The idiom of a broken heart seems like something deeply rooted in the melodrama of adolescence, when seeing Leonardo DiCaprio sliding into the frigid waters of the North Atlantic is enough to bring a physical ache to the chest, a hollow pain lying on the undefined border between emotional and physical pain. Few realise, however, just how damaging intense emotional turmoil can be on the heart, our most treasured organ of all.
Shockingly, every year over 250 otherwise healthy adults have their livelihoods greatly affected by so-called ‘Broken Heart Syndrome’, known medically as Takotsubo Cardiomyopathy – ‘Takotsubo’ arising from the Japanese term for an octopus trap which resembles the shape of a heart afflicted with this condition, and ‘cardiomyopathy’ describing the weakening and stiffening of the heart muscle. In fact, even more astonishingly, almost one third of patients presenting to hospitals in 2009 (according to a study conducted by Barrow Neurological Institute) can identify an emotional source contributing to their ailment, suggesting the that physical repercussions of emotional trauma are much more prevalent. Emotional factors documented by the study range from intense interpersonal conflict to the untimely death of a loved one – in short anything that could cause a surge in the production of the hormones dopamine, epinephrine and norepinephrine. Usually secreted in response to extreme stress (to initiate the fight or flight response), it is theorised that these hormones prompt the tiny blood vessels surrounding the heart to constrict. This interference in microvascular circulation results in a temporary decrease in blood flow to the left ventricle, the chamber of the heart that pumps oxygenated blood around the body, to balloon outwards. This is accompanied by ischaemia – an insufficient supply of blood, which causes the heart muscle to stop using fatty acid metabolism for energy and to utilise glucose instead, impairing cardiac function and causing the symptoms associated with TCM, including chest pain, breathlessness and collapse. If left untreated, these malfunctions lead ultimately to death, making the mortality rate approximately 3.2% for patients diagnosed definitively with TCM, not accounting for other deaths with similar causes. This theory holds the most water for explaining the mechanism behind Takotsubo Cardiomyopathy as it aligns with study showing that rats with stress-induced TCM proved responsive to beta blockers and is also supported by multiple myocardial imaging studies using hormone analysis alongside traditional techniques.
Despite growing evidence to bolster this theory, some experts claim that sufferers are simply experiencing heart attacks and mistakenly attributing this to stress. However, although the symptoms are undeniably similar, the mechanism of a heart attack – a myocardial infarction, is quite different to the pathophysiology of TCM. In a myocardial infarction, a physical arterial blockage stopping blood flow is the cause; however, in patients presenting with TCM, no such blockage is detected.
It seems clear, therefore, that it is possible to die of a broken heart and that it is an area greatly lacking in medical understanding. So next time you feel a twinge in your chest whilst watching Titanic, don’t hesitate to call a doctor!
Rosie Day
Dover Grammar School for Girls
"My name is Rosie and I am 16 years old. In the future, I hope to pursue a career which combines my passion for science and communication."