’s role in our emotional and physical well-being is more significant than what physicians and scientist have led us to believe in the past five hundred years. It may be that the heart talks to the brain as much as the brain directs the heart, and that this heart-brain connection plays a vital role in our overall health.

Excerpted with permission from The Curious History of the Heart by Vincent M. Figueredo, published by Bloomsbury.

Vincent M. Figueredo has been a practicing cardiologist and physician-scientist for thirty years. His experience spans academic medicine, medical research, teaching, private practice, and senior hospital administration, including as chair of cardiology and professor of medicine. Figueredo’s research interests include how the heart responds to injury, alcohol, and stress.

-The Wire

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