Broken Heart Syndrome: How Emotional Trauma Yields Physical Results
In May 2022, a teacher at Robb Elementary School in Uvalde, Texas, Irma Garcia, was shot and killed. Two days later, her husband of 23 years, Joe Garcia, visited his wife’s memorial to drop off flowers. When he returned home, he fell over and died. It may be important to note that Joe did not have heart disease. He died of a broken heart.
How do people die from a broken heart? Is it a real thing? Studies looking at the death of a loved one indicate this is a big issue. When a woman dies, her husband is three times more likely to die within two years. (But when a husband dies, the wife is not at increased risk.) However, when a child dies, a mother has twice the risk of death in the next two years. This is a good indicator of what breaks the heart. When my aunt died of cancer in her 50s my grandmother leaned over to me at her funeral and said, “No child should die before her mother!” Grandma lived another thirty years, despite the heartbreak.
Stress and Anxiety Causes a Broken Heart
Yes, people can die from a broken heart. But stress and anxiety disable many more with heart disease. The shock of a physical or emotional stressor can cause Takotsubo Syndrome, a type of heart disease. In this “broken heart” syndrome, trauma stuns and weakens the heart muscle, producing symptoms similar to a typical heart attack. This literally changes the shape of the physical heart, so that it looks like a “TOKOTSUBO” on an x-ray. Takotsubo is the word for octopus trap in Japanese. This sudden change to the heart, causing small vessels to close and only the top part of the heart to work, often affects Japanese women, but can be found all over the world.
Risk factors for the development of Takotsubo cardiomyopathy include domestic abuse, death of relatives, natural calamities, accident or major trauma, arguments, financial or gambling loss, diagnosis of an acute medical illness, stimulant drugs such as cocaine, amphetamines, or even positive life events the so-called “happy heart syndrome.”
The metaphorical heart is the wants, needs, and desires; and any major change can cause the heart to malfunction and constriction of heart vessels.
Angina and the Heart
Another effect known for many years is spasm of the arteries causing chest pain: angina. Angina is chest pain due to a lack of blood flow to the muscles of the heart. It is often caused by blockages in the arteries of the heart. But spasms of coronary arteries may also cause angina. This is called Prinzmetal’s Angina. Imagine the surprise of a doctor who has a patient with chest pain and abnormal EKG and even blood tests that indicate a heart attack, but who has squeaky-clean arteries! Up to 70% of people with angina do not have blockage of a coronary artery.
Heart Attacks and Heart Damage
The incidence of heart attack in people who do not have coronary artery disease can depend on many factors. For example, the sudden nature of the stress.
Joe Garcia’s loss was unexpected, whereas my aunt had a protracted course of cancer. People who have a big shock may have dysfunction of the arteries and blood flow to the heart, causing the heart to stop.
Even people who don’t have arterial disease can get constriction of arteries of the heart turning off the blood flow to the heart muscle just when it is most needed to handle the stress.
The combination of factors is the problem which may lead to heart damage or a fatal arrhythmia.
In the past, doctors said that since there are no plaques in the arteries that the person is not at risk. However, that turns out not to be true. One study showed that people who had and abnormal EKG with Prinzmetal’s Angina were three times more likely to die of a heart attack, irrespective of their level of heart disease. In other words, even if they had no blockages in their arteries, death from heart attack was just as likely.
People with vasospasm die at the same rate as those with coronary artery disease, even though they don’t have as many risk factors such as hypertension, high blood sugar, and older age. About 10% of people who die from a heart attack do not have any significant coronary artery disease, or blockage. They tend to be younger, with a lower cholesterol, blood pressure, high blood sugar, and smoking risks.
How To Tell the Difference Between Vasospasm and Arterial Disease
Stable angina is where a person gets chest pain and/or shortness of breath with a consistent amount of exercise. People who say, “I can’t walk past the mailbox before getting chest pain” probably have clogged arteries and not vasospasm. On the other hand, those who get chest pain unrelated to activity are more likely to have spasms. If sitting on the couch and watching an intense movie causes chest pain, it is likely to be from vasospasm.
One way a doctor will be able to tell if you have vasospasm is to give a medication that opens blood vessels. Nitroglycerine has been used for a century to relieve chest pain. If the blood vessels of the heart spasm, the nitroglycerine relaxes them and allows the blood to flow. There are others as well. Many years ago, when I was in training, the emergency room doctors would give intravenous magnesium to restore blood flow. This works better and longer than nitroglycerine and prevents damage to the heart muscle by increasing energy. Now, however, most physicians in hospitals don’t know about IV magnesium because it has fallen out of favor due to drugs and stents.