What becomes of the broken hearted?

There is a famous line in the song by Jimmy Ruffin, “what becomes of the broken hearted who had love that’s now departed”.

But what really does become of these people?

Before Christmas 2016 very few people had probably even considered the idea of dying of a broken heart. However, just a day after the tragic death of her daughter, Debbie Reynolds also passed away. Less real life and more the Christmas storyline of a soap opera this tragedy played out with an air of sweetness, mother and daughter bowing out together.

The cause of Reynold’s death is yet to be confirmed but the proximity between hers and Carrie Fisher’s death reiterates their bond. In fact, it’s not that uncommon for two people who share love to die around the same time.

A study printed in the journal JAMA Internal Medicine in 2014 found the month following the death of a partner contributed to a higher occurrence of myocardial infarction (heart attack).

Why?

According to researchers this is a disease which affects around 3% of the Western population and is called takotsubo cardiomyopathy or broken heart syndrome. Bereavement can cause several cardiovascular events due to its prolonged effect which can last months. Derived from the Japanese for “octopus pot”, takotsubo helps to define the enlargement of the left ventricle of the heart. An acute syndrome of heart failure which can have more sinister effects, with many studies concluding takotsubo cardiomyopathy follows an emotional trigger.  Bereavement has been identified as one of a number of factors which can increase mortality. Research has shown an increased risk of cardiovascular events in the month following spousal death which may be linked to a change in physiological processes in response to intense grief.

How?

The “octopus pot” shape identified on an x-ray is where the medical term for broken heart syndrome originates. First recognised in Japan in 1990, the left ventricle of the heart enlarges adopting the shape of a pot with a narrow neck and round bottom. As a result, the left ventricle is less efficient at pumping blood. Symptoms are similar to those of a heart attack including chest pain, breathlessness and collapsing.

 

(A) shows the effect of takotsubo cardiomyopathy compared with a normal left ventricle (B).

This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license

 

Importantly, broken heart syndrome differs to a “regular” heart attack even though the symptoms are similar. Heart attacks occur when there is a blockage to an artery in the heart (known as coronary arteries) if this blockage occurs over a prolonged period of time it can cause heart tissue to die resulting in irreversible damage. Takotsubo on the other hand, has been shown to occur in patients who may have perfectly regular coronary arteries with an absence of clots and blockages. Furthermore, the symptoms usually correct themselves as the cells of the heart are shocked by stress hormones such as adrenaline rather than killed off.


The romanticism of dying from a broken heart has featured in a number of texts throughout history. William Shakespeare perhaps unsurprisingly referred to dying of a broken heart in several if his texts. One of which was King Lear who dies shortly after discovering his daughter Cordelia had been murdered. Of course the probably the most famous love story, Romeo and Juliet, also features a similar story when Lady Montague is purported to have succumbed to death following the death of son, Romeo.


Broken heart syndrome or takotsubo cardiomyopathy may be tragic but it has a scientific bitter sweetness to it.

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