You really can die of a broken heart — science shows us how

When you think of a broken heart, you probably picture something out of a romantic movie or a cartoon heart, cracked like a fragile piece of china. Indeed, so-called “broken heart syndrome” has a certified place in popular culture, and has been eloquently used in films such as The Notebook. But while we certainly feel “heartbreak” during periods of emotional upheaval, can you actually die of a broken heart?

The answer is never going to be simple, so first we should start with a bit of science. In the last two decades, atrial fibrillation (AF), a form of irregular heartbeat, has become one of the most important public health problems and a significant cause of increasing healthcare costs in western countries.

Individuals with AF have a five-fold and two-fold increased risk of stroke and death, respectively. It is estimated that there will be 14-17m AF patients in Europe by 2030; with 120,000–215,000 new cases diagnosed each year. In the United States, AF prevalence is projected to increase from 5.2m in 2010 to 12.1m cases in 2030.

The exact cause of AF is still unresolved and is likely to involve multiple components such as genetic and environmental factors. Atrial fibrillation is a progressive condition, whereby the arrhythmia begins in a “sudden onset” form, progressing through “persistent” to so-called “permanent” AF. These steps can take many years to develop, but an essential element in this progression are the so-called “triggers”, which can be anything from illness and fatigue, to alcohol, caffeine and emotional stress.

Bereavement and ‘broken hearts’

But what does this have to do with a broken heart? Well, it appears that the two are linked. In a recent article published in the online journal Open Heart, a Danish research team based at Aarhus University reported findings showing that the death of a partner is linked to heightened risk of developing AF for up to a year after the bereavement.

This retrospective study examined hospital records of 88,612 people in Denmark (19.72% of whom had lost a partner) and identified persons that were diagnosed with AF for the first time between 1995 and 2014. For comparison, the team also randomly selected a control group (without AF) of 886,120 people (19.07% of whom had lost a partner) which was matched with the AF group on age and gender. Other factors that were controlled included civil status and education level, and whether the subjects had cardiovascular disease, diabetes or were taking medication for cardiovascular disease.

The study revealed that individuals whose cohabiting partner or spouse had died had an increased risk of getting AF within 30 days of the bereavement – a risk estimated to be 41% higher than average.

The risk was highest 8-14 days after the loss (90% higher than average) and gradually declined to a level close to that of non-bereaved population after one year. This risk was higher among people under the age of 60 and among those whose death was unexpected. Interestingly, where deaths were likely due to ill health, there was no increased risk of AF in the partners after the loss.

The main strengths of this study are the large sample size and the population-based design, but it is an observational study and they can’t prove the cause or the effect. Other contributory factors such as lifestyle or family history of AF could have affected the results, which the authors have acknowledged.

What would have provided more insight to this study is if blood biomarkers (indicating heart damage) or stress hormones (such as adrenaline) were monitored during hospital admission, or whether there were other more serious heart problems, such as heart failure, which would have been detectable with the use of echocardiography.

The origins of a broken heart

Scientific findings accumulated over the past 25 years seem to support the notion that a real-life broken heart can lead to subsequent heart problems. “Broken heart syndrome”, also known as stress-induced cardiomyopathy or Takotsubo cardiomyopathy, was first described in 1990 in Japan and has recently been globally recognized as a real medical condition.

It should be noted here that without echocardiography, blood markers and other evidence, we can’t say for sure whether those in the published Danish cohort had “broken heart syndrome” or not. Nevertheless, roughly in keeping with the condition described in the Danish study, Takotsubo cardiomyopathy starts abruptly and unpredictably (even in healthy individuals). Symptoms include chest pains, often with shortness of breath, and an abnormal electrocardiogram, which resembles a heart attack but is notable for the absence of blocked heart blood vessels.

Indeed, Takotsubo syndrome accounts for about 2-5% of heart attack cases seen by doctors, with a higher predilection for women over 50 years of age (only 10% in men). The significance of Takotsubo cardiomyopathy is reflected to the fact that there is an international registry for this disorder.

What is interesting is that Takotsubo cardiomyopathy is usually triggered by an emotionally or physically stressful event such as bereavement, major surgery or being involved in a disaster such as an earthquake. The exact mechanisms leading to Takotsubo cardiomyopathy are unknown but some evidence suggests excessive release of stress hormones, such as adrenaline, acts as a trigger during the initial onset which causes the weakening of the heart muscle.

In fact, the strong emotion doesn’t have to be negative – “happy heart syndrome” is initiated by happy events, such as the birth of grandchildren or a birthday, and accounts for 1.1% of broken heart syndrome cases.

The long-term affects of Takotsubo cardiomyopathy are unclear, but it does appear to be temporary and reversible. Nevertheless, it is certain that we can have our hearts broken – and that, for some, this can be very dangerous indeed.

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