It’s the second season of the hit PBS drama “Downton Abbey.” Matthew Crawley is back from the World War I battlefield, returning with his doting nurse and fiancée, Lavinia. She retires upstairs to rest. Before long, Matthew finds himself alone in the foyer with Lady Mary, his true love. They dance. They kiss. From the staircase, Lavinia sees all.
Not long after, Lavinia dies, a victim of the Spanish flu. Her rapid decline shocks the house, and plunges Matthew into guilt. “I know it’s cliché,” Matthew tells Lady Mary. “But I believe she died of a broken heart.”
From blues siren Billie Holiday to Icelandic pop artist Bjork, from “Downton Abbey” to the young adult-fiction of Abby McDonald, popular culture is brimming with melodramatic portrayals of betrayed lovers clutching their chests and collapsing. In reality, death-by-heartbreak is rare. But it can, and does, happen, experts say. Broken heart syndrome is real – a legitimate, recently recognized medical condition that is under study by researchers the world over.
One university scientist diving deep into the link between sudden loss and heart failure is Karen Bales, a UC Davis professor of psychology. “The loss of a mate and stress of being alone results in a manifestation of grief like broken heart syndrome,” Bales said. “Heart rates increase, arrhythmias occur, anxiety sets in, and cardiac function decreases. It’s very reasonable to expect this to happen.”
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The syndrome’s symptoms so closely mimic full-blown heart attacks that some lovelorn individuals experiencing them end up in the emergency room. Shortness of breath, angina or chest pains, poor blood circulation, arrythmias (irregular heart rhythms) and a racing heartbeat can overtake otherwise healthy people who have had a great shock or lost a loved one.
Cardiogenic shock, in which a suddenly weakened heart can’t pump enough blood through the body, may occur. This is where the outcome gets dicey; most fatal heart attacks are a result of severe cardiogenic shock, though typically not the sort seen in broken heart syndrome.
Researchers who have studied cases at Johns Hopkins University School of Medicine’s hospital estimate that only 1 to 2 percent of their broken heart syndrome patients died at the hospital.
The Feb. 3 death of her husband, health policy consultant Peter Harbage, left Hilary Haycock, 32, feeling short of breath. One day, wheeling a cart through the grocery store, she found herself repeatedly yawning. Both symptoms could be a signal of the heart’s failure to pump enough oxygen-rich blood through the body.
Haycock faced down her sorrow while assuming leadership of Harbage Consulting, a Sacramento-based health-policy firm. Harbage, 43, a marathon runner, media commentator, and Obamacare consultant, was diagnosed about two years ago with leukemia. In the end, his suppressed immune system shut down his lungs.
“Today was a better day,” she said recently. Yoga helps, she said. “Being able to be present in my grief is a really healing thing for me.”
The condition mainly strikes women, but can affect men, too. “In times of grief, a whole slew of things start happening to your body,” said Ryan Seng, a craft-cocktail mixer at The Grange, who considered Harbage a dear friend as well as patron. “You feel all of those unexplained pains on top of everything else.”
Researchers believe broken heart syndrome is triggered when emotional shock releases a stream of stress hormones, including adrenalin. The hormones, along with small proteins produced by an over-excited nervous system, leave the heart stunned, experts say.
The result is toxic to the heart. Pumping mechanisms swell up and slow down. Heart rates soar, rhythms are disrupted. Overall functioning slows down. Fluid can gather in the lungs. By this point, the organ has sustained real damage, doctors say.
In a true heart attack, clots or other blockages narrow the coronary arteries and interrupt blood flow, requiring life-saving procedures. In broken heart syndrome, Mayo Clinic physicians submitting patients to an electrocardiogram were surprised to find no clotting. Even more unexpected was the discovery that symptoms subside in days or weeks.
Dr. Ilan Wittstein, a cardiologist at Johns Hopkins University School of Medicine, wrote one of the first academic papers revealing the phenomenon in 2005 in the New England Journal of Medicine. In examining 19 cases, Wittstein found that most involved women – who ranged in age from their late 20s to 87. All had reported some kind of emotional distress within a 12-hour window before being admitted to Johns Hopkins.
The deeply emotional events included receiving news of a death, being held up by an armed robber, panicking over public speaking, surviving a car accident, even stumbling upon a surprise party. Depression and sudden emotional shock are both risk factors for developing broken heart syndrome.
To Bales, the professor of psychology at UC Davis and one of a number of scientific investigators, the key to reversing broken heart syndrome lies in understanding the effects of emotional stress, distress and social isolation on mammals, specifically tiny yellow-bellied rodents indigenous to the Midwest: prairie voles.
Known for forming lifetime bonds, prairie voles are often cited as an animal model for monogamy in humans. They huddle, grooming each other and share nesting and pup-raising chores. And they just happen to exhibit certain social needs that very closely resemble the needs of humans.
“I looked at (research on) prairie voles and found that, when separated from their mates, their heart rates went up, they had increased arrythmias in the heart (irregular heart rhythms) and stress at being socially isolated,” Bales said, citing work done by Angela Grippo at Northern Illinois University. “Being alone led to their decreased cardiac function and worsened heart health.”
Here’s what voles and humans have in common, Bales says: Prairie voles are easily stressed out. They retreat to their colonies at the whiff of threats or intruders. They suffer isolation poorly. And when it comes to coping with loss, prairie voles develop something akin to the blues and cardiac malfunction.
Laboratory study of the rodents begins with a Lilliputian-scale surgical procedure to insert wireless radio-frequency transmitters in their bellies to generate a constant feed of electrocardiogram recordings.
Once the rodents recover from surgery, they are able to interact with, but not touch, others. When they’re eventually returned to their home cages, they rush over to mates and siblings, crouch side-by-side, all scrunched up and cozy.
Only female prairie voles are used in lab studies because they are especially sensitive to the impact of social stressers. Researchers place them in isolation chambers for four weeks where their every move and mood is recorded. First, however, researchers inject them with the body’s natural “happy” hormone called oxytocin, which Bales believes just might be the key ingredient to treat a distress ailment such as broken heart syndrome. In humans, oxytocin flows naturally after the simple gesture of a hearty hug.
Oxytocin in prairie voles tends to reduce the negative long-term effects of social isolation, warding off some of their depressive behaviors. The hormone also guards against cardiac distress in mammals when it binds with the heart’s oxytocin receptors.
At the end of the isolation period they are euthanized and their brains and hearts are preserved for examination. The goal is someday to determine whether administered doses of oxytocin will ease social tensions and settle agitated hearts in people.
If Bales and others can crack the case of stress and grief in prairie voles, then potential treatments for forlorn humans can’t be too far off, experts say.
Editor’s note: This story was changed at 4:10 p.m. March 12 to clarify the author of the research cited by Karen Bales.
Call The Bee’s Cynthia H. Craft, (916) 321-1270.