Heart, a Mind of Its Own

shutterstock_119xThe renowned American writer, John Gregory Dunne died in 2003 of a sudden heart attack minutes after he and his wife, Joan Didion visited their dying daughter in the ICU.

In her best-selling memoir following his death, The Year of Magical Thinking, Didion says, “research to date has shown that, like many other stressors, grief frequently leads to changes in the endocrine, immune, autonomic nervous, and cardiovascular systems.”

When someone feels intense emotions, the body’s stress response kicks in. “Broken-heart syndrome” is a cardiac disorder with psychogenic dimensions that mimics a heart attack. But in this condition, unlike the typical heart attack, the coronary arteries are open.

Some people may respond to sudden, overwhelming emotional stress by releasing large amounts of adrenaline, cortisol and other potent chemicals into the blood stream, causing a rapid heart rate, trembling and sweating.

These chemicals can be toxic to the heart, especially to post-menopausal women who lack protective hormones, effectively stunning the heart muscle and producing a sudden heart attack or heart failure. “Broken-heart syndrome” is fatal in some individuals and results in life-threatening complications in others.

Negative emotional states are a greater cardiac risk factor than second-hand smoke.

Overlaying Factors of Grief

Anyone who experiences intense grief after losing a loved one may wonder whether they will survive.

A recent study from the University of St. Andrews shows that the risk of dying suddenly from a cardiac arrest is 16 times higher the day after losing a spouse.

“Overlaying factors such as dementia can exacerbate despondence, melancholy and hopelessness. Other variables that can intensify grief include preexisting family dynamics; financial stress; age and even gender differences,” Rabbi Brad Bloom of Congregation Beth Yam said.

“What I see over and over again in the 80 or 90 year-old generation is that men have a harder time coping with the death of a spouse. They compare it to losing an appendage.”

Prevalent “ageism” in the U.S. may also worsen grief in older men. They may see themselves as a burden and a drain on resources, rather than a resource for their family members and the community.

“In my many experiences, after the death of a spouse older women get depressed. Men get lost. Women often thrive off friendships and social networks to carry on. They are resourceful. Older men have a harder time living alone.“

Scared to Death

Can someone be frightened to death? Absolutely. A Charlotte, N.C., man was charged with first-degree murder of a 79-year-old woman whom police said he scared to death while fleeing from a bank robbery.

Several prominent studies and examples suggest powerful emotions like fear, guilt or shame may also trigger cardiovascular events during the anticipation or preparation of a stressful event.

Terror is another powerful emotion. For about seven days after the 9/11 terrorists attacks, many New Yorkers experienced life-threatening heart arrhythmias and sudden cardiac deaths.

Kenneth Lay, the Enron founder convicted of fraud and conspiracy, faced the possibility of spending the rest of his life in prison but died of a heart attack days before his sentencing. The Enron crisis came to symbolize the corporate excess and greed of the 1990’s.

Sixty-four year old Slobodan Milosevic, the former Yugoslavian leader accused of war crimes, suffered a sudden heart attack before the expected conclusion of his trial.

Voodoo death—a hex so powerful that the victim of the curse can die of fright—is one of the most extreme examples. Autopsies on patients who suffered the voodoo effect were found to have myofibrillar heart degeneration, a massive overdose of stress hormones triggering a cascade of biochemical events, proving fatal.

Intense emotions caused by sports events like the Super Bowl or World Cup can also lead to sudden death. Eleven soccer fans died of cardiac arrest in China during the 2006 World Cup. Chinese officials named the incidents “World Cup Syndrome.” Even the extreme emotional stress of a wedding can kill.

National Institutes of Health (NIH) studies estimate that 40 percent of sudden deaths involve intense emotions, citing, for example, people who died while experiencing sexual intercourse or the golfer who hit a hole in one, turned to his partner and said, “I can die now,” and then dropped dead.

Physical Dimensions of the Heart

Associations between emotional states and difficulties with the heart are well documented, according to eminent scholar and world-renowned cardiologist, Carl Pepine, M.D. who recently spoke to Monthly.

The heart and brain communicate on a biochemical level, continuously signaling each other. But to a certain degree, the heart has a mind of its own.

The heart has a unique nervous system with neurons (brain cells) and neurotransmitters. Unlike other muscles that rely on nerve connections to the brain to receive the electrical stimulation they need to function, the heart has its own electrical stimulator—the sinus node. The sinus node generates electrical impulses that synchronize heart rate and pump blood independent of the brain.

Most sudden cardiac deaths occur when electrical impulses become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating, blocking blood flow to the body.

“During periods of emotional stress, it is more common for women than men to experience ischemia or reduced blood flow to the heart that can lead to a heart attack,” said Dr. Pepine who specializes in researching and treating the female heart. He cited several NIH studies and a personal example when his young grandmother, the mother of seven children, died of a heart attack seconds after learning of her husband’s death.

When it comes to cardiac risk factors, most people know about the importance of smoking cessation, nutrition and exercise. More often than not, human beings underestimate the role emotional stress plays in their susceptibility to sudden death.

By Kim Kachmann-Geltz