- •The broken heart syndrome represents a relatively new nosological entity.
- •The broken heart syndrome might trigger cardiac damage and cardiovascular death.
- •The takotsubo syndrome would be a relatively new way of looking at stress-related cardiomyopathy.
The cardiac impact of psychological stress historically and socially understood as boundary experiences of human life has long since become an icon. From the aching heart to the sudden death provoked by awe, horror, grief, anger, and humiliation on one side and extreme enchantment, enthusiasm, and excitement on the other, the broken heart has become a globally recognized and powerful metaphor present from folklore to popular culture to high literature and back to everyday communication. In medicine, the “broken heart syndrome” is described as a relatively new nosological entity that has been used synonymously with the term tako-tsubo or stress cardiomyopathy. Among those three terms, however, the broken heart most vividly draws the connection between conditions under which lived experience triggers cardiac damage and conversely, cardiovascular death occurs. According to Hassan and Yamasaki (2013) [
] and quite apart from the general perception medical notions of the broken heart indeed go back to at least 1967, when Rees and Lutkins studied the death rate among 903 relatives of patients who died in Wales. They found that 4.8% of bereaved close relatives died within a year of bereavement compared with 0.68% of a non-bereaved control group. Among widows and widowers, the mortality rate was even 10 times greater than that of the matched controls. After the first year of bereavement, however, mortality rates of relatives of a deceased person did not differ significantly from the control group Rees and Lutkins (1967) [
- Y-Hassan S.
- Yamasaki K.
History of takotsubo syndrome: is the syndrome really described as a disease entity first in 1990? Some inaccuracies.
Int. J. Cardiol. 2013; 166: 736-737
]. Similar findings were published by Parkes et al. (1969) [
- Rees W.D.
- Lutkins S.G.
Mortality of bereavement.
Br. Med. J. 1967; 4: 13-16
] following up on 4486 widowers at the age of 55 for 9 years following the death of their wives in 1957. During the first six months after the spouse had died, the mortality rate of the widowers was 40% above the rate of married men of the same age.
- Parkes C.M.
- Benjamin B.
- Fitzgerald R.G.
Broken heart: a statistical study of increased mortality among widowers.
Br. Med. J. 1969; 1: 740-743
While it seems plausible to accept the etiological role and pathogenic impact of personal loss, the pathogenic processes causing death remained relatively blurred. We will explain, why inaccurately stressing the fact that the broken heart and/or tako-tsubo syndrome would be a relatively new way of looking at stress-related cardiomyopathy as outlined by Yoshikawa (2015) [
] and why attaching stress-related cardiomyopathy to culturally powerful yet value-laden metaphors, might obstruct pathways to a better understanding, prevention and clinical management of the disease. By looking at narrative understandings and clinical representations of the broken heart, we aim to highlight the need for a more contextualised view of the broken heart syndrome in order to facilitate multi- and transdisciplinary approaches aiming at its prediction, prevention, and treatment.
- Yoshikawa T.
Takotsubo cardiomyopathy, a new concept of cardiomyopathy: clinical features and pathophysiology.
Int. J. Cardiol. 2015; 182: 297-303
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Published online: December 22, 2016
Accepted: December 16, 2016
Received in revised form: November 29, 2016
Received: June 23, 2016
© 2016 Elsevier Ireland Ltd. All rights reserved.