Yes, You Can Actually Die of a Broken Heart

OJoe Garcia, his wife Irma was killed in the same accident on May 26, 2022. He died of a sudden heart attack. Uvalde, Texas school shooting. The papers reported a Garcia’s family member saying, “I truly believe Joe died of a broken heart.”

I am a cardiac scientist who is often called upon to comment on cases such as these. They may be celebrities like Debbie ReynoldsCarrie Fisher, her daughter, died shortly after her mother. They often die in the same day, or shortly after, if they were long-married.

These events can occur in a very rare and irregular fashion, making it difficult to establish a pattern. However, large-scale and controlled studies have confirmed that this phenomenon is real and are measuring its impact. This is the A. U.S. studyStudying 12,000 men over 50 who were in stable marriages and with a focus on the long-term and short-term effects of widowhood and mortality showed that men were twice as likely than women to die in the first three months after their partner died. The increased death rates continued for over a full year.

Sudden death from heart disease can occur after bereavement, especially if the circumstances are as severe as the Uvalde shooting. Sudden cardiac death usually results from a major disturbance in the heart rhythm (or arrhythmia), called ventricular fibrillation. It can be caused either by a heart attack as a whole or by itself. The heart is unable to pump blood through the body because it twists and wobbles in an uncoordinated manner. Death can occur in as little as four minutes without access to CPR or a defibrillator.

Continue reading: This Woman’s Heart Actually ‘Broke’ After Her Dog Died. Here’s How It Happened

Adrenaline is the main cause of this devastating effect. Adrenaline is known to be the heart stimulant that causes our hearts to beat faster and harder when we are stressed or exercising. Adrenaline is part the fight-or flight mechanism. It brings calcium into the cells of the heart to increase the rate of beating. When there is danger, blood levels of adrenaline rise.

But adrenaline has a dark side—too much can throw the heart into calcium overload and uncontrolled arrhythmia.

A major emotional shock is bereavement. This can lead to a surge in adrenaline. You may also experience the same effects from other extreme physical or emotional stressors such as earthquakes and other natural catastrophes, unaccustomed intense exercise or arguments. Sport is a powerful trigger. Hospital admissions spike during big events. football finals like the World Cup.

Even the most distressing events can be handled by most people without causing panic or triggering heart attacks. What is it that can make the difference between surviving and dying from a broken heart?

The clue came from an unlikely source: another disease called Broken Heart Syndrome, but with a different demographic and outcome: Takotsubo syndrome. Takotsubo is seen primarily in the 80-90% of Japanese. post-menopausal womenThis is compared to sudden heart death which is 80% male. Exactly the same triggers are involved in sudden cardiac death, but the death rate is far lower—around 5%.

Takotsubo patients usually present after a stressful event. They often have all signs of a cardiac attack such as chest pain, electrical signal changes and elevated markers of heart disease in their blood. Their heart scan shows no signs of blood vessel blockage, or death of the cardiac muscle.

The cardiac muscle of the heart suffers from a rare pattern of partial paralysis. This is often found around the lower portion of the heart, also known as the “apex”. New imagingThis pattern was first used over 20 years ago in Japan to treat heart disease patients who were admitted after an earthquake. The Japanese cardiologists named the condition after the tako-tsubo—a fishing pot meant for trapping octopus—because the left ventricle of the heart resembles this type of pot.

Although there are immediate risks to your life due to heart failure, the most remarkable phenomenon is that recovery can be very rapid—days or weeks. The patient can leave the hospital seemingly fine. This type of chronic heart failure is often very severe and difficult to treat.

Bereavement, strong emotional or physical stress and bereavement are all triggers of sudden cardiac death. Even the most pleasant and yet still emotionally charged events, such as a surprise birthday celebration, can cause sudden cardiac death. have been known to do the same. Two triggers stand out, an adrenaline-secreting tumor as well as the anaphylactic shock epi-pens that contain adrenaline. Takotsubo is also caused by Adrenaline and drugs that mimic it.

But is adrenaline now causing these conditions to depress heart function instead of stimulating it. What’s more, postmenopausal women are reacting in a very different manner?

We decided to test it. In a laboratory we created a system to investigate the phenomenon. mechanism of Takotsubo cardiomyopathy. An anaesthetized rat was given adrenaline that would be equal (adjusted to their smaller body weight) for one epi-pen treatment in a human. Amazingly, the one-hour dose produced the Takotsubo pattern in paralysis at rat’s heart.

This model was used to show that extremely high adrenaline could cause a change in the signaling pathway which temporarily reduces cardiac function. Surprisingly, the new signaling system was also connected to known protective pathways that act to protect the heart from damage.

Finally, we were ready for testing to see if blocking the new signaling pathway would stop Takotsubo. We hoped that this would allow us to target the disease with a treatment. Takotsubo patients were being treated with support in the hope they would heal spontaneously. But, there wasn’t a specific drug to offer.

The blocker was given to our rats along with adrenaline in an attempt to stop the Takotsubo effects. It worked. The heart did not contract. To our dismay, the blockage of the new pathway caused massive arrhythmia. The adrenaline overstimulated the heart and flooded cells with too much calcium. Now adrenaline was replicating the effects of sudden cardiac deaths, which can cause ventricular fibrillation or rapid decline in cardiac function.

The Takotsubo cure that we had hoped for was not to be, however, it was a complete failure. But it provided us with a valuable insight into the disease. Perhaps Takotsubo signals the body to switch to a protective mode to avoid the worst effects of an adrenaline rush. The heart is temporarily shut down to prevent a worse outcome, and maybe this protective pathway is active in most of us—but in a less dramatic form—to save us from the effects of sudden stress. People may feel like they are having a panic attack during panic attacks. But, as soon as they heal, the feeling fades.

What is the reason for this sex difference? We know that estrogen protects against arrhythmia. Younger women seem to be less susceptible to developing either the broken heart syndrome or estrogen. There is a significant difference in sudden cardiac death risk between women and men. below the age of 50. My personal hypothesis is that adrenaline toxicity has evolved in fertile women as a result of the risks associated with labor and birth.

The estrogen levels in women who are entering menopause will decrease, but there will still be some residual estrogen. They may be moving away from the protection of younger women to the more vulnerable male position, with some advantage. Men were 90% more likely to dieIn the three first months following bereavement, this was only half of the total. However, for women aged 50 and older, it was just 50%.

You can certainly die from a broken spirit, but the risk is dependent on your sex and your age. Perhaps the more important question is: If it’s possible to die of broken hearts, then why aren’t many people spared?

Get in touchAt letters@time.com.