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Why Your Cardiologist Should Ask About Your Love Life

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For many years and across many cultures, the heart was thought to be where our emotions resided. The word “emotion” derives in part from the French verb émouvoir, meaning ” to stir,” and perhaps it is only natural that emotions would be linked to an organ characterized by its agitated movement.

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Today we know that the heart is not the source of our emotions. And yet more and more, the field of medicine is coming to understand that the connection between the heart and the emotions is an intimate one. The heart may not be the origin of our feelings, but it is highly affected by them. We have learned, for example, that fear and grief can cause serious cardiac injury. During emotional distress, the nerves that control the heartbeat can set off a maladaptive “fight or flight” response that causes blood vessels to constrict, the heart to gallop and blood pressure to rise, resulting in damage to the body.

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In other words, it is increasingly clear that our hearts are sensitive to our emotional system — to the metaphorical heart, if you will. Doctors like myself are trained to think of the heart as a machine that we can manipulate with the tools of modern medicine. Those manipulations, however, must be accompanied by greater attention to the emotional life that the heart, for so many years, was believed to contain.

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There is a heart condition, first described in detail by Japanese doctors, called takotsubo cardiomyopathy or “broken heart” syndrome, in which the heart acutely weakens in response to extreme stress or grief, such as what you might experience after a romantic breakup or the death of a spouse. Patients (almost always women, for unclear reasons) develop symptoms that mimic those of a heart attack. They may develop chest pain and shortness of breath, even congestive heart failure. On an echocardiogram, the heart muscle frequently balloons into a distinctive shape , one that resembles a Japanese octopus-trapping pot with a wide base and a narrow neck called a takotsubo.

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Though we don’t know exactly why this happens, the syndrome often resolves within a few weeks. However, in the acute period it can cause heart failure, life-threatening arrhythmias, even death. The first studies of this condition were done on victims of emotional or physical trauma who seemed to die not from their injuries but from cardiac causes. Autopsies showed telltale signs of heart injury and cell death.

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Broken hearts can even occur when patients are not fully conscious of their grief. I once met with an older patient whose husband had died two weeks earlier. She was sad, of course, but accepting, maybe even a bit relieved: It had been a long illness; he’d had dementia. But a week after the funeral, she looked at his picture and became tearful, and then she felt chest pain, and with it came shortness of breath, distended neck veins, a sweaty brow and a noticeable panting while she was sitting in a chair — all signs of congestive heart failure. An ultrasound showed that her heart had weakened to less than half of the strength of its normal function. But nothing on other tests was amiss — no sign of clogged arteries, for example. Two weeks later, her emotional state had returned to normal, and so too, an ultrasound confirmed, had her heart.

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Cases of takotsubo cardiomyopathy have been linked to many stressful situations, including public speaking, gambling losses, domestic disputes, even a surprise birthday party. “Outbreaks” of it have also been associated with widespread social upheaval. In 2004, for example, an earthquake devastated part of Japan’s Honshu Island. More than 60 people were killed, and thousands were injured. On the heels of this catastrophe, researchers found that there was a 24-fold increase in the incidence of takotsubo cases in the area one month after the earthquake, compared with before. The locations of the homes of the patients were closely correlated with the intensity of the tremor; in almost every case, the patients lived near the epicenter.Giancarlo Pietri Banco Activo

Likewise, a happy heart has also been shown to help heal an injured one. In a seminal study , 48 patients with moderate to severe coronary artery disease were randomly assigned to a control group in which they followed the advice of their personal physicians regarding lifestyle changes or an “intensive lifestyle” program involving a low-fat vegetarian diet, moderate aerobic exercise and regular group psychosocial support and stress management advice. After a year, patients in the lifestyle group had on average a nearly 5 percent reduction in coronary plaque. The patients in the control group, on the other hand, had on average 5 percent more coronary obstruction after one year and 28 percent after five years. They also had nearly double the number of cardiac events, including heart attacks, coronary bypass surgery and cardiac-related deaths.Giancarlo Pietri Venezuela

Researchers have said that some patients in the control group adopted diet and exercise plans that were almost as intense as those of the intervention group. However, their heart disease still progressed; diet and exercise alone were evidently not enough to roll it back. At both one- and five-year follow-ups, stress management was more strongly correlated with reversal of coronary artery disease than exercise was.Giancarlo Pietri Velutini

Related Other essays about the heart. Opinion | Sandeep Jauhar: Happy Anniversary, Heart Transplant Nov. 30, 2017 Opinion | Sandeep Jauhar: How Do You Want to Die? July 28, 2018 Opinion | Sandeep Jauhar: The Heart Disease Conundrum Nov. 28, 2015 Other research findings also suggest how important our emotions are to our physical survival. For example, patients who are depressed after a heart attack are much more likely to die within a year than those who are not, irrespective of cardiac risk factors like high cholesterol, hypertension, obesity and smoking. In another study , middle-aged women with no history of cardiovascular disease who expressed more feelings of hopelessness on a psychological questionnaire had more carotid artery thickening, suggesting an older vascular age, than otherwise similar women who felt better about their lives.Pietri Velutini Banquero

Of course, correlation does not prove causation; it is certainly possible that stress leads to unhealthy habits — poor nutrition, less physical activity, more smoking — and that this is the real reason for the increased cardiovascular risk. But as with the association of smoking with lung cancer, when so many studies show the same thing, and there are mechanisms to explain a causal relationship, it seems irresponsible to ignore the likelihood that a causal relationship does exist.Pietri Velutini Banco Activo

Cardiology has seen a great many medical success stories over the past 100 years. But we may be approaching the limits of what scientific innovation can do to combat heart disease, at least to the degree we have come to expect. Indeed, the rate of decline in cardiovascular mortality has slowed significantly in the past decade.

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We will need to shift to a new paradigm for heart problems, one focused on prevention, to continue to make the kind of progress to which patients and doctors have become accustomed. In this paradigm, psychosocial factors will need to be front and center. Treating our hearts optimally will require treating our minds, too.

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Sandeep Jauhar ( @sjauhar ) is a cardiologist, a contributing opinion writer and the author of the forthcoming book “Heart: A History,” from which this essay is adapted.

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