‘Cause it’s not just love that can break your heart

It’s rare, but you really can die of a broken heart. The syndrome has many causes and they are not always emotional tragedies

Another tragedy unfolded following Tuesday’s devastating massacre at Robb Elementary School in Uvalde, Texas.

Joe Garcia, the husband of Irma Garcia, one of two teachers killed in class, died at home of a heart attack, which family members believe may be a case of broken heart syndrome. The couple are survived by four children, according to the elementary school’s website.

“I truly believe that Joe died of a broken heart and losing the love of over 25 years was too much to bear,” Irma Garcia’s cousin Debra Austin wrote in a family post on the site. GoFundMe website.

What it’s like to have your heart broken

It’s rare, but you really can die of a broken heart.

A sudden emotional shock, such as the death of a loved one, can produce a shock to the heart, which can take on an unusual oval shape, rendering it unable to do its job.

“When a person first arrives, the heart may feel terribly weak. They may barely be able to contract it. In a severe case, they would be in shock in intensive care, and without medical care they would not survive,” says Ilan Wittstein, assistant professor of medicine at Johns Hopkins Medicine, who published one of the first papers on broken heart syndrome, also called stress cardiomyopathy.

Mary Brittingham, with her dog Alfie, had three episodes of broken heart syndrome

However, when Mary Brittingham’s heart first broke, at 53, then at 56 and 69, it had nothing to do with the loss of a loved one.

“I didn’t have a tragic episode of heartbreak because of a romance. My first time was a surprise – or a shock, really,” said Brittingham, a former law professor at Georgetown Law School. “My second time was out of anger, and my third time was out of fear.”

It was 2006. Brittingham had been told to prepare a quick toast to colleagues who were being honored at a college party in Georgetown. Suddenly she heard the host say, “We’re going to hear three speakers tonight, for about 15 minutes each. And our first speaker is Mary Brittingham.”

“It was a total WHAT?” he recalls. “I was completely surprised.” Was I supposed to get up and prepare a speech about my dear colleagues? All I had prepared was two lines! And suddenly I felt a kind of pressure in my chest that crushed me. It was very painful, but I transferred it to anxiety.”

Stunned and hurt, Brittingham managed to get up to the pulpit and talk for a few minutes: “I must have said some meaningful things because I had a few laughs,” she smiles.

But as the night progressed, the pain did not subside, she went to the hospital, fearing that she had suffered a heart attack.

“My heart enzymes were high so they did a test, I had heart failure,” he recalls. “My dad died of heart failure at the age of 36. So I was like, ‘Oh my god, this is it.’ But after all, I hadn’t had a heart attack or a heart attack. heart failure, I had broken heart syndrome.”

A broken heart has an unusual shape

Wittstein first encountered stress cardiomyopathy as a young doctor in a cardiology unit in 1998, when he had three unusual cases in a row.

“I saw three patients in a row who had all experienced some sort of emotionally stressful event. The first was the death of their mother, the second was a scary car accident, and the third was a surprise encounter. One of them arrived at the hospital with very similar echocardiogram results,” says Wittstein.

The footage showed the left ventricle of each of their hearts – which is the main pumping chamber – bulging into an odd shape that looks suspiciously like a takotsubo, a pot used by Japanese fishermen to catch octopus.

An illustration of takotsubo cardiomyopathy, also known as broken heart syndrome. Translation: on the left, normal shape of a left ventricle after contraction; in the center, the shape of the left ventricle in a heart affected by “takotsubo” cardiomyopathy; on the right, the Japanese octopus trap (“tako-tsubo”)

The name “takotsubo” cardiomyopathy crystallized when it was first identified in Japan in 1990, by which time the syndrome was not well known in the United States – and may have often been misdiagnosed, points out Wittstein.

Symptoms such as sweating, chest pain and shortness of breath can be the same as a heart attack, he says. But unlike a heart attack, which is usually caused by blocked arteries, these early patients had “clean, normal coronary arteries” with little or no signs of cholesterol and plaque.

Even stranger, although blood tests showed significant damage, the women’s heart muscles were not permanently altered or damaged like a heart attack, Wittstein says. For many patients, function returned to normal a few days or weeks later.

“In the first few years, we were surprised how quickly we saw hearts brighten up again. It was almost like they were waking up,” he said. “I remember people being sent to our center because they thought they were going to need a heart transplant. And a week later they were home.

“At the time it was completely new, but as soon as the clinical features of the syndrome were recognized, it started popping up everywhere,” he says.

Wittstein and his team began studying the phenomenon, publishing one of two seminal papers in 2005. “We called it ‘broken heart syndrome’ because at the time no one in medicine believed that emotions could have a such a dramatic impact on the human heart”, Wittstein reports “We wanted to raise awareness.”

What triggers a broken heart

Today, science still doesn’t know exactly why broken heart syndrome occurs or why some people have repeated episodes, Wittstein says. “We think it has to do with a body’s fight-or-flight dysfunction, the release of chemicals like adrenaline, norepinephrine and dopamine that the body uses to prepare us to flee or get up and go. beat,” Wittstein said.

It is estimated that around 2% of people seen in the emergency room for a heart attack may have the syndrome, and a 2020 study found an increase in cases, particularly among women. The increase in diagnosis may simply be due to doctors’ increased awareness of the syndrome, Wittstein says.

Almost everyone who has had episodes of broken heart syndrome are women, he adds, especially postmenopausal women who are then lacking in estrogen.

“When estrogen is injected into a blood vessel, the blood vessel expands, it gets bigger. So estrogen is a very important mediator of how blood vessels work in women,” says Wittstein. “In fact, studies have shown that your risk of broken heart syndrome increases fivefold after age 55 if you’re female.”

Today, doctors know that only a third of all cases are related to emotional shock, Wittstein said. Two-thirds are caused by physical stimuli, such as severe pain, asthma attacks, seizures, strokes, high fever, low blood sugar, surgery, and pneumonia.

“We know that of all the physical stimuli that can cause this disease, pneumonia is one of the most potent.” That’s a concern during the pandemic, adds Wittstein, because Covid-19 damages the lungs and also causes microvascular function, where the body’s small blood vessels don’t function properly. Damage to these small blood vessels around the heart is another theory of disease.

“When we’re stressed, we want more blood to reach our heart and help the body respond, right?” Wittstein points out. “But with broken heart syndrome, we think adrenaline causes the heart’s small blood vessels to constrict instead of dilate and temporarily reduce the amount of blood reaching the heart.”

Surviving Broken Heart Syndrome

When Mary Brittingham felt a familiar pain in 2009, she knew she was having another attack. It was three years after her first episode, and this time she was in the middle of a heated argument with another lawyer.

“That’s my telltale sign, that overwhelming sensation just below my sternum that radiates from my chest all the way to my neck,” he says. “And then I know, ‘My God, it’s not anxiety or indigestion. “That’s it.”

The third episode took place a decade later, when his beloved doodle Alfie was threatened while on a hike. “For five minutes I took care of it, then I went into the house, closed the door and my chest started to collapse,” he recalls. “I had retired and done all kinds of things to reduce the stress in my life. And I thought to myself, I’m almost 70 – will the next one kill me?”

By then Brittingham had sought out Wittstein as a doctor and she went to him with her concerns. “I asked him, ‘How do I explain this to people who will think I’m fragile? I’m really not. In fact, I feel pretty tough.” He told me that being frail had nothing to do with it, and that a woman had eight episodes without dying.”

“My favorite story he told me to make me feel better was about a woman who was camping with her husband and decided to dye her hair while he was fishing,” he adds. she. “A tent started flying and she had to deal with it before she could wash the dye out. All she could think about was the color of her hair.” Wittstein picked up the story: “And she had an episode of broken heart syndrome.”

“It’s strange, when we started describing this, we thought it had to be triggered by a massive tragedy, like the death of a loved one or a near-fatal car accident,” he says. “What we’ve seen over the years is that’s not really true. Some of the triggers can feel pretty soft.”

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