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I don't know anyone who doesn't fall in love with Dr. John Elefterides upon meeting him.  The reason is, Dr. "E" is so darn humble, gracious, gentle and understanding, despite the enormous respect and world-wide reputation he has established for himself as a leading Cardiothoracic surgeon and author in the medical community. It is this as well as his "own"enormous heart that made him well-suited to write the following essay on "Broken Heart Syndrome."  I thank him for doing so and you will too, I assure you.  Ladies, you will soon learn that a "Broken Heart" may not only be in your "head" after all!

 

“Broken Hearts” are Real

 

            by John A. Elefteriades, MD

 

Maureen was fifty-five. She had just made it through menopause. She was married for thirty-two years to a pharmaceutical executive. Their three daughters were happily married and living in different parts of the world. Maureen herself held an important administrative position at a major Mid-western health clinic. She and her husband had had some differences over the years, but the duration of their experience and their common love of their children would always keep them together—or so she thought. She drove to her suburban home one night after work to find the doors barred, the locks changed, and an envelope taped to the front door.

 

The letter from her husband indicated that he had left her for his high school sweetheart and gone to the Bahamas. She should find another place to live, he said. Maureen wept on the doorstep for about an hour before driving to her best friend’s house. Her comfortable life had, in an instant, been rent asunder. She was on the highway when the pains came on. Her chest hurt so badly that she swerved towards oncoming traffic. She was barely able to regain control and bring the car to rest on the grassy median.

 

The next thing Maureen remembered was being wheeled into the cardiac catheterization suite. She could grasp only bits and pieces of what the doctors and nurses were telling her. She was having a heart attack, they said. Her echocardiogram (echo) showed that nearly half her heart, the part toward the apex, was not functioning. The nasty elevations on her EKG indicated that a heart attack was in progress. She needed an urgent cardiac catheterization to find out which artery was closed and to open it immediately.

 

As it turned out, her arteries were clean. She had no arteriosclerosis. There was no heart attack. She was merely suffering from a “broken heart”.

 

Maureen was, however, in cardiogenic shock, a serious, advanced state of heart failure in which the heart is unable to pump enough blood to maintain the blood pressure and provide adequate nutrient flow to the internal organs. *

 

Maureen’s case vignette is illustrative of one of many ways in which the woman’s heart is different from the man’s—more complicated, if you will.

 

Maureen’s story illustrates vividly the close link between a woman’s emotions and the physical functioning of her heart—a link that is much less powerful in men, in whom the “Broken Heart Syndrome” is quite rare.

 

This syndrome was discovered and named in Japan, acquiring the medical moniker “Tako-Tsubo” syndrome—named after the clay octopus-catching pots favored by Japanese fishermen. Why this name? Well, the pots have a narrow neck and a bulbous body. The octopus squirms in and then cannot get out. The fisherman cracks the pot with a hammer, and he has his valuable catch.

 

This “broken heart” syndrome is brought on by a sudden, intense, devastating loss—of a loved one, a marriage, a pet, a job, or a bank account, or some other bereavement of similarly devastating impact and intensity. The affected lower part of the heart just stops beating. Despite speculation, we honestly do not know the mechanism of this link between the emotions (the brain) and the pumping organ (the heart).

 

When recognized (and often it is not), the broken heart syndrome usually resolves in five to seven days, with strong medical and often mechanical (artificial heart pump) support.

 

Maureen, you will be pleased to know, recovered fully and continues well.

 

The broken heart is just one manifestation of the many ways the woman’s heart is so different from a man’s. Here are a few others:

 

• A woman often does not feel the typical mid-chest pain of a heart attack, which may have a much more subtle presentation.

• All cardiac procedures (including angioplasty and bypass surgery) are riskier in women, because of the small size and increased delicacy of the structures.

• The woman’s heart lives in a complex hormonal milieu, which changes constantly during the monthly cycle. Men are much simpler—and we know full well which is their single dominant hormone!

• Pregnancy puts a great strain on the woman’s heart. By the third trimester, the heart is called upon to pump over three times more blood than in a non-pregnant woman.

• The woman’s heart is considerably smaller (even accounting for body size) than a man’s. Why? Those fantastic woman’s curves are composed of fatty tissue, which does not need much blood flow.

 

So, not only is the adage true about women—smarter, stronger, and much better looking—but their hearts are considerably more complicated as well.

 

*******

 

(*Vignette excerpted from The Woman’s Heart: An Owner’s Guide. John A. Elefteriades, MD.)

 

Dr. Elefteriades is the William W. L. Glenn Endowed Professor of Surgery (Cardiothoracic) at Yale University and the Director of the Aortic Institute at Yale-New Haven Hospital. In addition to "The Woman’s Heart: An Owner’s Guide" (Prometheus), he has also authored Your Heart: An Owner’s Guide, The Inspirational Extraordinary Hearts (Penguin), and the medical mystery thriller Transplant (Penguin). You can find him on his author’s website at HeartAuthorMD.com.