Is it really possible to die of a broken heart? Photo / Getty Images
Is it really possible to die of a broken heart? Photo / Getty Images
Opinion
The first time you see a living heart is breathtaking. When you touch a working heart and feel every contraction pumping blood around the body, it is spellbinding.
It is almost impossible to describe what it is like to see a life-giving donated heart take its first beat in someone's chest. It feels like nothing less than wizardry, or science fiction.
I love hearts. The heart is an astonishing organ, both simple and incredibly complex. If you knew hearts like I do, you would fall in love with them, too.
Did you know that surgeons can stop a heart to operate on it — and then, at the end of the operation, it just goes back to doing its job, hopefully better than when it was rudely interrupted? The heart is tireless and reliable. Yet it can also be vulnerable.
My love affair with hearts is deep and personal: I'm a cardiothoracic surgeon — a doctor who cares for the heart and lungs, repairing their mechanical faults. I'm a 'fancy plumber', as one of my mentors used to say.
I sew together vessels that are 1mm to 2mm wide with 'thread' not much thicker than a human hair. I cut into the heart at just the right spot to repair or replace a diseased valve. I make special burns in heart muscle to direct the electricity of the heart the right way, so it cannot beat irregularly or too quickly.
For me, the magic never wanes.
In folklore and in ancient medicine, the heart was seen as a mystical, life-giving core — and that is exactly how I feel about it.
My path to the heart wasn't straightforward though. As a teenager, I desperately wanted a career in musical theatre, but my father suggested (insisted) I get a 'real' degree first, so I planned to study accountancy. Numbers and balance sheets.
A brief illness and an admission to hospital changed the course of my life.
My experience as a patient, seeing staff who were wrapped up in the world of the human body — its workings, its failings, along with the very human side of what it is to care for another person — inspired me to put medicine at the top of my list. Accounting was relegated to the bottom.
Heart surgery still wasn't a priority. My mum has a dreadful form of arthritis and had her first hip replacement at 40. Because I wanted to help people like her, I originally aspired to be an orthopaedic surgeon.
New doctors have to experience different specialisms so they can decide on their eventual career pathway. As a trade-off for a stint in orthopaedic surgery, I had to spend time in cardiothoracic surgery.
It was love at first sight. I never left.
I still recall an early experience meeting a lung transplant patient. I saw him in the intensive care unit two days after surgery and asked how he felt. He just looked at me and said: 'You have no idea how good it feels to breathe.' That was the moment I knew the chest and its organs had ensnared me, and nothing else would be able to replicate the fascination I felt.
The heart is put together in such a way that it works just beautifully. Every day, the average human heart beats around 70 times a minute, which is about 100,000 beats a day. Unlike the muscles of our arms and legs, it doesn't tire and doesn't need a rest.
Imagine doing 100,000 bicep curls in a day. We couldn't.
When we exercise, our heart can beat 190 times a minute or more. When we sleep, it may slow to 40 beats a minute. Over an average lifetime, this adds up to more than three trillion beats.
At its simplest, the heart is just a pump. But it is also an enigma: its simplicity is possible because of complexities that we are only just learning about. And every heart is different in some way.
In the developing foetus, it is one of the earliest organs to form. At about four weeks, a primitive heart starts beating. For most of us, from that point on it will never stop beating until the day we die.
I feel fortunate to be able to look at hearts almost every day of my life, and I am on a mission to ensure that others find the heart as fascinating and precious as I do.
I want everyone to learn how to love this beautiful organ that has long fascinated artists and scientists, so we can all fall in love with our heart and look after every beautiful beat.
SEARING AGONY OF A BROKEN HEART
Ancient scholars believed the heart was the centre of the soul — and while I'm yet to locate a soul, I am completely sure of one thing: the heart may not be the centre of our emotions, but it is definitely affected by them.
The chest is the place where we often 'feel' most strongly. There is that dull ache when we have lost someone, the tightness of anxiety, the lightness of love or elation.
If we concentrate, we can feel our heart skip along when we're happy or thunder when we're scared.
It flutters when we're excited and pounds when we're nervous.
We sometimes even feel our hearts miss a beat at the sight of the love of our life.
So is it really possible to die of a broken heart? In short, yes, it is. Our emotions and mental well-being can have a real impact on the health of our hearts.
In the early Nineties, a woman arrived at a highly respected U.S. hospital complaining of the classic chest pain that everyone associates with heart attacks. When her coronary arteries were tested, doctors expected to see blockages to explain her heart attack.
But there were none. It was then revealed that her teenage son had committed suicide that day. The woman was suffering from 'broken heart syndrome'.
The medical name for this is takotsubo cardiomyopathy, or stress-induced cardiomyopathy. Takotsubo is the name of a squid-fishing pot used by Japanese fishermen, which looks like a damaged heart. Cardiomyopathy means heart muscle disease.
This syndrome — caused when someone is subjected to a horrible shock — is similar to a heart attack.
Emotions cause the release of huge amounts of hormones such as adrenaline, noradrenaline and dopamine that lead the coronary arteries to spasm and squeeze down, limiting vital blood supply to the heart muscle cells, which in turn leads to heart-attack symptoms.
IT'S WOMEN WHO SUFFER MOST...
Women are much more likely to be affected by broken heart syndrome — up to 90 per cent of patients with this disease are female.
Women may be perceived as more emotional than men, but that is unlikely to be the explanation. Many other cellular processes, body signals and hormones are responsible, and science is still working them out.
Additionally, oestrogen protects the heart, so when oestrogen starts to decline in menopause, the heart may be more vulnerable, particularly the blood vessels of the heart. The good news is that most people with broken heart syndrome make a good recovery.
The poor old heart can be really vulnerable when a person loses their soulmate.
The grieving have higher heart rates, higher blood pressure and an increase in abnormal heart rhythms, all of which places an enormous stress on the heart.
Even their blood is more prone to clotting — which can lead to more clogged-up arteries.
One study showed that on the first day after losing a loved one, the risk of a heart attack is 16 times greater than normal. Some studies report a 66-fold increase in the death rate of widowers in the first 30 days.
Why are men more likely to die soon after their partners? Possibly, it's because when they have lost their partner, many men have also lost their sole confidante (whereas women are more likely to have a circle of friends they confide in).
It could also relate to the fact that it's often the woman who oversees the man's health. When she is gone, there is no one to urge him to take care of himself any more.
When the body's nerve and hormone systems are activated at a time of stress, it can cause the heart to beat abnormally. Photo / Getty Images
If you lose a partner, your risk of developing atrial fibrillation — an abnormal heart rhythm which can lead to issues such as heart failure or clots — is around one and a half times that of the general population.
This is probably because when the body's nerve and hormone systems are activated at a time of stress, it can cause the heart to beat abnormally. This is more pronounced in younger people, and that risk remains elevated for about a year after your partner dies.
DIVORCE PAIN RUNS DEEP
While separation, divorce or breaking up with a partner are not the same as watching your soulmate die, they still put your heart through the mill. For women who are divorced, the risk of a heart attack is between 1.29 and 1.39 times higher than for women who remain married.
For men, the figures are similar, with the risk of heart attack for those who are divorced being 1.38 times greater than for their married counterparts.
What is different, though, is that, when men remarry, the risk drops back down — but this doesn't happen to women when they find a new partner.
To put the figures into perspective, the risk posed by divorce to a woman's heart health is on a similar level to that of high blood pressure or smoking.
Not surprisingly, of course, the more divorces you have, then the worse it is for your heart.
DEPRESSION PUTS HEARTS AT RISK
In a study of more than 93,000 women, those with depression were found more likely to have heart troubles — almost one and a half times more than people who didn't suffer from depression.
Depression can be enough to damage the heart and blood vessels in those with no history of heart problems.
One study even showed that having depression increased the risk of a heart attack by 1.6 times. Patients who have had a heart attack and also have depression are nearly two and a half times more likely to have another heart attack or die from their heart disease.
Why? Depression causes cells in the body to release substances called cytokines, which activate the immune system and cause damaging inflammation. The same cytokine levels that are heightened in depression are thought to directly injure the heart and cause blood vessels to clog up.
What's more, depression saps you of the will to eat healthily and to exercise, which affect the heart.
Oxytocin is released during romantic and physical bonding. Photo / Getty Images
No emotion is simply an emotion. It is a biological process, and love, centred around the hormone oxytocin, is no exception.
Until recently, oxytocin was thought to relate primarily to mother and babies. But now it is believed all hearts benefit from this 'super' hormone, which is released during romantic and physical bonding — a hug for instance.
Oxytocin can fight inflammation — and while inflammation is an important defence mechanism that on a small scale is good (a sign cells are fighting infection or trying to repair damage from an injury), it can get carried away and cause further injury.
When the heart becomes inflamed after a heart attack or infection, oxytocin may help limit the collateral damage. It also makes blood vessels relax so the heart can pump more easily, which helps to lower blood pressure and heart rate.
NEW WAYS TO MEND A BROKEN HEART
It sounds like something out of science fiction, but the ability to mend a broken heart may not be so far in the future. Last year, U.S. scientists were able to grow heart cells on a spinach leaf. The leaf was important because it acted as scaffolding for the cardiac myocytes — heart muscle cells — which grew along the network of fine vessels inside the leaf.
Meanwhile, UK and Australian scientists are studying the zebra fish, which can regrow a damaged heart, to learn how to help the human heart repair itself.
Research has found that not getting enough sleep almost triples your risk of heart disease. Lack of sleep stresses our bodies and brains so cortisol is pumped out, thereby increasing blood pressure, which over an extended period of time can damage the heart.
One study found an insomniac was 1.8 times more likely to have hypertension (high blood pressure) than someone who slept well.
As it is, there is a natural surge of cortisol just before we wake up, which is thought to be our body gearing up for any stress we have to face during the day. This necessary surge in stress can be a strain on vulnerable hearts, and is one of the reasons why there is a spike in people having heart attacks first thing in the morning.
