A love come to grief

Broken heart syndrome is medical recognition finally of what literature has always known, that anguish and sorrow can kill, says Sharon Ní Chonchuir

TALES of death from a broken heart feature throughout history. Irish mythology has Deirdre of the Sorrows, who died of grief following the loss of her lover Naoise, while modern celebrity has Simon Monjack, the husband of starlet Brittany Murphy, who died of a heart attack five months after her premature death.

The physical impact of thoughts and emotions on your heart was dismissed as sentimental nonsense but this view is changing. In the past decade, cardiac researchers have identified cases of severe emotional distress damaging the heart. They’ve given it a name — stress cardiomyopathy or broken heart syndrome.

Swedish doctor Yrsa Sverrisdottir has pushed the boundaries of our knowledge of this syndrome. She has published research explaining how hearts get broken; she hopes to understand how we can help them recover.

Her work was driven partly by her personal experience. Her body started to collapse following what she calls a “double crisis” in her life. “I couldn’t breathe properly,” she says. “I set off for work but couldn’t make headway because I was so weak. I rang some friends who came and picked me up, put me to bed and looked after me for a week.”

Because Dr Sverrisdottir works with the sympathetic nervous system, the part that controls the heart and blood pressure, she explored what was happening when people went through extreme emotional distress.

“I was interested because of what had happened to me,” she says. “Emotions are powerful, and in this syndrome they literally change the shape of your heart. Even though the heart usually recovers within days and goes back to its normal shape, the syndrome emphasises how powerful these emotions can be.”

Dr Sverrisdottir has been studying the phenomenon at Sahlgrenska Hospital in Gothenburg, and John Radcliffe Hospital in Oxford, for the past two years. Patients diagnosed with the syndrome are sent to her and she evaluates their nervous system. “You could say that I listen to the orders the brain is giving the heart and the blood vessels through the nerves,” she says.

When someone suffers emotional distress, the brain sends out waves of catecholamines, hormones released in response to stress. These cause the heart to beat so wildly that it can become paralysed or stunned. “Essentially, it’s a protective mechanism,” says Dr Sverrisdottir. “The heart is saying ‘please stop or you will kill me’.”

In this state, the heart is like a balloon gripped at the neck so that the rest bulges out below. It can stay like this for a few days, pumping slowly as it recovers. In some cases, it doesn’t recover and the patient dies.

Dr Sverrisdottir wants to understand why. She wants to identify the part of the brain that triggers the release of these hormones so that it can be disabled and people’s hearts can be prevented from breaking.

People like the grieving mother who presented with heart problems having lost her child to cot death after years of trying to have a baby. Or people whose jobs and lifestyles require them to confront distressing situations regularly.

Shane Kelly, a psychotherapist and professional services manager with The Irish Association for Counselling and Psychotherapy, is one such person. “The potential for therapists to be exposed to horrendous stories with a huge amount of emotional impact is always there,” says Kelly. “That’s why we need to know how to look after and protect ourselves.”

Kelly says that self-knowledge, regular discussions with his supervisor and time off are the best ways for him to deal with emotional distress.

“Nothing can prepare you for the stories you are going to hear,” he says. “You are going to be affected by them. But being aware of ourselves and our pasts can help us to understand what might trigger us in the future. Talking can be cathartic and taking proper time off to rest and relax — all of these things have helped me and my colleagues.”

Emergency personnel are exposed to as much trauma as therapists. “We see things most people will never see and we see them every day,” says John Kidd, national secretary for The Irish Fire and Emergency Services Association and a fireman in Dublin. “Seeing things like children dying is hard because we’re human beings too. We’re bound to suffer.” He has witnessed the impact such suffering has had on his colleagues. “I’ve seen family breakdown, depression and illness,” he says. “We pay a high price for our jobs.”

The situation is as dire in the ambulance service, says Tony Gregg, secretary for the National Ambulance Service Representative Association and a paramedic in Dublin for the past 20 years. “We’re exposed to war-time levels of carnage,” he says. “Road-traffic accidents and accidents involving children are particularly affecting and linger with you. People expect us to move in and move off, but you can’t just wash your hands of these things. They stay with you.”

A 2008 stress survey carried out by the department of psychology of the Royal College of Surgeons proves his point. “They surveyed 500 ambulance personnel out of a total of 1,100 people in the service and they found a 33% incidence of psychological trauma,” says Gregg. “That’s double what it is in the civilian population.”

Both the fire and ambulance services are campaigning for psychological counselling for their members to deal with the distress they witness. But what of those of us dealing with lower, but debilitating, levels of stress in our daily lives? What of those worried about losing jobs and paying the mortgage? Or those undergoing a separation or divorce? How can we protect our hearts? Considering that 34% of all deaths in Ireland are related to cardiovascular disease (or heart problems), these are vital questions.

The Irish Heart Foundation has some answers. They recognise the impact stress can have on the heart and have recommendations. Dr Angie Brown, of the Irish Heart Foundation, says “having friends and family to discuss problems with, having a healthy diet, sleeping and exercising regularly will help us all to deal with stress. Get exercising. Stop smoking. Cut down on the alcohol and sleep well and you’re on your way to coping with stress.”

Dr Sverrisdottir agrees. While she continues to work on the relationship between our emotions, our brains and our hearts, she advises taking steps to actively protect our hearts.

“We all know that being physically active helps strengthen the heart and mind,” she says. “But at times of emotional distress, the key to recovery is a good social network and the love of your family and friends who can support you when you need it most.”

* For more information, visit: www.irishheart.ie.

Manage your stress and maintain a healthy heart by:

* Making the most of your social circle. Keep in touch with friends and discuss your problems with them.

* Being more physically active every day. The endorphins produced by exercise mitigate stress.

* Eating more fruit and vegetables and less fat.

* Quitting smoking.

* Cutting back on alcohol.

* Checking your blood pressure and cholesterol regularly.

* Trying to accept what you cannot change.

* Doing only one thing at a time.

* Getting enough sleep.

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