The heart can actually become sick with grief. This may look like a heart attack, but it isn’t. 

In the medieval legend, Isolde suffers a sudden cardiac death out of mourning for her beloved Tristan. In Goethe’s novel “Wilhelm Meister’s Apprenticeship”, the girl Mignon dies of Heart-pain. The common parlance also knows the broken heart. But it has only been medically recognized since the beginning of the 1990s that our pumping organ can become ill from grief.

How the so-called broken heart syndrome comes about is far from being fully understood. But there are new insights into the causes. And last year, for the first time, an international team of experts published recommendations on diagnosis and treatment.

Paralyzed by stress

Of course, the heart muscle usually doesn’t actually tear in two. But as a result of massive emotional stress – in some cases an overwhelmingly positive experience – the pumping performance can decrease acutely. In extreme cases, this leads to cardiogenic shock: the blood pressure drops and the body is no longer supplied with sufficient blood. A good five percent of patients die, as the data from a large registry show.

Compared to other heart conditions, broken heart syndrome is rare. Experts estimate that around two percent of all patients who come to the hospital with suspected heart attacks are affected. Women get sick far more often than men, especially after menopause. Why, is a mystery.

Shortness of breath, tightness, pain

Broken heart syndrome is not easy to spot anyway. The symptoms are very similar to those of a heart attack: shortness of breath, tightness in the chest, sometimes massive pain. Often the blood pressure drops, the heart races, the patient breaks out in a sweat, they can suffer from nausea and vomiting.

The recordings of the ECG are also often similar to those of heart attack patients in whom a coronary artery is blocked. There are patients who have all the signs of a heart attack – but no abnormalities in the coronary arteries.

These substances have a direct effect on cardiac activity. If the level of stress hormones rises sharply, the heart muscle cells may be overwhelmed and stop working. The “broken” heart is, therefore, calmed down with medication. Doctors use various active ingredients for this.

Heart and head – one connection

But why do only a few emotionally stressed people suffer from broken heart syndrome? Scientists from the University Hospital Zurich recently published a possible answer. “We have observed that certain areas in the brain of Takotsubo (Broken heart syndrome) patients communicate poorly with one another,” says Dr. Jelena Templin-Ghadri.

The researchers focused on regions that are important for processing emotions and regions that control unconscious body functions – such as the heartbeat. “We have thus found a first indication of the way in which overwhelming feelings can actually have a direct effect on heart function,” says Templin-Ghadri.

© W&B/Jörg Neisel

Heart in stress: signs, causes, diagnosis, therapy

Signs

Typical symptoms of broken heart syndrome are shortness of breath and chest pain – the same as those of a heart attack

Causes

Stressful events such as the death of a close relative or separation from a partner are the most common causes

Diagnose

An X-ray of the coronary arteries and the left ventricle, as well as further examinations, can help the doctor differentiate the syndrome from a heart attack

Therapy

Medicines relieve and support the heart. They also lower the risk of further complications

It wasn’t until the 1990s that Japanese researchers realized that the heart muscle was partially paralyzed in some of these patients. This usually affects the left ventricle, which can inflate like a balloon. The scientists were reminded of a typical clay octopus trap called Takotsubo. This gave the disease its technical name: Takotsubo syndrome.

Medicines for broken hearts

However, doctors cannot rely on the bulge to make a diagnosis; it is not always visible. “We, therefore, proceed according to the principle of exclusion,” said Dr. Jelena. “If a patient with the symptoms doesn’t have a heart attack, we need to consider Takotsubo syndrome.”

How it comes to paralysis of the heart muscle is not yet fully understood. A research group has established that there is a genetic predisposition for this. We also know today that the heart muscle cells of those affected are up to six times more sensitive to stress hormones, so-called catecholamines.

The cardiologist is a member of an international team of experts that issued recommendations for the treatment of Takotsubo syndrome for the first time last year. “In it we emphasize the importance of examining which harrowing or joyful events may have affected the patient’s heart,” says Templin-Ghadri. It makes sense to accompany those affected with psychotherapy in order to avoid relapses.

Similar to a heart attack

In broken heart syndrome, the shape of the left ventricle is reminiscent of a pitcher for catching squid (click on the magnifying glass)

© W & B / Dr. Ulrike Möhle arr. Jörg Neisel

A recurrence is by no means rare, emphasizes the expert. In addition, there could be complications such as blood clots in the heart chamber or cardiac arrhythmias. Therefore, the patients would have to be carefully monitored, possibly over a longer period of time. “For me that is the most important recommendation of the team of experts,” confirms Dr. Jelena.

Takotsubo syndrome has been underestimated in the past. His urgent advice to those affected: “If you have symptoms such as chest pain and shortness of breath, you should definitely go to the emergency room!” Because a heart problem from grief is no less dangerous than a heart attack.

We know from Chinese medicine that emotions are stored in various organs in the body. During a colonic, we not only let go of physical material but also of stored emotions that are trapped in the colon and related organs. This is why people often feel so light and happy after a colonic. Of course, we cannot fix your broken heart, but we can help your body to release some of the emotions that you are holding on to.