You really can die of a broken heart – however healthy you are
22:45 GMT, 13 August 2012
Last Tuesday Marcus Ringrose was sitting at his desk responding to letters of condolence about the death of his wife, when he suffered a fatal heart attack.
Just 12 days earlier the Doctor Who actress Mary Tamm, his beloved wife of 34 years, had died after a lengthy battle with cancer.
It seems the heartbreak of losing her proved too great, said Ms Tamm’s agent: ‘He adored her. If you can die of a broken heart, then that’s what he died of — his heart just gave out.’
Grief: Marcus Ringrose died 12 days after his wife, Dr Who actress Mary Tamm. They had been married for 34 years
Doctors have long known the stress of a bereavement can trigger heart problems — studies have shown the risk of heart attack rises ten-fold in the 48 hours following the death of a loved one.
It’s previously been assumed that the patient already has an unhealthy heart as a result of bad diet or clogged arteries.
But scientists now say that a bereavement can trigger a specific type of heart attack very different from these ‘unhealthy’ heart attacks.
In ‘broken heart syndrome’, as they call it, the bottom of the heart suddenly balloons, leaving it unable to pump blood around the body.
The lack of oxygenated blood reaching the rest of the body — and indeed the heart — causes breathlessness, pain and a loss of consciousness.
The patient can die as a result of cardiac arrest, causing the brain and body to be starved of oxygen.
What’s so alarming is that it can happen to an otherwise perfectly healthy heart.
And it’s not just bereavement that prompts it — experts believe the reaction can be triggered by any stressful experience or shock, such as divorce, an operation, even winning the lottery.
In fact, the range of possible triggers is so great, and the condition so recently recognised, that medics believe the number of cases they are identifying (around 3,000 a year in the UK) is just ‘the tip of the iceberg’.
The underlying cause is thought to be an overload of the ‘fight-or-flight’ hormone adrenaline, explains Dr Alexander Lyon, a cardiologist at Royal Brompton Hospital, London, who recently published a study on the condition in the journal Circulation.
‘Adrenaline and other hormones are good at low and medium doses because they cause the heart to pump harder and faster — you need this in many situations, such as when you’re doing exercise.
‘But in some people very high rates of adrenaline have a toxic effect on the heart. And this surge in adrenaline can come from a number of events.
'Bereavement is a classic stressor — but I’ve seen people who developed the condition after being bullied by their boss, or separating from their partner.
'There was a surge in cases after the New Zealand earthquake.’
In 'broken heart syndrome', the bottom of the heart suddenly balloons, leaving it unable to pump blood around the body
But the stress doesn’t need to be negative.
‘One patient developed it at a surprise party — the lights went on, the poppers went off and the patient collapsed in a heap.
'In another case, someone experienced it when they won the lottery,’ says Dr Lyon, who is also a researcher at Imperial College London.
The condition can be triggered by periods of severe stress as well as sudden shock. It causes the left ventricle — the lower chamber of the heart that sends blood to the rest of the body — to stop pumping.
As a result, top chambers of the heart squeeze and contract, so the heart appears narrow at the top and wide at the bottom, like a balloon.
The heart races shortly before it stops pumping, triggering a thumping heartbeat or palpitations.
The lack of oxygenated blood reaching the rest of the body leads to breathlessness, pain in the chest and dizziness.
In extreme cases this can be fatal — but, surprisingly, most people recover in weeks without any long-lasting effects.
Beta-blockers are sometimes prescribed as these help protect the heart against the effects of adrenaline.
‘The heart returns to its normal shape very quickly; it’s almost as if it is stunned but not dead.
'We’ve only been able to identify this condition in the past five or ten years due to the introduction of imaging technologies,’ adds Dr Lyon.
Most hospitals can now examine the arteries of a suspected heart attack patient very soon after they’re admitted into A&E with an angiogram — where a thin tube is inserted into the blood vessels to check if these are blocked.
But if the blood vessels are clear, as they frequently are with broken heart syndrome, an MRI scan or an ultrasound scan of the heart will reveal the classic balloon shape.
‘Patients didn’t used to receive an angiogram until maybe a week after their heart attack, and by then the heart looked normal, so the condition was diagnosed as a straightforward heart attack,’ says Dr Lyon.
Many patients could have ended up unnecessarily on statins or blood thinners (low-dose aspirin) to prevent further heart attacks.
Around one in ten patients with broken heart syndrome may have further episodes, but misdiagnosis could have meant they were not followed up and given appropriate advice and medication,
An estimated one in ten heart attacks in the UK is unexplained — not caused by blocked arteries — and Dr Lyon believes that broken heart syndrome could account for a significant number of these.
Richard Bogle, a cardiologist at St George’s Hospital, South London, warns some people could have suffered broken heart syndrome without realising.
‘There may well be people who have some kind of emotional stress and don’t feel particularly well afterwards, but don’t seek help.
'And unless you have an angiogram and ultrasound or MRI it won’t be detected.
‘So if people go to their GP, by the time they have an appointment with a cardiologist their heart is back to normal.
'Plus most non-cardiologists, like GPs, haven’t heard of this condition.’
Intriguingly, around 90 per cent people who survive are post-menopausal women.
But this doesn’t mean men aren’t affected, say experts — it could mean they are more likely to be killed by the syndrome.
This may be because the female hormone oestrogen has a protective effect on the heart, says Dr Lyon.
Its levels drop after the menopause — but post-menopausal women have enough to protect them from sudden death.
Dr Lyon adds: ‘We’ve seen in animal experiments that when we subject the heart to high doses of adrenaline, female hearts tend to cope.
'We need more studies before we can say the same is happening in humans.’
Scientists are unclear why this condition affects some people and not others, though genetics may play a role.
Professor Abhiram Prasad, cardiologist at the Mayo Clinic in the U.S. recently identified a mother and daughter affected by the condition.
He warns we have still to fully appreciate the total numbers affected.
‘We are seeing the tip of the iceberg,’ he adds.
‘Many with severe cases may die before they reach hospital. Physical stress can trigger it, too — such as major surgery or another major illness.’
Research published last month in the Archives of Internal Medicine found that the risk of heart attack in the over-80s rises in the six weeks following hip and knee surgery.
Risk was raised 25 times after hip replacement, and 31 times for knee replacement, which the Dutch researchers attributed to stress.
For sufferers of the syndrome, the experience is terrifying. Dympna MacNeely, a grandmother-of-five from Croydon, South London, had been under ‘a lot of stress’ when she had her heart attack in October 2008.
‘A good friend of 25 years had died very suddenly around 12 months before, and my brother-in-law was dying with cancer,’ says Dympna, 70.
‘And my daughter had just emigrated to Italy along with my grandchildren.’
Dympna collapsed at the office where she was a cleaner.
‘I don’t remember collapsing, just waking up at hospital,’ she says.
‘My work had called my husband James and he travelled with me in the ambulance. My heart had stopped on the way to the hospital and the paramedic had to re-start it.’
An angiogram revealed her arteries were healthy, but the MRI showed her heart had ballooned.
‘When they told me that it could have been stress-related it made sense to me. I never talk to anyone when I’m upset,’ she says.
Dympna was out of hospital after a week, and another scan a week later showed that her heart had returned to normal. But the illness took a huge psychological toll.
‘The doctors told me that it probably wouldn’t happen again, but still you carry that fear,’ she says.
‘In the days after I returned home I kept getting very breathless.
'Then after around a month, my heart started racing. My GP told me I was having a panic attack, and prescribed valium.’
Doctors say we urgently need to try to identify who is at risk.
In response to campaigning from Dr Lyon, from next year broken heart syndrome will be introduced into the national heart attack audit, where every attack requiring hospital admission is recorded.
There will now be a separate category for the condition.
Doctors hope that this, together with new research, will help identify those most at risk, and lower the number of Britons who are dying of a broken heart.