When the sadness is overwhelming, it’s like a heart attack

Since October 7, Israeli cardiology services have reported a sharp increase in cases of broken heart syndrome, which closely resembles the symptoms of a heart attack but is entirely different.

Dr. Amnon Eitan, deputy director of the cardiology unit at Carmel Medical Center, says the main difference is that “broken heart” looks like a heart attack, but when examined, doctors find no blocked arteries causing the heart attack.

According to Dr. Eitan, in cases of broken heart syndrome, there is usually no lasting damage to the heart, although the person suffering from it often feels most of the symptoms of a heart attack, chest pressure ECG changes that resemble heart attacks. Dr. Eitan explains that if there is significant impairment of heart function, it is treated with heart failure medications. “But in rare cases, you can even die from it.”

Broken heart syndrome usually occurs after a sudden emotional stressful event. “It is mainly negative emotions, whether unrequited love, deep grief or the loss of a loved one, such as death in war, but it can also be something trivial like anger at work, but it will not be a one-off anger, but something prolonged over time,” explains Dr. Eitan.

He says that because of the war, three trauma patients were hospitalized in his department and that a woman arrived with the syndrome after her son fell during the war.

Broken heart syndrome is clearly linked only to acute stressful situations and not to other standard risk factors for heart attacks,” explains Professor David Pereg, director of the Cardiac Intensive Care Unit at the Meir Medical Center.

“The phenomenon occurs mainly in women aged 50 to 60 and is characterized by a change in the shape of the heart. In fact, heart function is impaired and it does not contract but expands, a condition called Apical Ballooning. The heart literally looks like a balloon,” he explains. The syndrome was first identified in Japan, where the heart shape was linked to a trap traditionally used to catch octopuses, called Takotsubo in Japanese, which became one of its names.

The mechanism behind the syndrome is linked to the release of adrenaline in the body following nervousness or prolonged stress, but doctors testify that in most cases the event causing the syndrome is heart broken can be identified through conversation with the patient. Treatment mainly involves support, and in cases of significant impairment of heart function, standard heart failure medications are used.

Dr. Eitan explains that such an event can recur when there is a higher risk, especially in women who have already experienced it. However, nerves aren’t the only negative emotion that can harm the heart. For example, anger or rage can also lead to a heart attack.

Many studies have already demonstrated the link between anger and stress and the risk of heart attack, as well as a US study conducted on the latest drug which proved the immediate and direct effect of anger attacks on heart function.

The study, published in the Journal of the American Heart Association and conducted in collaboration with researchers from Columbia University’s Irving Medical Center, Yale Medical School, St. John’s University in New York and other institutions, revealed that intense tantrums can indeed impair blood vessel dilation, potentially leading to a heart attack.

Professor Pereg compared the research results to a familiar scene from many films where, during a fit of anger, excitement or bad news, the movie star clutches his chest and sometimes even collapses following to a heart attack. “This research aimed to examine whether this link holds true in reality,” he says.

During the study, 280 young, healthy participants were divided into groups and asked to recall events that aroused various emotions in them, such as anger, grief and anxiety, while others maintained a neutral state and constituted a control group.

Before, during and after the emotional experience, various biological parameters were examined, such as blood pressure, heart rate and laboratory parameters related to blood vessel function, inflammation and blood clotting, which are all associated with an increased risk of developing a heart attack.

Among the emotions examined in the study, a physiological link was found with anger alone, demonstrating its negative influence on arterial function, which could increase the risk of heart attack. The research findings highlight the importance of anger management for heart health and could impact clinical recommendations for patients with heart disease.

However, Professor Pereg adds a caveat, saying the researchers’ conclusions are limited due to the conditions of the study. “The research results are intriguing, but there is a difference between emotions elicited in laboratory conditions and real emotions. A nerve stimulated in the laboratory cannot be equated with grief after the death of a loved one.”

Indeed, despite the importance of the research and the significant information it provides on heart health and anger management, its investigators recognize the need for continued research involving a diverse demographic of patients who are neither young nor in good health. For example, studying patients with chronic anger problems, heart disease, vascular problems or diabetes, can help to better understand the mechanisms involved and study the effects of anger on various health risks.

Dr. Eitan notes that in 1994, there was a sharp increase in heart attack rates in Los Angeles following a severe earthquake in the area. An increase in heart attacks has also been observed during times of war, during severe economic recessions and during the COVID-19 pandemic.

“While the link between stress and heart attacks is known, the importance of the research lies in demonstrating the direct and immediate connection between the body and mind: acute emotional stress triggers a rapid biological response that increases the risk of heart attack.”

Researchers say the function of endothelial cells, responsible for dilating blood vessels, is a key factor. Impaired dilation is an early marker of atherosclerosis, a disease linked to heart disease, heart attacks, strokes and other disorders.

Professor Pereg explains that such an event is called acute coronary syndrome, in which the arteries supplying the heart with blood are suddenly and rapidly blocked, leading to a heart attack. “At the heart of the disease is atherosclerosis, where cholesterol and inflammatory cells build up in the lining of the heart’s arteries, forming plaque.”

Professor Pereg testifies that there are two possible outcomes: first, an impairment of the ability of the heart’s arteries to expand and contract to meet the blood supply needs of the heart, and second, the formation of clots arterial. He said a dangerous event occurs when a blood clot forms, severely blocking the artery. If a tear occurs in this wall, blood encounters the contents of the plaque, making the situation similar to an injury. “This can cause blood to clot in a heart artery, potentially leading to a heart attack.”

According to Professor Pereg, it is one of the Holy Grails of cardiology. “It is closely linked to blood pressure, blood flow and heart rate. Therefore, vigorous physical activity is generally very healthy, and it is also linked to other parameters, including mood. We know that when we are upset or excited, blood pressure rises. Thus, heart attacks present one of the most intuitive links between angry and excited states and heart problems. Does it prevent heart attacks?

Dr. Eitan says: “That’s the million-dollar question. Interventions have never been proven to reduce risk, but it makes a lot of sense. Generally, negative emotions are directly linked to rapid heart rate, high blood pressure, and high cortisol release due to stress. All of them are associated with an increased risk of atherosclerotic processes. It’s important to remember that stress is also linked to other illnesses, including diabetes, cancer, and more. So it is clear that it is advisable to reduce stress of all kinds, but the way to achieve this. reducing stress will vary for each patient.

“Workload can be reduced, hobbies developed and vacations taken. Physical activity and yoga are also linked to stress reduction and, in some cases, there is also room for psychological treatment. There is a message that comes from the subject, mainly that of try not to take things to heart, figuratively.

Professor Pereg adds: “Western lifestyles are full of pressure. We work long hours and try to move forward all the time, realizing our potential and our time. Our bodies are not designed to work in such conditions. This must be taken into account. in the most fundamental aspects of healthy living, physical activity and nutrition, these are closely linked and influence each other on our mental and physical health. Therefore, part of the recommendations for maintaining heart health is to reduce stress and pressure and be aware of them. Stress negatively affects heart health.