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11 July 2016

Can you die of a broken heart?

Doctors have caught up with folklore. We now know you can die of broken-heartedness.

By Phil Whitaker

Medicine has some fantastic diagnostic labels. My favourite is exploding head syndrome. Not as messy as it sounds, EHS is an example of a hypnagogic experience: phenomena that occur during the brain’s transition from wakefulness to sleep. Most people will be familiar with the commonest of these – an abrupt sensation of falling. In EHS, the slumberer is jerked awake by a deafening bang emanating from inside the skull. It’s over in a flash, leaving the person alarmed but otherwise unharmed – though doctors unfamiliar with it may perform urgent scans and lumbar punctures, confusing EHS with a thunderclap headache, an ominous symptom of an impending brain haemorrhage.

Pott’s puffy tumour, by contrast, sounds almost cuddly. It presents with a large, boggy swelling over the forehead, caused by an abscess in and around the frontal bone of the skull. Teenagers are most prone, the tumour forming as a result of infection spreading from the sinuses. If untreated, it causes life-threatening brain complications. Puffy tumours became uncommon following the development of antibiotics but have staged something of a comeback due to an association with snorting cocaine.

Perhaps the most poignant label is the one that Maria encountered. She arrived as an emergency case, suffering pains in her chest and shortness of breath. As a female non-smoker in her late forties, Maria was unlikely to have heart disease, and these symptoms occur frequently with panic attacks and anxiety. Maria, I knew, had been under enormous strain. Her beloved father had died a couple of months earlier, and once the contents of his will were made known, a full-blown war had erupted in the family. Bitter arguments over inheritance had reignited traumas from the past: fault lines had reappeared, siblings weren’t speaking, and legal action was being mooted.

Yet although Maria’s symptoms sounded stress-related, my examination forced a rethink. No amount of personal turmoil, I reasoned, could account for the abnormal sounds coming from her heart, nor the fluid I could detect on her lungs. An ECG returned a grossly abnormal trace: it seemed that Maria was indeed having a heart attack. I sent her to hospital in a blue-light ambulance.

The cardiologists took her straight in to Angiography, where dye injected into the bloodstream delineates the arteries supplying the heart muscle with oxygen. To everyone’s surprise, there was no blockage, which is what one would normally see with a heart attack. Instead, Maria’s heart itself had assumed a grotesquely abnormal shape. The apex of the main pumping chamber, the left ventricle, had blown up like a balloon, its usually thick, muscular walls stretched thin and barely contracting.

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A diagnosis of takotsubo cardiomyopathy was made. This is a strange condition, often precipitated by grief or other profound emotional shocks. The heart muscle seems somehow to become stunned, causing it to malfunction and fail. The mechanism is not understood, but it may be the result of an aberrant reaction to high levels of adrenalin. The name originates in Japan, where the condition was first documented in 1990. It can be fatal, but if, like Maria, the patient survives the initial phase, complete recovery occurs within a couple of months.

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It’s a classic example of medical technology belatedly catching up with folk wisdom. It has long been known that a severe shock in your personal life can cause sudden death, but only with the advent of sophisticated imaging techniques can we now see what is happening to the heart. “Tako tsubo” means “octopus pot”; the bizarre shape of the failing heart is reminiscent of a traditional Japanese fisherman’s trap. But I prefer the anglicised version, “broken-heart syndrome”, which Maria’s bereavement and family trauma had precipitated. A few months later, she is off medication – but it will take far longer to heal the emotional wounds.

This article appears in the 06 Jul 2016 issue of the New Statesman, The Brexit bunglers