Dy­ing of a bro­ken heart

Stress and de­spair can in­flu­ence health

Weekend Argus (Saturday Edition) - - LIFESTYLE - ANAHAD O’CON­NOR Heart: A His­tory,

A CEN­TURY ago, sci­en­tist Karl Pear­son was study­ing ceme­tery head­stones when he no­ticed some­thing pe­cu­liar: hus­bands and wives of­ten died within a year of one an­other.

Though not widely ap­pre­ci­ated at the time, stud­ies now show that stress and de­spair can sig­nif­i­cantly in­flu­ence health, es­pe­cially that of the heart.

One of the most strik­ing ex­am­ples is a con­di­tion known as Takot­subo car­diomy­opa­thy, or bro­ken-heart syn­drome, in which the death of a spouse, fi­nan­cial wor­ries or some other emo­tional event se­verely weak­ens the heart, caus­ing symp­toms that mimic a heart at­tack. This emo­tional bur­den trans­forms the heart into a shape that re­sem­bles a tra­di­tional Ja­panese pot called a Takot­subo, which has a nar­row neck and a wide bot­tom.

The link be­tween emo­tional health and heart health is the sub­ject of a new book, by Dr San­deep Jauhar.

Jauhar, a car­di­ol­o­gist, traces the his­tory of car­dio­vas­cu­lar medicine and ex­plores its re­mark­able tech­no­log­i­cal ad­vances, from open­heart surgery to the ar­ti­fi­cial heart. But while th­ese car­diac in­no­va­tions have been trans­for­ma­tive, Jauhar ar­gues that the field of car­di­ol­ogy needs to de­vote more at­ten­tion to the emo­tional fac­tors that can in­flu­ence heart dis­ease, like un­happy re­la­tion­ships, poverty, in­come in­equal­ity and work stress.

“I think the it­er­a­tive tech­no­log­i­cal ad­vances will con­tinue,” he said. “But the big fron­tier is go­ing to be in mar­shalling more re­sources to ad­dress the in­ter­sec­tion of the emo­tional heart and the bi­o­log­i­cal heart.”

Jauhar’s in­ter­est in this sub­ject stems from his fam­ily’s ma­lig­nant his­tory with heart dis­ease, which killed sev­eral of his rel­a­tives. As a young boy, he heard sto­ries about his pa­ter­nal grand­fa­ther, who died sud­denly at the age of 57 when a fright­en­ing en­counter with a black co­bra in In­dia caused him to have a heart at­tack. He be­came fas­ci­nated with the heart but also ter­ri­fied of it.

“I had this fear of the heart as the ex­e­cu­tioner of men in the prime of their lives,” he said.

Af­ter med­i­cal school, he did a car­di­ol­ogy fel­low­ship and be­came di­rec­tor of the heart fail­ure pro­gramme at Long Is­land Jewish Med­i­cal Cen­tre, as well as a con­tribut­ing opin­ion writer for The New York Times.

At 45, Jauhar had his own brush with heart dis­ease. A CT an­giogram re­vealed that he had block­ages in his coro­nary ar­ter­ies. As he re­viewed the ra­dio­graphic im­ages of his heart, Jauhar came to a star­tling re­al­i­sa­tion.

“Sit­ting numbly in that dark room,” he writes, “I felt as if I were get­ting a glimpse of how I was prob­a­bly go­ing to die.”

The heart is both a sim­ple bi­o­log­i­cal ma­chine and a vi­tal or­gan that many cul­tures have revered as the emo­tional seat of the soul.

It is a sym­bol of ro­mance, sad­ness, sin­cer­ity, fear and even courage, which comes from the Latin word for heart, “cor”. The heart, sim­ply put, is a pump that cir­cu­lates blood. But it is also an as­ton­ish­ing work­horse. It is the only or­gan that can move it­self, beat­ing 3 bil­lion times in the av­er­age per­son’s life­time, with the ca­pac­ity to empty a swim­ming pool in a week. This is why sur­geons did not dare to op­er­ate on it un­til the end of the 19th cen­tury, long af­ter other or­gans had been op­er­ated on, in­clud­ing the brain.

“You can’t su­ture some­thing that’s mov­ing, and you couldn’t cut it be­cause the pa­tient would bleed to death,” Jauhar said.

Heart dis­ease is still the lead­ing killer of Amer­i­can adults. But car­dio­vas­cu­lar medicine has grown by leaps and bounds: mor­tal­ity af­ter a heart at­tack has dropped ten­fold since the late 1950s. Yet the role that emo­tional health plays in the de­vel­op­ment of the dis­ease re­mains largely un­der­ap­pre­ci­ated, Jauhar says. He traces this to the land­mark Fram­ing­ham Heart Study, started in 1948, which fol­lowed thou­sands of Amer­i­cans and iden­ti­fied im­por­tant car­dio­vas­cu­lar risk fac­tors like choles­terol, blood pres­sure and smok­ing.

“What came out of it were the risk fac­tors that we now know and treat,” Jauhar said. “What was elim­i­nated were things like emo­tional dys­func­tion and mar­i­tal health.”

That, he says, was a mis­take.

In the decades since then, other stud­ies have shown that peo­ple who feel so­cially iso­lated or chron­i­cally stressed by work or re­la­tion­ships are more prone to heart at­tacks and strokes. Stud­ies on Ja­panese im­mi­grants to Amer­ica found that their heart dis­ease risk mul­ti­plies.

But those who re­tain their tra­di­tional Ja­panese cul­ture and strong so­cial bonds are pro­tected. Jauhar ar­gues that health au­thor­i­ties should list emo­tional stress as a key mod­i­fi­able risk fac­tor for heart dis­ease.

Ac­cord­ing to some stud­ies, doc­tors give their pa­tients about 11 sec­onds on av­er­age to ex­plain the rea­sons for their clin­i­cal visit be­fore in­ter­rupt­ing them.

Since writ­ing the book, Jauhar has a new­found ap­pre­ci­a­tion for let­ting pa­tients talk about the things that are both­er­ing them so he can bet­ter un­der­stand their emo­tional lives. He has also tried his hand at new habits to help re­duce stress, like yoga and med­i­ta­tion. He ex­er­cises daily now, spends more time with his chil­dren.

“I was prob­a­bly putting an in­or­di­nate amount of stress on my­self,” he said. “Now I think about how to live a lit­tle more health­fully, to live in a more re­laxed way. I have also bonded more with my pa­tients and their fears about their own hearts.”

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