History and literature are full of accounts of people who died of shock and sorrow.
In 1914, conservationist John Muir lost a passionate struggle to save the Hetchy Hetchy glaciated valley from development. He died three days later, some say, of a broken heart.
In 1984, a New York pathologist begins an autopsy on a young partygoer who wasn’t quite as dead as she seemed. The pathologist was quite shocked when the patient grabbed his throat; so shocked, in fact, he died.
In 2004, the mother of an American soldier killed in Iraq dies herself, seven days after viewing his remains.
One year ago today — just in time for Valentine’s Day — the New England Journal published its explanation of this phenomenon. In their paper, Hunter Champion (born for success, he was), Ilan Wittstein et. al showed that myocardial stunning could be the result of stressful news and prolonged catecholamine release. The stricken patients had areas of motionless heart tissue, even though they had no coronary artery blockage:
…the research team found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines (notably adrenalin and noradrenalin, also called epinephrine and norepinephrine) into the blood stream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a typical heart attack, including chest pain, fluid in the lungs, shortness of breath and heart failure.
Upon closer examination, though, the researchers determined that cases of stress cardiomyopathy were clinically very different from a typical heart attack.
“After observing several cases of ‘broken heart’ syndrome at Hopkins hospitals – most of them in middle-aged or elderly women – we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening,” says Wittstein. “These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease.”
For example, examination by angiogram showed no blockages in the arteries supplying the heart. Blood tests also failed to reveal some typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the blood stream from damaged heart muscle. Magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage. Of greatest surprise, the team says, was that recovery rates were much faster than typically seen after a heart attack. Stressed patients showed dramatic improvement in their hearts’ ability to pump within a few days and had complete recovery within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart muscle damage is permanent.
Japanese researchers had recognized this phenomenon in the 1990s, and dubbed it takotsubo, or octopus, cardiomyopathy (after the shape assumed by the akinetic portion of the left ventricle.)
It’s now believed that a not-insignificant fraction of what gets diagnosed as acute myocardial infarction — especially in women — is actually the stress cardiomyopathy described above.
The good news is that once diagnosed and properly treated, the cardiac muscle recovers quickly. The same cannot be said of the shock-stricken patient, whose emotional scars may never heal.
On that note, have a splendid weekend and enjoy Valentine’s Day!
