Heartbreak is a common expression in fiction. In the real world, it is called takotsubo syndrome.
In the Star Wars universe, Padme Amidala may have died of a broken heart after her husband turned to the dark side of the force, becoming
Darth Vader, and she gave birth to Luke and Leia. Shakespeare's King Lear dies of a broken heart after learning of the death of his precious Cordelia.
Perhaps it's just a gimmick in dramaturgy, or perhaps these characters are victims of takotsubo syndrome, a short, intense dysfunction of the left ventricle of the heart. It can occur after severe emotional or physical stress, making "heartache" both real and potentially deadly.
According to Trisha Singh, a cardiologist at the University Hospital of Dorset in Dorset, England, death from "heartbreak" has long been a popular topic in fiction, but it wasn't until the 1960s that doctors began to document actual cases. "It was usually described as an elderly or middle-aged woman who had just lost a loved one, and a day or so afterward she died of a broken heart," Singh says.
As imaging technology improved, doctors were able to directly study the hearts of sick patients. In many of them, the left ventricle - the chamber that pumps oxygenated blood to the body - is swollen. This shape reminded Japanese doctors of a takotsubo, a round lobster and octopus trap. In 1990, cardiologist Hikaru Sato and his colleagues at Hiroshima City Hospital proposed the term "takotsubo" to describe this condition.
What causes it is still a mystery. According to one hypothesis, an acute traumatic event causes a surge of
stress hormones, such as norepinephrine in the brain and epinephrine in the adrenal glands. Because the left ventricle of the heart is particularly rich in receptors for these chemicals, a sudden increase in fluid levels can cause the firm and elastic muscle to become loose and puffy, making it unable to deliver enough blood to the body.
Another hypothesis is that the stress response temporarily "stuns" the heart. Since most cases are seen in postmenopausal women, it is possible that decreased estrogen levels also play a role.
Takotsubo syndrome is relatively rare - only about 2 percent of people who seek medical attention for an apparent heart attack.
Cardiologist Peter Rahko of the University of Wisconsin-Madison recalls a case from the 1980s. An elderly woman was called to a hospital in rural Wisconsin and shown the body of her son, who had died in a car accident. "About five minutes later, she started having severe chest pains and collapsed to the floor," Rahko says.
The woman was airlifted to Madison, where Rahko inserted a catheter into her heart to see if a blockage in the heart muscle had caused a heart attack. To his surprise, "herher arteries were perfectly fine, but her cardiac function was dramatically reduced." In Takotsubo syndrome, the vessels of the heart are often clear. Moreover, most patients have no classic risk factors for heart problems.
In retrospect, Rahko now realizes that his patient had Takotsubo syndrome. Today, decreased heart function without obvious signs of disease is a red flag. The doctor will look for acute stress, such as a recent bereavement.
In some cases, the tragic event is obvious. But even events with longer-term effects, such as the
COVID-19 pandemic or the New Zealand earthquakes, have been documented as turning points. Many patients, Singh notes, suffer from mental illnesses such as anxiety or depression.
Despite its severity, takotsubo comes on very quickly and is usually not fatal. About 4 percent of patients die, and about 75 percent fully recover in 10 days, as happened with Rahko's patient. Many recover in just 48 to 72 hours. "It's absolutely incredible," Singh says. "I remember a woman who was admitted to us who had severely impaired left ventricular function, and six hours later I went back and re-scanned her and it had changed from severely impaired to mildly impaired to almost normal."
Standard medical care is to treat heart failure. "But now, recently, especially when we see some people recovering so quickly, it begs the question," Rako says. "Should we even try to move people onto medications? Would there be any benefit from them? It's possible that when a patient is given basic medical care, the heart may rupture on its own."
Knowing that takotsubo syndrome still happens today, Rahko says it wouldn't surprise him if some deaths from "grief" in history were takotsubo. "When people had nothing but faith, it was reasonable to think that 'some god struck someone for some transgression and they dropped dead,'" he says. Now, however, "there is one potential physiological explanation."