Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact

Autoren

Thomas Efferth
Mita Banerjee
Norbert W Paul

DOI

10.1016/j.ijcard.2016.12.129

ISSN

0167-5273

Zeitschrift

International Journal of Cardiology

Sprache

en

Paginierung

262 - 268

Datum der Veröffentlichung

2017

Status

Published

Herausgeber

Elsevier BV

Herausgeber URL

http://dx.doi.org/10.1016/j.ijcard.2016.12.129

Datum der Datenerfassung

2019

Titel

Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact

Ausgabe der Zeitschrift

230

Data source: Crossref

Abstract

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) [1] 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) [2]. Similar findings were published by Parkes et al. (1969) [3] following up on 4486 widowers at the age of 55 for 9years 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. 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) [4] 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.

Addresses

Department of Pharmaceutical Biology, Johannes Gutenberg University, Mainz, Germany. Electronic address: efferth@uni-mainz.de.

Autoren

Thomas Efferth
Thomas Efferth
Mita Banerjee
Norbert W Paul

DOI

10.1016/j.ijcard.2016.12.129

eISSN

1874-1754

Externe Identifier

PubMed Identifier: 28041712

Funding acknowledgements

Deutsche Forschungsgemeinschaft: GRK2015/1

Open access

false

ISSN

0167-5273

Zeitschrift

International journal of cardiology

Schlüsselwörter

Humans
Electrocardiography
Incidence
Survival Rate
Risk Assessment
Risk Factors
Stress, Psychological
Emotions
Metaphor
Takotsubo Cardiomyopathy
Global Health

Sprache

eng

Medium

Print-Electronic

Online publication date

2016

Paginierung

262 - 268

Datum der Veröffentlichung

2017

Status

Published

Datum der Datenerfassung

2017

Titel

Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact.

Sub types

Review
Journal Article

Ausgabe der Zeitschrift

230

Data source: Europe PubMed Central

Abstract

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) [1] 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) [2]. Similar findings were published by Parkes et al. (1969) [3] following up on 4486 widowers at the age of 55 for 9years 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. 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) [4] 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.

Date of acceptance

2016

Autoren

Thomas Efferth
Mita Banerjee
Norbert W Paul

Autoren-URL

https://www.ncbi.nlm.nih.gov/pubmed/28041712

DOI

10.1016/j.ijcard.2016.12.129

eISSN

1874-1754

Zeitschrift

Int J Cardiol

Schlüsselwörter

Life writing
Narrative-based medicine
Stress cardiomyopathy
Electrocardiography
Emotions
Global Health
Humans
Incidence
Metaphor
Risk Assessment
Risk Factors
Stress, Psychological
Survival Rate
Takotsubo Cardiomyopathy

Sprache

eng

Country

Netherlands

Paginierung

262 - 268

PII

S0167-5273(16)34540-5

Datum der Veröffentlichung

2017

Status

Published

Datum, an dem der Datensatz öffentlich gemacht wurde

2017

Titel

Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact.

Sub types

Journal Article
Review

Ausgabe der Zeitschrift

230

Data source: PubMed

Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact

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