How Do You Mend a Broken Heart? Learn About Takotsubo Cardiomyopathy

Can a broken heart be mended? Perhaps if we are talking about takotsubo cardiomyopathy - also called broken heart syndrome - which is stress-induced damage to the heart muscle. Ninety percent of the people with this heart syndrome are post-menopausal women whose symptoms occur after severe emotional or physical stress. Learn about it in this episode: https://bit.ly/4g9Ma8x

In this Episode:
03:04 - Obituaries My My Mother Wrote for Me When I was In My 20's
07:21 - Feeding a Broken Heart:  Chicken Tetrazzini
09:15 - Takotsubo Cardiomyopathy (TTS) -You Really Can Die from a Broken Heart
24:22 - Epitaph by Merrit Maloy
25:41 - Outro

Related Content:

• S4E18: How to Exorcise Depression and Anxiety with Exercise
• S3E37: What Can a Mindfulness Practice Offer You?
• The Tao of Ironing
• S1E23: Support Groups
• S2E16: Big Girls Do Cry
• S3E22: Why Do We Fear Death?
• S1E07: No Mud, No Lotus – What is the New Normal?

Chapters

• 0:00 Intro
• 3:04 Obituaries My My Mother Wrote for Me When I was In My 20’s
• 7:21 Feeding a Broken Heart: Chicken Tetrazzini
• 9:15 Takotsubo Cardiomyopathy (TTS): You Really Can Die from a Broken Heart
• 24:22 Epitaph by Merrit Maloy
• 25:41 Outro

Transcript

How Do You Mend a Broken Heart, Learn About Takotsubo Cardiomyopathy

This podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording. Hello and welcome to Everyone Dies, a podcast where we talk about serious illness, dying, death, and bereavement.

I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlene Everett, an actor in New York City, and here to offer an every-person viewpoint to our podcast. We are both here because we believe that the more you know, the better prepared you will be to make difficult decisions.

Welcome to this week's show. Please relax, get yourself some sweet tea and cake, and thank you for spending the next hour with Charlie and me as we talk about how people can die from a broken heart. Like the BBC, we see our shows offering entertainment, enlightenment, education, and divide that into three halves to address each of these goals.

Our main topic is in the second half, so feel free to fast forward to that drivel-free zone. In the first half, Charlie has obituaries that a mother wrote for her daughter when her daughter moved to San Francisco. I think I could be good friends with this mom.

In the second half, I'm going to talk about broken heart syndrome. And in our third half, Charlie presents the poem Epitaph by Merritt Malloy. So, Charlie, what's new in the big New York City? You know, everything old is new again this year.

New York will be officially 400 years old. Wow. I know.

Are they having a party? It's New York, baby. We always party. Even the rats will be celebrating with us.

So, I don't see any, you know, official – anything officially scheduled. But, yeah, people just say, you know, the city now is 400 years old. You know, it began at the very bottom of Manhattan, where today it's – where Wall Street is today, it was called Wall Street because literally a wall was built from one end of the island to the other end of the island to keep out those pesky bears and, you know, the Native Americans who were here thousands of years before the Europeans arrived.

So, you know, we have that to look forward to. So, how about out there in Oklahoma? Well, we've been having monsoons, storms, tornadoes. Stormy weather.

Yeah. So, Marianne, in our first half from The New Yorker, obituaries my mother wrote for me while I was living in San Francisco in my 20s. It is with deep sorrow that we announce the passing of Bess Kalb, 24, of San Francisco, formerly of New York, the cause of death with botulism from a homemade strawberry rhubarb jam that was prepared by one of her housemates.

The housemate, Aviva something, holds a degree in, I kid you not, modern culture and media. She certainly had no formal training in sterile canning and preservation. If the kitchen in this co-op where the jam was prepared looks anything like it did six months ago, there is compost decaying right there on the counter next to the sink.

Bess is survived by her brother who once looked up to her. Next, we mourn the death of Bess Kalb, 25, beloved daughter and sister who passed away late yesterday while hiking in the middle of nowhere with no cell phone reception. A product of Manhattan, Bess had no awareness of wild animals.

So, when she inevitably encountered a bear slash coyote slash mountain lion, apparently no longer nocturnal due to the ambient city light, which she had known if she had read the article I sent her, she may as well have had a giant sign around her neck that said, dinner. It also could have been sunstroke that did her in. She had a fair complexion like her mother.

Next, the day we lay to rest our daughter Bess Kalb, 26, who was claimed Saturday morning by contact yoga. In an attempt to prove that she's some kind of free spirit, she decided it would be a good idea to do this thing where you balance your entire body on a stranger's hands and legs like a child. That Bess's brief puzzling life was cut short is a tragedy, though the far greater tragedy is that right before she snapped her neck, some kid with a tribal tattoo was staring down her shirt.

Our hearts are broken as we announce the demise of our daughter Bess Kalb, 27, who was taken from us by a Lyft driver and dismembered. Despite learning at the youngest possible age never to get into a strange man's car, Bess, ever the techno-optimist, decided to enter her home address into an app, hop into a Hyundai, and hope for the best. The family would like mourners to treat Bess's death as more or less a suicide.

Today, we say goodbye to Bess Kalb, beloved daughter, sister, and former reader of serious books. After years living in the Bay Area, her brain essentially atrophied beyond the point of return, forcing us to make the brave decision to let her slip away peacefully. Shortly before the end, Bess spoke with genuine enthusiasm about a TED Talk, a pat distillation of a zeitgeisty subject spewed by some billionaire narcissist in a headset, accompanied by inaccurate line graphs.

Weeks prior, she had used the word impactful in a sentence. In lieu of flowers, donations in her memory can be made to the Bess Kalb Fund for Adult Illiteracy. And lastly, Bess Kalb, 28, died immediately upon entering Burning Man with her new boyfriend, Travis, or Trevor.

There were no remains. I like that. I love these.

Having two daughters, I could write these myself. Yes, exactly. Moving on, ladies and gentlemen, our recipe for this week comes from a recipe series called Feeding a Broken Heart from Lindsay at Pinch of Yum.

She writes, In the days and weeks after our son Afton passed away, I found myself unable to eat. How do you eat when you have a broken heart? Your body practically forgets. My most emotional moments, I was often trying to swim through a deep abyss of heartbreak that taking even a few bites of food became miserable.

The anxiety, depression, and sadness of our situation made it nearly impossible to enjoy the one single thing that normally brings a body so much healing and joy, food. Folks, our recipe this week is Chicken Tetrazzini, which Lindsay describes as roast chicken, egg noodles, garlic mushrooms, and silky creamy sauce. Can't go wrong.

Make this to take to your next funeral lunch to begin to heal the broken hearts. Bon Appetit. And please go to our webpage for this week's recipe for Chicken Tetrazzini and additional resources for this program.

Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can. Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can continue to remain accessible to everyone.

You can also donate at www.everyonedies.org. That's every, the number one, dies.org. Or at our site on Patreon, www.patreon.com and search for Everyone Dies. Marianne. Thank you, Charlie.

Tacosupocardiomyopathy, which is also known as broken heart syndrome, stress-induced cardiomyopathy, and apical ballooning syndrome, is a cardiac syndrome, meaning heart, a heart syndrome, with 90% occurring in postmenopausal women after an acute episode of severe emotional or physical stress. Literature suggests a higher prevalence of anxiety and depression among patients with Tacosupocardiomyopathy, and the abbreviation for that is TTS. So I'm going to just call it TTS for the rest of this talk.

Dr. Akira Osato first described TTS in Japan in 1991. Tacotosubo is Japanese for an octopus trap, which has a similar shape to the enlarged ballooning of the left ventricle in patients with TTS. So you know me, a tiny bit of anatomy.

We have two upper chambers in our heart called atria, there's a left and a right, and two lower chambers called ventricles, also a left and a right. TTS occurs in the lower left chamber, the ventricle, which sends blood, and that's oxygenated blood, directly to the body. In TTS, the left ventricle balloons out, causing the heart to inefficiently pump the blood to the body.

The symptoms are like those of acute heart failure and include chest pain, difficulty breathing, dizziness, and weakness. You should consider this a medical emergency and go to the emergency room for evaluation and treatment. Diagnosis of the TTS has increased from 2% in 2006 to 8% following COVID-19 and is triggered by extreme physical or emotional stress.

While the exact reason this occurs is still under discussion, the main theory is that there is an excess of catecholamines released into the blood that causes spasms in the cardiac vessels. So catecholamines are nerve transmitters, things like dopamine, adrenaline, norepinephrine, produced by the brain, nerve tissues, and the adrenal glands. They play a vital role in what's called the body's fight or flight response, which prepares us to react to stress or to danger.

Another theory is that estrogen plays a role in setting off the TTS. So TTS is triggered, as I said, by extreme physical or emotional stress, and these can be happy or sad events. Emotional stressors can vary widely and include grief, like death or an accident of a loved one, receiving unexpected or bad news, like being diagnosed with a serious illness, fear, like armed robbery, public speaking, change in residence, anger, a fight with a partner, relationship discord, like a breakup or divorce, financial troubles, being laid off or demoted, and even being bullied.

Environmental stressors include significant earthquakes that have been associated with this condition. People are usually admitted for treatment, which focuses on treating the heart failure. They may be given oxygen and diuretics, you know, people call them, you know, the water pills, to help with the shortness of breath.

If it's severe, mechanical left ventricular support, such as a left ventricular assist device, you might have heard the term LVAD, may be used. The focus of treatment is preventing a stroke or heart attack, which can occur in about 7% of people with TTS. Some of the modifiable risk factors for TTS, and modifiable risk factors are things that are within our control.

Non-modifiable risk factors are things that we can't control, like our gender or our genetic history. So modifiable risk factors for TTS in the absence of any coronary artery disease include obesity, about 17%, smoking, 22%, and pre-existing medical conditions like high cholesterol, 54%, high blood pressure, diabetes. Other comorbidities include psychological disorders, about 24%, lung diseases, 15%, cancer, 10%, neurological diseases, about 7%, chronic kidney disease, 7%, and thyroid diseases, 6%.

The broken heart syndrome is mostly associated with negative emotions and their impacts. The significance of positive emotions in TTS is poorly defined. Positive emotions and excessive happiness are just as endocrinologically powerful as negative emotions.

These can alter the autonomic nervous system response, leading to altered heart rate, peripheral vascular resistance, and increasing the blood pressure. However, there are contradictory findings about the influence of good emotions on cardiovascular disease. Positive emotions have been linked to a lower risk of cardiovascular disease in the long run, although some data do suggest the contrary.

Positive emotions can trigger both the sympathetic and the parasympathetic nervous system. Interestingly, in a predisposed individual, the chances of having a cardiovascular event on one's birthday are 27% greater than on some other day, which can directly be attributed to the associated positive stress. So be careful on your birthday.

Various cases have been reported of TTS after some joyful or socially acceptable fun moment highlighting that cardiomyopathy is stress-induced, whether that be positive or negative, and associating it with only negative emotions may be an oversimplification. One systematic analysis compared the broken heart syndrome and happy heart syndrome and concluded that the baseline characteristics and clinical findings, such as chest pain and shortness of breath, were similar between the two syndromes, regardless of the nature of the triggering event. Happy heart syndrome makes up only about 1% of all TTS cases, implying that the happy events may require more intense stimuli than negative emotions to cause a significant emotional reaction to bring on TTS.

For a long time, TTS was thought to be a non-life-threatening condition. However, recent research has shown that TTS is a potentially fatal illness with high morbidity and mortality during the acute phase, meaning when it first happens, and outcomes that are comparable to those of acute coronary syndrome. For many, their heart will heal, but about 10% will have future episodes.

Men are three times more likely to die or have permanent symptoms from TTS. Depending on the specific set of circumstances that bring TTS on, TTS can be anything from a mild inconvenience to a potentially lethal disease. Given that we still don't have a good understanding about why TTS happens, your best bet is to reduce the number of modifiable risk factors that you have.

Things like losing weight, not smoking, watching your cholesterol. Also, any continued chest pain could be due to a heart attack. Call 911 or your local emergency number if you have new or unexplained chest pain.

Also call if you have very rapid or irregular heartbeat or shortness of breath. Charlie, any questions? Oy vey. You know, that song from the Bee Gees, How Do You Mend a Broken Heart? Yeah, I mean, really, what you were saying, how do you mend a broken heart? I start, you know, Carrie Fisher, the actress who played Princess Leia, I don't know if you remember, but, you know, she was on a plane, started, had to be taken off the plane before it took off because she was just having horrible symptoms and she died.

It was a mixture of different things, but also, you know, she was taking too many, you know, pills. I don't remember exactly what, but, I mean, she died from that. Her mother, Debbie Reynolds, singing in the rain in a lot of great films, died a week later, maybe 10 days later.

I mean, just from that and, you know, her son said that, you know, mom did not want to live without Carrie. I know they were very close. And you'll also see that in real log marriages where one person will die and, you know, kids are planning two funerals within a week of each other.

And if that's broken heart or broken heart syndrome, you know, those are two different things, and I think, I wanted to do this topic because I think, you know, people aren't aware of it, and the numbers are going up, I think, because of awareness of it. You know, to that point, though, I mean, this has been your life's work for decades, so you are very aware of it, but I wonder, I mean, unconsciously, people just, I wonder if unconsciously people are just not aware of it. I mean, for example, you gave different examples, including, you know, I keep saying for example, including environmental, and that is just always in the background.

It's more and more in the, you know, people are very aware that, you know, in general, people are, you know, are dying from this, you know, the environment is changing. It is not in control of most people. This, you know, corporations, oil companies, plastics, all that stuff that we as just regular people cannot control, you know, it's just, I think it's coming more and more to the forefront, but I don't know, it just seems it's not, people are just not conscious of that.

Also, just specifically about America, you know, the job situation, AI is again coming to the forefront, and just unconsciously, I wonder if that's just putting stress on people, too, wondering, well, is my job going to go? You know, how am I going to make a living? You know, family size is decreasing, less and less people want to get married, and it's crazy, even not sure how to have a relationship, so it just seems that all of that is unconscious, and maybe people just not aware of all these different things just piling up on you. Right, and that's why you need to be aware of what the symptoms are, that it's potentially a lethal disease, and if you have those symptoms, don't ignore them, don't say, well, I'm just upset right now. Well, yeah, maybe you are just upset right now, but your heart also, your left ventricle could also be ballooning, and that's why you're not being able to breathe, and that's why you're having chest pain, so be aware that these are the symptoms, don't ignore them, go to the emergency room.

So is there something if people, and I understand in that situation, yeah, you need to, you know, you need medical assistance, but what's that thing about, you know, breathe in and breathe out, and it's just, if you start to feel that anxiety? Well, there's the mindfulness things that we've talked about, and David's done a lot of shows about that, and there's also being aware that this can happen, and if you have modifiable risk factors like obesity, smoking, high blood pressure, high cholesterol, diabetes, you know, if you have these diseases, that that puts you greater risk, and so if it's possible to lose weight, to quit smoking, to manage your diabetes better, do that, because that's going to decrease your risk for other things. Yep. In our third half, the poem Epitaph by Merrick Molloy, listeners who are fans of the series NCIS will remember this poem.

It was read by one of the characters. Epitaph. When I die, give what's left of me away to children and old me that wait to die, and if you need to cry, cry for your brother walking the street beside you, and when you need me, put your arms around anyone and give them what you need to give to me.

I want to leave you something, something better than words or sounds. Look for me in the people I've known or loved, and if you cannot give me away, at least let me live on in your eyes and not your mind. You can love me most by letting hands touch hands, by letting bodies touch bodies, and by letting go of children that need to be free.

Love doesn't die, people do, so when all that's left of me is love, give me away. And that's it for this week's episode, folks. Stay tuned for the continuing saga of Everyone Dies, and thank you for listening.

This is Charlie Navarette, and from the TV show Young Sheldon, if something's wrong with me, I don't want to know about it. If I'm going to die, I'd rather drop dead and leave looking good. And I'm Marian Matzo, and we'll see you next week.

Remember, every day is a gift. This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.