In 2003, Rollin McCraty, the Director of Research at the Institute of HeartMath in Boulder Creek, California, published an e-book called The Energetic Heart: Bioelectromagnetic Interactions Within and Between People. In it he explains his research on an electromagnetic field created by the heart that he believes communicates with the brain and the body simultaneously, and affects those around us. In one study, McCraty monitored six longtime married couples’ heartbeats while they slept alongside each other. Both heartbeats fell into harmony, beating in sync. Electrocardiogram printouts of each person were laid on top of one another, revealing practically identical heartbeats and rates converging in nearly perfect synchronization—two hearts, as it were, beating as one.
If his observation sounds a bit too neat for mainstream science, it should. McCraty is a scientific entrepreneur. He inhabits the more respectable alternative edge of modern medicine and is something of a medical visionary. The HeartMath Institute where he works is a nonprofit charity whose main mission is to study the heart and teach people that health begins with the heart and to use this new understanding of the heart to solve many of the distressing—and still poorly treated—woes of modern life: stress, anxiety, worry, depression.
For nearly two decades McCraty has been studying the heart and its relation to the brain, and how it affects one’s experiences and consciousness. Over time he has discovered what he calls “coherence:” when we are feeling happy or sad, the heart beats out the message and an electromagnetic signal reaches the brain instantaneously. McCraty believes his research has revealed that the heart is a sensory organ, with its own nervous system, able to remember, sense, and feel by itself without the brain. “The flow of intuitive information is heart, brain, body,” says McCraty, “and then the body responds and one becomes consciously aware.”
McCraty also studies heart rate variability (HRV), a measurement of beat-to-beat changes in heart rate, also known as heart rhythm, and its relation to emotions. The heart’s rhythmic patter, McCraty explains, becomes erratic and chaotic when experiencing frustration, anxiety, or anger, while heart rhythms become harmonious and coherent when experiencing love or appreciation.
We often think that everything we process and understand begins with the brain, but McCraty’s study in 2004, seemed to show just the opposite. In the study, “Electrophysiological Evidence of Intuition: The Surprising Role of the Heart,” published in The Journal of Alternative and Complimentary Medicine 2004, participants were hooked up to various sensors monitoring heart and brain activity and their interaction with each other. Participants sat at a computer while an image would appear every few seconds, either a disturbing image (snake, car accident victim) or a “pleasant” image (flowers, sunsets). Although the participants were unaware whether a disturbing or pleasant image was to appear next, their hearts responded before an image was displayed, sending a message to the brain depending on what the future image was going to be.
From this McCraty tentatively concludes: “It appears as though the heart and brain have access to a field of information not bound by time and space.”
“Not bound by time and space”—might seem troubling, and although McCraty’s claims are fairly new, his research demonstrating the heart is the first organ to respond continues to slowly gain acceptance as more research is conducted.
What is more than certain is that, for many, it is the first organ to fail.
Heart disease is currently the leading cause of death, not only in the United States, but worldwide. Presently, the average life expectancy in the United States for both males and females is 78.1 years, ranking the U.S. 50th out of 223 nations. Although U.S. life expectancy has risen over the last decade, it has risen slowly compared to other nations, largely because of obesity and heart disease. In 2010, nearly 785, 000 Americans suffered from a coronary attack and an estimated 470, 000 Americans suffered a coronary attack for the second time.
But there is another kind of heart attack that victims and doctors only recently, have recognized. It comes from a broken heart. Which wouldn’t surprise Rollin McCraty at all.
Four pieces make up the puzzle of the heart. Two small chambers called atriums reside above two larger chambers called ventricles. De-oxygenated blood flows steadily through the right chambers into the blood vessels of the lungs where it becomes oxygenated and makes its way in rivulets through the left side of chambers. The left ventricle is the final chamber blood streams through before entering the aortic valve, where it is then passed into different parts of the body.
For this reason, it is the strongest and largest chamber in the heart because its undertaking is utterly crucial. As blood fills this chamber, it contracts, creating a powerful pressure that pumps the rich oxygenated blood through the aortic valve so it can be dispersed through the body. The heart performs this task tirelessly throughout our lives. At our joyous moments, when we are enchanted and overflowing with love, and during disheartening times, when perhaps we may not want it to, our hearts beat on.
But for some, a stressful happening, trauma, or heartrendingly bad news can exhaust their hearts enough to disrupt the left ventricle’s timely contraction, beat, and blood flow. For most, just enough to be sent to the hospital only to fully recover within days or a week. For others, just enough to kill them.
In 2005, Dorothy Lee and her husband, Dick Lee, were driving home from Bible study when they crashed into a curb. The crash was forceful. Dorothy looked over to her husband, saw his head move up and down, and then sink on his chest. After arriving at the hospital Dorothy was informed her husband died of a heart attack. On hearing the news, Dorothy got chest pains and eventually fell unconscious. Doctors performed an angiogram x-ray photo of her blood vessels and were certain she was suffering from a heart attack, as her husband did. But they saw no clot or clogged arteries in the x-ray. Only then did they realize she was suffering from a strange and, in some ways, very McCratian syndrome: tako-tsubo cardiomyopathy, TTC, or broken heart syndrome.
Physiologically the syndrome operates in a well-understood sequence. Under stressful experiences or trauma, surges of catecholamines get released from the adrenal glands into the blood stream. Also knows as “fight-or-flight” hormones, catecholamines increase heart rate and blood pressure, preparing the body to survive. Unfortunately, the release of these hormones can arrive in such an outpouring surge of adrenaline and norephrineprine that it becomes toxic, numbing the heart. In TTC, what happens next is unique: a catecholamine concentration above the left ventricle stuns the tissue, altering its normal contraction. Un-treated, Dorothy Lee would have died within hours, if not for a quick diagnosis and a pump to aid her left ventricle in its contraction for the first few days. Within a week, Dorothy was released from the hospital, her heart functioning on its own.
First discovered in Japan by Hikaru Soto in 1990, TTC is now recognized and diagnosed around the world, with more than 400 entries in the National Library of Medicine. The ballooning of the left ventricle into a bowl-like shape earned the syndrome’s name, tako-tsubo, Japanese for octopus trap. Normally, the ventricle contracts in the shape of a horseshoe, evenly, rhythmically, and steadily. In TTC, the heart weakens, as catecholamines stun the uppermost tip of the left ventricle, while the bottom spasms, causing the ballooning and round shape the chamber takes on.
TTC is often mistaken for acute coronary syndrome because of the similarity of symptoms: chest pain, shortness of breath, electrocardiographic (ECG) abnormality, and high levels of cardiac biomarkers. But doctors will find no coronary blockage, the more common cause for the left ventricle to dysfunction. The diagnostic question was, well, if it’s not a heart attack, then what is it? What caused this impairment of the left ventricle was unknown.
Before Hikaru Sato, known for naming the syndrome, there was cardiologist Kanji Iga, who in 1989 encountered the syndrome in a patient undergoing surgery to remove a tumor. His was the first case report of TTC, and Iga, like many doctors who would come after him, most likely took an angiogram expecting to see a clogged artery, only to find none. Iga knew it wasn’t a heart attack, and could do nothing but describe the syndrome, “left ventricle wall motion impairment” as a result of high catecholamine levels.
Two years later, Sato and his colleagues reviewed the cases of 415 acute myocardial infarction patients and came across 5 patients with symptoms typically associated with heart attack, including difficulty breathing and chest pain but upon further examination found no blockage of their coronary arteries, a signature of heart attack, Sato observed. In the patients the top of the left ventricle was unable to make muscular movement, while the bottom of the ventricle was contracting wildly, resulting in a dome-like shape of the left ventricle. Miraculously, within seven days, akinesis, (movement impairment) in the top portion of the ventricle disappeared and the spasm below resolved. The heart healed itself. The tako-tsubo shape has become the syndrome’s signature, what doctors look at to confirm the diagnosis.
Although the anatomy of TTC is no longer a mystery, the syndrome’s transiency certainly is. Within a few days or weeks, the left ventricle in most cases is back to normal, fully recovered and working, as if nothing happen.
Since the first recorded case in 1990, more and more people have been diagnosed with the condition. Whether this increase stems from awareness, from an aging—and thus more easily heartbroken—population, or better diagnostics, one thing is certain: the most vulnerable are post-menopausal women. Writing in a recent issue of the International Journal of Cardiology, Austrian physicians Claudia Stöllberger and Josef Finsterer hypothesize that men, over time, have become biologically fitter and better at dealing with a rush of catecholamines than females. Males have historically endured more physical stress than females in terms of labor. Over time, males possibly developed various biological techniques for dealing with stress and catecholamines, specifically epinephrine and norepinephrine. Male heart muscle contains more adrenergic receptors than women do, and so better prepared to handle long-term, chronically elevated catecholamine levels.
So why do more males die suddenly from cardiac arrest than females? Stöllberger and Finsterer suggest one answer: while males can handle more efficiently catecholamines over longer periods of time, their hearts have a lower breaking point than women, whose hearts seem better at fast self-repair. It’s possible males experience TTC but die immediately, before doctors recognize the left ventricle dysfunction and diagnose the syndrome. In which case, the cause of death is believed to be by heart attack, when it could be TTC. Both hypotheses remain speculative. No research has been done that support either.
There are exceptions nevertheless. In 2009, a two-year-old girl in Germany, after undergoing surgery, was diagnosed with the syndrome. In March of 2010, the Journal of Trauma reported TTC in an 81 year-old-man after suffering from severe burn injuries. The same year, the Anesthesiology Intensive Therapy Journal reported the case of a 57 year-old-man who after being resuscitated from cardiac arrest, experienced left ventricle ballooning and impairment. His diagnosis was TTC.
Hearts, often portrayed as delicate, are even more resilient. All around us we see heartache, broken-hearted people, and most of us know someone who has suffered from some type of heart failure. It’s easy to forget the strength of the heart, when so often we see the “broken” side in movies, in songs, in others’ lives, in our own.
Angela Strong saw it in herself when her best friend of fifteen years, Jennifer, died at her side of terminal cancer. Six years ago, Jennifer was diagnosed with cancer, but like the fortunate few, won the battle. Until 19 months later, when she was diagnosed with chronic terminal breast cancer of the bones and told she only had months to live. Faithful, Angela drove Jennifer to her chemotherapy appointments, a time in which Jennifer shared her most personal thoughts and wishes to Angela. Jennifer didn’t want to die in the presence of her husband, or her two boys, or her parents. She did not want to be remembered for her last breath, but for her many.
Jennifer and those around her tried to make life as normal as possible. Angela and family planned Jennifer’s birthday party even though Jennifer didn’t know if she’d make it to then. But she’d certainly try and she did. Even more than a birthday celebration, it was a celebration of Jennifer’s life and what was left of it. A week later, Angela found herself at Jennifer’s bedside whispering, “We are alone, you family is out of the room, if you would like to go now, you can. We all love you.” Jennifer opened her eyes to Angela, and closed them for the last time.
The same day, Angela started getting severe chest pains. She managed to get through the night, but the next day was unbearable. She began to climb up the stairs of her house when, by the fifth step, she became dizzy and dropped to her knees. Miraculously, she managed to get herself up and drive to the ER, where the cardiologist on call noticed that her heart enzymes were up. After an angiogram, the doctor diagnosed TTC. At one point, Angela’s heart was beating merely 40 beats a minute. She was given aspirin and beta-blockers, which halt the stimulation of stress hormones that cause the heart to react. Like many, Angela’s left ventricle returned to normal within five days. Left untreated, Angela’s case was severe enough to have killed her.
Susan Charles, a psychology professor at the University of California Irvine, studies emotions and how they correlate with health throughout a lifetime. Her ideas differ from the heart-as-ultimate messenger theories of McCraty, but only in explaining the possible mechanism for such suffering in tandem. “The heart responds to emotion,” says Charles. “We are used to seeing this person and producing opioids [feel good chemicals] when we see them. Then these chemicals no longer are produced and our body goes through withdrawals.” We meet people and our hearts no longer beat for ourselves but for someone else.
When we become attached to someone, live with him or her and love him or her, everything about our life we can only think of in relation to the time before and after we met this person. For they see us when we weep, when we smile, through good and bad, the people you love and who love you back, are with you. Our bodies adapt and rely on this person to be there for us.
In the name of love, new life is brought forth and so it’s only natural that, in the name of love, life can end and when it does, and this person we love is suddenly gone, it’s all but impossible to find peace.
Christie Sosa is a graduating senior in literary journalism at the University of California, Irvine. Her work has appeared in the New University, Student Health 101, and various blogs. She is currently freelancing and resides in Whittier, CA. This is her first article for Science2.0
Tako-Tsubo: Can We Diagnose And Treat True Heartbreak?