What becomes of the broken hearted?

broken heart

From time to time we all hear stories about devoted couples who have spent their whole lives together and then go on to die just a week, day or even an hour apart. In such a situation many people might be inclined to say that the widow or widower in question died from a “broken heart”, but is there really such a thing?

A study undertaken in 2014 looked at a large number of people aged 60 to 89 years over a period of 7 years to see if there was a correlation between the death of their partner and a heart attack or stroke in themselves in the days and weeks following their bereavement. The results showed that twice the number of bereaved individuals had sustained a heart attack or stroke in the first 30 days following their partner’s death, compared with the control group who had not suffered a bereavement. So what are the possible reasons behind this?

In the days following the loss of a loved one many people neglect their own needs and may under or overeat, drink more alcohol, smoke more than usual or forget to take prescribed medication in the usual way, and this constellation of factors can predispose to a cardiovascular event. In some cases the bereaved individual will also have lost their main caregiver and may struggle to look after themselves in general.

Some small studies have also demonstrated a change in several physiological factors in the immediate post-bereavement period, including a rise in blood pressure, an increase in levels of cortisol (the “stress” hormone), variability in heart rate and an increase in blood clotting factors. Although these changes are thought to be relatively short-lived, they are possible triggers for heart attack and stroke.

There is also a condition known as “broken heart syndrome”, or takotsubo cardiomyopathy, to give it its medical name. The word “takotsubo” is actually the Japanese word for “octopus pot”, the condition so being called because of the shape the main pumping chamber of the heart takes on with this condition. In roughly a third of patients who develop takotsubo cardiomyopathy it is a severe emotional stress or shock which causes a transient weakening of the main pumping muscle in the heart (left ventricle), which presents as severe chest pain or acute shortness of breath, together with changes on an ECG which mimic a heart attack. The difference between a heart attack and takotsubo cardiomyopathy is that the former is caused when an area of disease in a coronary artery ruptures, triggering an injury response and clot formation which then blocks the artery and starves the heart muscle of oxygen. With takotsubo cardiomyopathy there is no such blockage. 

The precise cause of the condition is unknown, although the main hypothesis is that the sudden increase in stress hormones causes spasm and dysfunction at a microvascular level, such that the tiny blood vessels surrounding the left ventricle are not able to supply the muscle with the blood it needs to pump effectively. 

The prognosis is generally very good indeed, with the majority of people going on to make a complete recovery, but in some cases, particularly in the elderly or those with existing heart conditions, takotsubo cardiomyopathy can be life-threatening. The importance of good social support, especially in the face of a major life event, cannot be underestimated, and there are a number of charities, such as Cruse, which offer invaluable support in the days and weeks following a bereavement. There are also many organisations, such as the Marie Curie charity, which offer assistance and advice to those who are looking after a loved one who is terminally ill. Your GP should be able to give further guidance on the services available in your area.

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