Can you die of a broken heart?

By Lydia Hales.

Being ‘sick at heart’ is a common complaint in romantic novels, but can intense emotional pain actually damage your heart?

The answer is yes, cardiologists say, and sometimes it can be deadly – although thankfully this seems to be rare.

One example that made headlines around the world recently was Adelaide grandfather NK Paliwal, who had a heart attack and died upon learning his family had been killed in a road crash in India.

And it is known that spouses or partners who lose a loved one are at increased risk of death from heart attacks in the days, weeks and months afterwards.

It is thought the impact of stress hormones on heart rate, blood pressure, and blood clotting may be one reason for these associations.

Broken heart syndrome

But experts now wonder if at least some of the deaths linked with high emotions might actually be missed cases of a different heart condition that has been recognised in Australia for only about 10 years.

‘Broken heart syndrome’ or stress cardiomyopathy happens when a surge in the stress hormone adrenaline causes inflammation of the heart. It also goes by the name Takotsubo cardiomyopathy, because the abnormal shape of the affected heart resembles a traditional Japanese octopus fishing pot.

“You can actually inject adrenaline into someone and cause it… there’s a lot of evidence to suggest that adrenaline is involved,” said Professor John Horowitz, head of cardiology at Adelaide’s Queen Elizabeth Hospital, who researches the syndrome.

It is thought the overload of stress hormones essentially ‘stuns’ the heart, but exactly how this happens is not understood.

While the symptoms are similar to a heart attack (where an artery leading to the heart is partially or completely blocked), there is no blockage involved.

It is still a serious condition though, because a large part of the heart muscle is temporarily weakened to the point it does not pump properly. This reduced function can be fatal, resulting in cardiac arrest (where the heart’s electrical system is disrupted so that it stops pumping).

Emotions like grief, anger or anxiety appear to be a trigger in almost 28 per cent of cases, according to one study of the condition published in the New England Journal of Medicine last year.

But there is clearly still much to learn about the syndrome, as the study found a physical trigger – such as severe breathing difficulties or an infection – was even more common, accounting for 36 per cent of cases, and around 28 per cent had no identifiable trigger at all.

Some ‘triggers’ – such as damage to the home or an argument with a neighbour – may seem trivial, but in a susceptible person can cause the syndrome, said Dr Angela Kucia, who also works in the Takotsubo research team at The Queen Elizabeth Hospital.

“There are also a number of anti-depressants that work by increasing adrenaline in the bloodstream, that have been shown to increase the risk of broken heart syndrome,” Professor Horowitz said.

Hidden heartbreak

Professor Horowitz said people are not as aware of broken heart syndrome as they should be. The fact 25 cases were diagnosed in one day when the 2011 earthquake occurred in Christchurch, New Zealand, suggests it may be more common than previously thought.

“We don’t know how many of them drop dead before they reach the hospital,” he said.

Because symptoms are the same as a heart attack (including arm and chest pain, shortness of breath, dizziness, and loss of consciousness) it can be difficult to tell the difference initially – even for doctors.

If you have such symptoms, you should go to hospital immediately, regardless of what you think might be the cause.

Current data suggests 2 per cent of all people who have an angiogram (a special type of x-ray) for a suspected heart attack will be suffering the syndrome, Dr Kucia said.

“But if we look purely at elderly women, they say the percentage is higher than that – up to 10 per cent in some reports,” she said.

“It’s suggested there’s a subgroup of the population that doesn’t respond well to the stress hormone; their heart doesn’t cope.”

Long road to recovery

Though the acute symptoms usually ease within days to weeks, it can take months for patients to fully recover.

Treatment may involve medications and possible complications of the syndrome include shock, low blood pressure and fluid build-up in the lungs.

“We tell patients we expect three to four months of feeling like they don’t have a fourth gear,” Professor Horowitz said.

But some people outside the medical profession don’t see broken heart syndrome as a condition to be scientifically analysed.

“I don’t see this as an ‘illness’ that traditional medicine can hope to heal,” one woman posted on Facebook in response to a previous ABC story on the subject. Her father had died a very short time after her mother.

“It is an indicator of a profound connection and depth of love. If you can manage and/or reduce the emotional pain of the loss, perhaps some will recover and continue living. We know where our dad would rather be and will never begrudge him. Mum was a pearler.”

If you or someone you know needs help, call:

• Lifeline on 13 11 14
• Kids Helpline on 1800 551 800
• MensLine Australia on 1300 789 978
• Suicide Call Back Service on 1300 659 467

This post originally appeared on ABC News.