Rhythms of Broken Hearts by J. Anthony Gomes

Author:J. Anthony Gomes
Language: eng
Format: epub
ISBN: 9783030773823
Publisher: Springer International Publishing

Takotsubo heart tends to occur after emotional stress like the death or a severe injury of a close family member. However, almost any severe stress can bring it on. It can happen after an earthquake, financial reverse, receipt of bad news, bad arguments, car accidents, a surprise reunion, a court appearance, a sudden big gambling loss, or public speaking. Sometimes there is no discernible trigger.

What killed Jean Pierre? He was frightened, certainly, but possibly he felt grief too. “Witch doctors” all over the world have exercised voodoo-like powers, and as anthropologist Walter B. Cannon observed in a classic 1942 paper, the hexed targets commonly lose all social support and often actually mourned before their deaths. Jean Pierre lived far away from Haiti and might have felt heartbreak at being cut off from emotional sustenance from those in his homeland. At the same time, since he believed he might die, he plainly felt enormous stress that probably resulted in an adrenergic storm and a sudden lethal heart rhythm abnormality like ventricular fibrillation that caused sudden cardiac death. Whether he harbored a genetic abnormality in the heart’s electrical system (discussed in a previous chapter), we will never know.

In cases like that of Dorothy and my two relatives, people have literally “died of a broken heart” or been “scared to death,” like Jean Pierre. But usually, takotsubo heart has an excellent prognosis. It is most often reversible, as with Dorothy. In a literature review of 816 published cases, sudden cardiac death occurred in 9 of the 816 cases during the acute episode and in 4 during follow-up, weeks to months later.

Women make up by far the largest percentage of sufferers. In a 2011 study conducted at seven tertiary medical health-care centers in Europe and North America in a total of 256 patients with this condition, the investigators found that 81% of them were postmenopausal women, another 8% were women under 50, and only 11% were men. The study cited triggers 48 hours before the event that were both emotional (30%) and physical (41%). Death of a relative or friend accounted for the majority of emotional events followed by interpersonal conflict, while stress before and after surgery accounted for most of the physical factors. As the name takotsubo shows, this condition changes the heart’s shape. The study showed that in addition to echocardiography, magnetic resonance imaging (MRI) can identify the condition.

The pathophysiology of takotsubo heart remains uncertain. However, the two leading hypotheses include (1) excess adrenaline and noradrenaline (also known as epinephrine and norepinephrine) causing cardiac injury and (2) spasm of the heart arteries. Of the two, there is considerable evidence for the first and less for the second. Emotional stresses of many kinds can cause a spike in the two hormones that harms the heart muscle and precipitates rhythm abnormalities. In 2005, Dr. Ilan S. Wittstein and coworkers showed that such patients had elevated plasma levels of these hormones on initial examination. These levels in fact exceeded those seen in acute myocardial infraction and left ventricular failure.

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