Broken heart syndrome is no fairy tale

MEDICAL MATTERS:We all know couples who have died within weeks of each other – and now we know why

“His flawed heart – alack, too weak the conflict to support – twixt the extremes of passion, joy and grief, burst smilingly”

Shakespeare, King Lear

THE INTUITIVE sense that emotional stress can be bad for us is the source for expressions such as “scared to death” and “a broken heart”. But this isn’t just the stuff of folk wisdom: we all know of couples who have died within days or weeks of each other.

Many Johnny Cash fans believe he succumbed to a broken heart just three months after his wife, June Cash, died of complications following heart surgery.

Back in 1969, the renowned psychiatrist Colin Murray Parkes published a research article in the British Medical Journal in which he and others looked at the cause of death of some 4,500 widowers. The study examined 213 widowers in detail, all of whom had died within six months of their wives. It found a greater than expected number of deaths from “coronary thrombosis” (heart attack).

The increase was 67 per cent above the number expected if the widowers had the same death rate as married men of the same age.

“It may well be the emotional effects of bereavement, with concurrent changes in psycho endocrine functions, which are responsible for the increased mortality rate,” Parkes wrote.

The changes he referred to were alterations in pulse, blood pressure, clotting time and cardiac output. More recent research has added to our understanding of the role of psychological stress in heart disease.

“Broken heart syndrome” was described for the first time by Japanese researchers in the early 1990s.

The symptoms are the same as for a heart attack – chest pain, shortness of breath and collapse.

However, instead of a sudden blockage in one of the coronary arteries – the problem that causes a heart attack – patients with broken heart syndrome suffer sudden heart failure, that is their heart muscle stops pumping effectively.

Especially prevalent in women who have gone through the menopause, the principal characteristic of the syndrome is that it follows sudden emotional or physical stress. It seems the heart is “stunned” by a huge outpouring of the stress hormone, adrenaline.

Modern X-ray techniques have allowed doctors to visualise what actually happens to the heart muscle during one of these attacks. The upper region of the left ventricle, the heart’s principal pumping chamber, contracts normally, but the apex or bottom part appears paralysed. The tip of the ventricle actually balloons outwards instead of contracting inwards.

The Japanese doctors who first described this finding named it “tako-tsubo syndrome”. Tako-tsubo is a traditional Japanese clay octopus trap that has the same characteristic shape as the “ballooning” ventricle seen in broken heart syndrome.

Patients with the condition do not have any narrowing or obstruction in their coronary arteries. And although some are extremely ill when they arrive in hospital and require treatment in intensive care, nearly all patients experience a full and complete recovery from the event.

Research to be published in next month’s issue of the American Journal of Cardiology looks at the experience of some 70 patients with the syndrome. About 67 per cent had been exposed to some sort of severe stress – such as bad news about a family member, a domestic argument, severe physical illness or a car accident – just before the onset of symptoms.

The good news is all were alive and well four years after the event.

While bereavement was a common trigger, a New York study of the syndrome identified two women who had just learned their husbands were having affairs.

Broken heart syndrome is an example of science confirming intuition.

And it suggests that birthday parties for granny should not begin with her assembled grandchildren shouting “Surprise” when she enters the room.

Following last week’s column on the tragic death of Natasha Richardson, after a post-mortem it has emerged that she died from an extradural haemorrhage. This follows damage to the middle cerebral artery, caused by trauma to the head above the ear.

Sadly, if the accumulated blood had been drained quickly, the actress may have made a full recovery. I am grateful to a Canadian correspondent for bringing this to my attention.

Dr Houston is pleased to hear from readers at mhouston@irishtimes.com, but regrets he is unable to reply to individual medical queries