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

Since October 7, Israeli cardiology departments have reported a sharp increase in cases of broken heart syndrome, which is very similar to the symptoms of a heart attack but completely different.

Dr. Amnon Eitan, deputy director of the cardiology department at Carmel Medical Center, explains that the main difference is that “the broken heart” looks and feels like a heart attack, but examination cannot detect a blocked artery that is causing the heart attack.

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Broken heart syndrome

(Photo: Shutterstock)

According to Dr. Eitan Broken heart syndrome usually does not cause permanent damage to the heart, although the affected person often experiences most of the symptoms of a heart attack, from pressure in the chest to similar changes on the ECG heart attack. Dr. Eitan explains that if the heart function is significantly impaired, 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. “Most often it is negative emotions, be it unrequited love, deep sadness or the loss of a loved one, such as death in war, but it can also be something trivial, such as: B. Anger at work, but it will not be a one-time anger, but something that is prolonged over time,” explains Dr. Eitan.

He says that as a result of the war, three patients with trauma were hospitalized in his department and a woman with the syndrome arrived after her son was killed in the war.

“Broken heart syndrome is clearly only related to acute stressful situations and not to other standard risk factors for heart attacks,” explains Prof. David Pereg, director of the cardiac intensive care unit at 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, the heart function is impaired and instead of contracting, it expands, a condition called apical ballooning. The heart in the truest sense of the word.” “Looks like a balloon,” he specifies. The syndrome was first identified in Japan, where the shape of the heart was associated with a trap traditionally used to catch octopuses, called takotsubo in Japanese, which became one of their names.

The mechanism behind the syndrome is related to the release of adrenaline in the body after prolonged nervousness or stress. However, doctors confirm that in most cases the event that caused broken heart syndrome can be identified by talking to the patient. Treatment is primarily about support; if cardiac function is significantly impaired, standard medications for heart failure are used.

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Dr. Eitan explains that such an event can happen again if there is a higher risk, especially in women who have experienced it before. However, nerves are not the only negative emotions that can negatively impact the heart. For example, anger or anger can also lead to a heart attack.

Numerous studies have previously demonstrated the connection between anger and stress and the risk of a heart attack, as well as an American study of the latest drug that demonstrated the immediate and direct effect of tantrums on heart function.

The study, published in the Journal of the American Heart Association and conducted in collaboration with researchers at Columbia University Irving Medical Center, Yale Medical School, St. John’s University in New York and other institutions, found that severe tantrums can actually be detrimental to health Expansion of blood vessels, which can potentially lead to a heart attack.

Prof. Pereg compared the research results to a well-known scene from many films in which the film star clutches his chest during a tantrum, excitement or receiving bad news and sometimes even collapses due to a heart attack. “This research aimed to investigate whether this connection holds true in reality,” he says.

During the study, 280 young and healthy participants were divided into groups and asked to recall events that evoked various emotions in them, such as anger, sadness and fear, while the rest remained in a neutral state and formed a control group.

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

Within the emotions examined in the study, a physiological link was found with anger alone, showing that it has a negative impact on artery function, which could increase the risk of heart attacks. The research highlights the importance of anger management for heart health and may impact clinical recommendations for patients with heart disease.

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However, Prof. Pereg points out that the researchers’ conclusions are limited due to the conditions of the study. “The research is fascinating, but there is a difference between emotions evoked in laboratory conditions and emotions in real life. A nerve stimulated in the laboratory cannot be equated with grief after the death of a loved one.”

In fact, despite the importance of the research and the significant insights it provides into heart health and anger management, researchers recognize the need for further research that includes a diverse population of patients who are not young and healthy. For example, studying patients with chronic anger problems who suffer from heart disease, vascular problems, or diabetes can help better understand the mechanisms involved and examine the impact of anger on various health risks.

Dr. Eitan points out that in 1994, Los Angeles saw a sharp increase in heart attack rates following a major earthquake in the area. Increases in heart attacks have also been observed during times of war, severe economic downturns and the COVID-19 pandemic.

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

Researchers argue that the function of endothelial cells, which are responsible for dilating blood vessels, is a key factor. Impaired dilation is an early marker of atherosclerosis, a condition associated with heart disease, heart attacks, strokes and other illnesses.

Prof. Pereg explains that such an event is called acute coronary syndrome, in which the arteries that supply blood to the heart suddenly and quickly become blocked, leading to a heart attack. “At the heart of the disease is atherosclerosis, in which cholesterol and inflammatory cells build up in the lining of the heart arteries and form plaque.”

Prof. Pereg testifies that there are two possible consequences: first, impairment of the ability of the heart’s arteries to expand and constrict to meet the heart’s blood supply needs, and second, the formation of arterial blood clots. In his opinion, a dangerous event occurs when a blood clot forms and acutely blocks the artery. If there is a tear in this wall, the blood hits the plaque contents and resembles an injury. “This can cause blood to clot in a heart artery, potentially resulting in a heart attack.”

According to Prof. Pereg, it is one of the holy grails of cardiology. “It is closely related to blood pressure, blood flow and heart rate. Therefore, intense physical activity is generally very healthy and is also related to other parameters, including mood. We know that when we are angry or excited, blood pressure goes up.” So heart attacks have one of the most intuitive connections between states of anger and agitation and heart problems.” So does rest help prevent heart attacks?

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Dr. Eitan says: “That’s the million dollar question. Interventions have never been proven to reduce risk, but it is very logical. In general, negative emotions are directly related to rapid heart rate, high blood pressure and high cortisol secretion due to stress. Stress is associated with an increased risk of atherosclerotic processes. It is important to remember that stress is also linked to other diseases such as diabetes, cancer, etc. Therefore, it is advisable to reduce stress of all kinds. The way to reduce stress is different for each patient.”

“The workload can be reduced, hobbies can be encouraged and vacation can be taken. Physical activity and yoga are also associated with stress relief, and in some cases there is room for psychological treatment as well. If there is a message emerging from the topic, it is above all: try not to take things to heart in a figurative sense.

Prof Pereg adds: “Western lifestyles are full of pressure. We work long hours and constantly try to move forward by maximizing our potential and time. Our bodies are not designed to work in such conditions. This needs to be taken into account. “The most basic aspects of a healthy lifestyle, physical activity and diet are interconnected and impact each other on our mental and physical health. Stress negatively impacts heart health.”