Matters of The heart

Can you die of a broken heart? It can feel that way, and anyone who experiences intense grief after losing a loved one may wonder whether they will survive. Dr Alexander Lyon, a consultant cardiologist at the Royal Brompton, the specialist heart and lung hospital, is working with researchers at Imperial College to understand why some people die in the few days after a sudden, devastating loss. A rush of overwhelming fear or extreme pain are the types of shock he says might also lead to catastrophic heart failure. But it's not just "bad" emotions that can trigger a condition known as "broken heart syndrome". Lyon says it could equally be the shock of intense, unexpected happiness, such as winning the lottery. The trigger for the syndrome — also called stress cardiomyopathy or Takotsubo cardiomyopathy — is the body's sudden, massive release of adrenalin, which can "stun" the bottom half of the main pumping chamber of the heart, in effect paralysing it and requiring the top portion of the chamber to work much harder to compensate. This, says Lyon, can be confusing to someone attempting a diagnosis, as doctors are taught that adrenalin is the "fight or flight" hormone that makes the heart pump faster and stronger. Broken heart syndrome is a condition in which adrenalin causes weakness instead. In his research Lyon is trying to find out why this type of acute stress causes the heart to get weaker, why just one part of the heart is affected by the adrenalin surge and what factors make some people susceptible or resilient to the rush. Present figures suggest that in the UK about 2 per cent of the 300,000 "heart attacks" each year will, in fact, be broken heart syndrome. Over ten years, that could be up to 60,000 cases. And Lyon suggests that rather more people may be dying suddenly of the condition before arriving at hospital, without an accurate diagnosis ever being made either pre- or post-mortem. "Humans have always been exposed to these kinds of stresses," Lyon says. "The only reason we know about the syndrome now is because people presenting with heart attack symptoms can have coronary angiograms very soon after their chest pain begins. "To a cardiologist, a heart attack means a blocked coronary artery, but in this condition we find the coronary arteries are open and the blood supply is fine. We then look at the pumping chamber and it's paralysed, plus it's taken on a unique and abnormal shape; it looks like a Japanese fisherman's octopus pot, called Takotsubo, hence its name." About 90 per cent of diagnosed broken heart syndrome cases are in post-menopausal women — which begs the question, why aren't men getting it? Lyon suggests that men may in fact be suffering from the condition but collapse and die before reaching hospital. Sudden deaths in otherwise healthy young men in custody, young men who are high on drugs and have been forcibly restrained, and deaths under restraint in psychiatric hospitals, are all situations in which Lyon says stress cardiomyopathy should be considered. But can you, quite literally, die of heartbreak after being dumped, or from the emotional pain of a loved one's demise? The answer is that during the few days after experiencing stress of this nature, it is possible — a thought that might prompt GPs to consider how to support people in such situations.