“Broken” heart syndrome: how emotions can affect physical health

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According to the World Health Organization, people with major depression or schizophrenia have a 40% to 60% greater chance of premature death than the general population.

Every anniversary of my grandmother’s death (she died 6 years ago), my mother repeats a phrase when I ask her how she is: “My heart hurts.” She says it without drama, without putting her hand on her chest. But I believe him. My heart also hurt when my grandmother died, when I argued with my best friend, and when the woman I liked told me that she wasn’t interested in me at all. Our hearts hurt after a breakup or a duel, a fight or a shock, and we feel that it hurts even when we know that it is not a heart attack or an arrhythmia. Are we inventing that pain?

“Our body works like a great communications center. We receive external stimuli that first reach our brain, are decoded and then generate a reaction,” says Carlos Sánchez, cardiologist at Compensar Salud. This connection between mind and heart, adds the doctor, surpasses poetic and philosophical readings. “It is a physical bond. Love, like heartbreak, sadness and grief, can be felt in the heart.” (Can see: PAHO warns of record dengue fever in Latin America)

My mother, however, has never gone to the doctor to treat the symptom of unfinished grief. I have also never made an appointment because of a breakup, nor have I been incapacitated because I felt one morning that I didn’t have the slightest will to live. It hurts, but not enough? “We are able to recognize physical pain if we can associate it with an organic explanation, that is, human beings, in general, are beings of meaning: if we have a cut on a finger, we can explain and associate pain with that cut. But, on the other hand, we are less aware that emotional pain also has correlates in the body,” says Diana María Agudelo, clinical psychologist and vice dean of Research at the Faculty of Social Sciences at the University of the Andes. It’s something like a lack of awareness.

Anger and stress can increase muscle tension and be the source of that intense and annoying back pain that won’t let you rest. Anxiety can cause digestive problems, such as constipation or diarrhea. Frustration can even increase the risk of heart disease, and sadness and grief can affect sleep and appetite. (Can see: They present an alternative health reform project)

“We associate pain with a fracture, a muscle contracture, a cut, or any of these signs of damage to the tissue, to the muscle, that we can see and touch. It is more difficult for us to think that it could be related to something mental,” explains Agudelo. In a country where depression is the second cause of disease burden, according to data from the Ministry of Health, and where there are more than 1.5 million people diagnosed with a mental health problem (and a large number, experts estimate, underdiagnosed), this “mute” suffering of the body can be a big problem.

Health is mental and it is physical

I ask Professor Agudelo at what moment we separate the mind from the body. In 1948, the World Health Organization (WHO) defined health as “a state of physical, social and mental well-being,” and not merely the absence of disease or infirmity. “The separation between one and the other occurs in contemporary times, based on the hyperspecialization of professions, which has led to health professionals from different areas focusing very specifically on one aspect of health and considering it even in the absence of correlation with other aspects,” she answers me.

So, the cardiologist focuses on the heart; the neurologist in the nervous system and neurological diseases; the dermatologist in the skin, hair and nails, and the psychiatrist in mental and emotional disorders. (Can see: Colombia dreams of producing medicines, but there is a long way to go)

Of course, that has had great advantages. José Bernstein, physician and professor in the department of orthopedic surgery at the University of Pennsylvania, pointed out in a article published in 2018 that undoubtedly surgeons and doctors who specialize in an organ or condition become more efficient, produce superior results and possibly help deepen the knowledge about that part of the body (and also tend to be better positioned in the market ).

But Bernstein also recognized some difficulties of this medical hyperspecialization, of which he himself was a part. “Specialists, like all of us, see the world through the prism of experience. As such, they can easily overlook or dismiss important findings,” he said. And he gave an example: imagine that your index toe hurts. Based on his experience, a neurosurgeon might think it is a problem in the cervical spine (cervical radiculopathy). But a hand surgeon could diagnose a problem with the median nerve. “Both would be relatively blind to the possibility that a metabolic abnormality, say, is the true cause.”

It’s something Bernstein called “availability bias”: focusing on the causes that are most common, based on one’s experience, and overlooking other real possibilities.

Even if specialists could free themselves from their cognitive limitations, the orthopedist continued, patients could still suffer as they move from one expert to another, searching for an explanation and solution to their ailment. “They go to the doctor with tremors, chronic fatigue, muscle and joint pain that never goes away, choking problems, tachycardia and even palpitations. When they are lucky, they take tests in all specialties and everything turns out well. Until someone, out there, in the midst of the patient’s frustration, occurs to mention that perhaps the problem is not just physical,” explains Guillermo Mendoza Vélez, psychiatrist and director of the Mental and Emotional Health center in Bogotá.

“It is the body expressing, screaming, if you will, some emotional problem through physical pain, one that sometimes not even the person themselves has made aware of and that specialists can overlook in their examinations,” says Vélez. Fragmenting mental health from physical health would make it impossible to understand why, according to the World Health Organization, people with major depression or schizophrenia are 40% to 60% more likely to die prematurely than the general population.

The WHO says that, in addition to suicide, this is due to physical health problems that are often not attended to in this population. “There is an unfounded idea that tends to underestimate the quality of physical symptoms when they have some emotional correlate. That is, when you can think that a pain or discomfort has an emotional origin, you tend to think that it is less relevant, that it is less important. It even gives many people the idea that it is invented or that it is not real,” explains Agudelo.

While this happens in doctors’ offices, science leaves evidence of the complete opposite. Major depressive disorder, panic disorder, and generalized anxiety disorder are associated with diabetes; anxiety and depression with asthma, mood disorders with arthritis, phobic anxiety with heart disease, disordered eating with obesity, and bipolar disorder and schizophrenia with cancer. (Can see: Who is responsible for the shortage of some medications in Colombia?)

There are dozens of studies that reiterate this, but one of the largest and most recent was published in 2020 in JAMA. There, researchers analyzed a population of 6.9 million people with and without mental disorders in Denmark, finding that those diagnosed with any mental disorder had a life expectancy between 11.2 years and 7.9 years shorter compared to the population. general.

It is not, then, something that only happens in the head. Or rather, precisely because it occurs in the head and mind, it occurs throughout the body. Feeling stress, for example, releases hormones such as cortisol that increase heart rate, blood pressure, and muscle tension. In some cases, the situation that triggers this can be so traumatic that it gives rise to something known as post-traumatic stress, which basically causes the brain to begin to function erratically.

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“We know that emotions are not generated, for example, in the heart, but they are part of all neurological functioning, so they impact the heart. When there is a breakup, for example, a situation of stress or deep emotional pain, hormones such as cortisol are released, which have receptors within the heart that could generate alterations in its function and even sensations of pain,” he says. Miguel Giraldo, cardiologist at the San Vicente Fundación hospital, in Medellín. Elevated by art and popular culture as the great symbol of love and passion, the heart’s bond with emotions goes far beyond mere poetic inspiration.

The pulse of the heart

The heart beats about 100,000 times a day, or 3.5 billion times throughout an average life. It pumps 5 liters of blood per minute, 2,000 gallons per day, at a force capable of generating enough pressure to shoot blood a distance of 10 meters. Over a lifetime, it generates enough energy to move a car at a speed of 32 km/h. “The heart is a small and impressive electrical pump that allows life,” says Giraldo. (Can see: AI could help in cancer prevention)

Surgeons did not dare to operate on it until the end of the 19th century and it was not until 1948 that the famous and historic Framingham Heart Study began, research that has been key to understanding cardiovascular risk factors, including high cholesterol, blood pressure, high blood pressure or smoking.

“But it was a mistake to leave out things like emotional dysfunction and marital health,” Sandeep Jauhar, a cardiologist who in 2018 wrote “Heart: A Story,” a book that traces the history of cardiovascular medicine. Over the past few decades there has been increasing evidence linking stress, anxiety or depression with a greater likelihood of suffering heart attacks. (Can see: Supersalud investigates three pharmaceutical managers for shortages)

In 1990, a group of Japanese doctors described what became known as “Takotsubo syndrome,” or simply, “broken heart syndrome.” Hikaru Sato and several other colleagues reported in an article published in the scientific journal “Kokyu to Junkan” the situation of several postmenopausal patients who experienced cardiac symptoms similar to a heart attack after a stressful event (in many of them it was the loss loss of a loved one), but who did not have significant blockages in their coronary arteries, the most common cause of a heart attack. Something then caught the doctors’ attention: the unusual appearance of the heart on the angiography images.

In them, the shape of the left ventricle (which is the largest and most powerful muscular chamber of the heart and whose main function is to pump oxygenated blood to the rest of the body) had swollen, taking on a shape similar to a popular octopus trap in Japan. called Takotsubo. “This affects the heart’s ability to pump blood, which triggers the feeling that we are facing a heart attack. This is a rare condition that is usually temporary: that is, after a while, the ventricle returns to its original size,” explains Giraldo. The problem, he adds, is that in Latin America and Colombia, Takotsubo syndrome is underdiagnosed.

The World Health Organization has considered it a medical condition since 2001, when a series of 88 cases was published, while the American Heart Association classified it in 2006 as a type of acquired cardiomyopathy. After more than three decades, however, knowledge of broken heart syndrome remains limited.

It is known, as Morales Hernández and his colleagues reviewed in a scientific article published in 2016 in the journal of the College of Internal Medicine of Mexico, that it commonly affects postmenopausal women and is associated with previous stressful, emotional or physical events. “This disease,” they wrote, “is a classic example of a complex, intertwined feedback loop involving psychological or physical stimuli within the brain that subsequently affect the cardiovascular system.”

It is neither magical nor, let’s say, difficult to explain: “Let’s not fragment the body into pieces. “I believe,” summarizes Agudelo, “that what we have to learn in this sense is to pay attention to the physical signals that our body wisely tells us.”