Broken Heart Syndrome
Broken Heart Syndrome
Can you really die of sorrow? Science suggests its possible.
In 2018, Karin nearly died of a broken heart. No disease, no congested arteries, no signs and no symptoms, yet her heart suddenly ballooned in size and threatened to burst. If she hadn’t been lying on an operating table for an entirely different medical procedure, she would have died. Karin would be diagnosed with broken heart syndrome. Severe stress, sudden shock, bereavement, financial losses, even a surprise party can cause it. And it can kill you.
I first about broken heart in a book by Neurologist Suzanne Sullivan, Sleeping Beauties. Death by broken heart was more of a side story, a mere mention. And yet, I couldn’t let it go.
As it happens, I know a lot about heart disease. My father had his first massive heart attack when I was twelve; he has had several more since. I turned to research, and even delivered various lectures on heart disease at teaching hospitals and the Global Health Center in Cleveland. It’s an important organ. It’s a strong organ. But it’s also the likeliest to get sick—at least in the West. Heart disease kills almost 700,000 people every year. [i]
Unlike our emojis, the human heart is shaped a bit like a fat tear-drop. At the upper part of that teardrop we find the aorta, the large artery responsible for carrying blood away from the heart and to your body. Also near the top we have the pulmonary artery, which brings blood back to the lungs. The heart’s interior has four chambers. There’s a right and left atrium near the top, and a right and left ventricle, near the bottom.[ii] Two large veins deliver de-oxygenated blood into the right atrium—and that’s when things get interesting. The human heart is myogenic; that means activity originates in the muscles rather than the nerves. We have specialized muscle tissue called pacemaker cells, and they generate a continuous sequence of electrical signals. It starts in the right atrium, where the oxygen-poor blood has just been delivered. The signals zoom down heart pathways from the right to the left and up to down. First, the right atrium pushes blood into the right ventricle—from there, it goes to pick up oxygen from the lungs (conveniently located nearby). Pulmonary veins bring the oxygenated blood back to the left atrium, which pumps it into the left ventricle. It’s slightly larger than the other chambers, which is why the heart tends to look a bit heftier on one side. The left ventricle pumps blood through the aorta to the rest of your body.[iii] The whole process happens in micro-seconds, which is why the heart can beat sixty-plus times a minute in humans—or 1,260 times a minute in hummingbirds.[iv]
Plenty can go wrong with this system. The electrical conduction of the heart can misfire, causing atrial fibrillation, irregular electrical impulses in your atrium, or arrhythmia, a heartbeat that is too fast, too slow or too erratic.[i] There’s cardiomyopathy: the thickening or stiffening of your heart muscle, congestive heart failure, when the heart is too weak to properly pump blood, pericarditis, inflammation of your heart’s lining, and congenital problems of form or function. But the heart disease most likely to kill you, in the United States at least, has less to do with the heart muscle and everything to do with the plumbing.
That’s the bit we readily understand. But what happens when a heart is broken? When trauma and grief enter into our lives, can they really make the physical organ sick? The answer, surprisingly, is yes.
Broken heart syndrome, also called stress-induced cardiomyopathy, can strike even if you’re healthy. The heart often acts as though arteries are blocks, but they aren’t. Instead, part of your heart temporarily enlarges and doesn’t pump well. At the same time, the rest of your heart might response with even more forceful contractions. [vi] That’s the pathology. But that doesn’t really explain very much about the experience, does it? Luckily, I know someone who can.
Florence Williams talks about falling in love like a hurricane. Falling out of love, though—that’s long and slow and dwindling. When her twenty-five-year marriage fell apart, she wasn’t sure what to do. That’s natural. Isn’t it? But then other things began to go wrong; she grew physically sick, losing weight and sleep. She even developed adult diabetes. How and why was this happening? She wanted to know more, to find out why our ability to love somehow causes us to break when love ends. Or, as one of the people Williams interviews puts it, “I think nature had overdone it.”
The journey Williams takes (in addition to road trips out west) cuts a path through strange territory. Grief and yearning release neuropeptides in the brain, resulting (in mice, anyhow) in aggression and anti-social behavior, along with a persistent fear. We all know stress is a killer. But stress can come in forms we don’t expect. Lose your job, your home, your stability—of course we expect stress. Lose a loved one or a marriage, and you tend to lose all the former and suffer the emptiness of grief. Your cells, Williams realized, are listening. The result? Two autoimmune disorders.
The breakdown goes like this—in a brief excerpt from Williams book:
We sense a threat. Our brain’s fear center, the amygdala, instructs our sympathetic nervous system to release the fight-or-flight neurotransmitter norepinephrine into just about every organ of our body. Our monocytes carry receptors that allow them to sense the norepinephrine and fire up the production of RNAs that make inflammatory protiens, while also shutting down the production of RNSs that defend us against viruses. At the same time, sympathetic nerve fibers in our bone marrow prime our stem cells to make more monocytes […] “It’s a recipe for Covid, not to mention heart attachs and cancer and many other life-shortening maladies of lonlieness.”
What does it all mean? It means we were evolved to run from predators in short bursts of stress. There: tiger. Run. We were not evolved to a lifestyle of constant low-level not-quite-tiger stressers like Twitter trolls, acidic political speeches, sedentary but unrewarding jobs, terrible work to rest ratios, epidemic isolation, and a speed of living that even Cheetah’s wouldn’t survive. The thing is, your body doesn’t make a bit of inflammation for a bit of stress. It’s all or nothing. And most of us are riding the precipice as it is. Then comes heartbreak and we tip over the edge.
I mentioned that my father is a heart patient. His first hit when he was 33. Dad was fit, thin, muscular, and active. He ate a healthy diet and had given up alcohol several years before. An imposing ex-marine, he looked the picture of health. But he was, and still is, an ex-marine. A veteran of the Vietnam war and a helicopter gunner, a man who saw horrors and was forced to commit some, too. He told me once that it exists like a hole in the ice; he can never skate to close to those memories or he’ll get sucked in and drown. And yes. He still has flashbacks. For a long time, we wondered if maybe the napalm had been to blame for messing up his heart (there is some evidence for this). But I wonder, too, if living with the constant stress of that painful past operated like a time-bomb; a heart, very seriously broken.
Willaims’ book Heartbreak will be the next one up for the Peculiar Book Club show; our first author guest of March. What I find interesting about the book is that it has closure but doesn’t end. We don’t have magic pills for heartbreak. We don’t even have especially good therapy because all hearts break in unique ways that have to be sorted out by the one experiencing it. I imagine that every single one of my readers, right this minute, as I type these words, is experiencing heartbreak. I know that I am; several different varieties, in fact (a big one covered in my last newsletter). I suppose I would like to end by saying this:
Your heartbreak is real.
Your heartbreak is allowed.
You have value.
Please ask for help and support to heal (because, as Williams makes clear, that is definitely a requirement).
Want to join us on March 9th? Please do—the liveshow is 7pm (on FB and Youtube; just subscribe to the newsletter for the links). We have signed books for sale, too.
[i] “Heart Disease,” CDC Fast Facts (blog), accessed September 25, 2022, https://www.cdc.gov/nchs/fastats/heart-disease.htm.
[ii] “Heart Anatomy and Function,” Cleveland Clinic (blog), accessed September 26, 2022, https://my.clevelandclinic.org/health/body/21704-heart.
[iii] “Heart Anatomy and Function.”
[iv] Schutt and Wynne, Pump, 23.
[v]“Heart Anatomy and Function.”
[vi] “Is Broken Heart Syndrome Real?” Heart.org, accessed February 20, 2023, https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real
I have had 4 episodes of "Broken Heart Syndrome" - a.k.a. Takotsubo Cardiomyopathy. Each event was brought about by unexprected, sudden emotional stress. The last event that I had, in 2018 - due to THC use for medical purposes - I had such heart damage that I now have Chronic Congestive Heart Failure. It sucks. I'm 59. Had my first event at age 43. It has changed my life...had to retire, from Nursing, early. Now have a pacemaker/defibrillator - so my own little paramedic in my chest.