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How do you mend a broken heart? It usually fixes itself

Military personnel wearing a face mask, gets his heart checked out by military heath personnel Michael Service, a family nurse practitioner at Naval Branch Health Clinic Jacksonville, checks Navy Petty Officer 3rd Class Gabriel Upunda's heart in September 2020 (Photo by: Jacob Sippel, Naval Hospital Jacksonville).

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After Americans recently celebrated a COVID-19 version of Valentine’s Day, with its accompanying isolation, video dating, and physical distancing, it’s no wonder that the subject and the science of Broken Heart Syndrome is receiving renewed attention.

You might have found an occasional story about it in years past, but in 2021 the tone has shifted from a curiosity tale to a deadly serious topic.

“The only thing we really like about it is it usually goes away,” said Dr. Mark Haigney, professor and director of cardiology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. “With most people who come in with heart failure, you don’t get much improvement, even over time. Broken Heart Syndrome is one of the so-called reversible causes of heart failure. The heart can spontaneously recover its function. Unfortunately, that doesn’t always happen, and sometimes people die from it.”

From a military readiness perspective, love and matters of the heart may seem trivial. But heart healthiness is not just about solid nutrition and enough exercise. It also goes to the Total Force Fitness (TFF) domains of spiritual, social, and ideological fitness — that is, the beliefs and practices that strengthen one’s connectedness with sources of hope, meaning, purpose, and even love. The heart is not just a powerful red symbol of our inner selves. Our emotions connect directly to our entire health, head to heel.

Haigney remembers the first case of Broken Heart Syndrome that he ever saw, sometime in the late 1990s. It was a woman in her 40s getting a breast biopsy, when suddenly her blood pressure dropped, and the anesthesiologist had to give her a large dose of adrenaline. Her electrocardiogram (EKG) had changed drastically.

They stopped the procedure, took her to the intensive care unit where Haigney was working, and saw via ultrasound that her heart was not contracting in a normal way — it looked like she was having a major heart attack. But upon being rushed into a cardiac catheterization procedure, it was evident that her arteries were clear and normal.

“It was really mysterious because she had all the EKG changes suggesting a heart attack, and the pumping function of her heart was severely reduced, and yet the usual cause was not there. It got better over time and everything went back to normal, but it really had us perplexed,” Haigney recalled, citing a paper on the subject that came out years later from a cardiologist at Johns Hopkins Medicine in Baltimore.

“It described this transient, mechanical disorder in the heart that’s brought on by some kind of profound shock, or mental stress,” he said. “It’s a really interesting phenomenon, because if the person survives, they often go back to normal. They usually recover and do quite well. But to this day we don’t understand the exact mechanism, although it clearly involves the flight-or-fight response, the stress response by the nervous system that releases adrenaline into the circulation around the heart.”

Normally, he said, adrenaline causes the heart to contract in a more vigorous manner. But if there’s too much — perhaps brought on by overwhelming emotion — it can cause heart cells to die, and outright stun the heart. The condition, also called stress cardiomyopathy or Takotsubo cardiomyopathy, is usually brought on by grief, but can also be triggered by sudden overwhelmingly positive news. If you play the lottery, in other words, be forewarned: the chances are tiny, but you might win.

military personnel wearing a mask, getting his heart checked by military health personnel wearing a face mask
Dr. Mark Haigney, a cardiologist at the Uniformed Services University, performs an electrocardiogram in August 2020 on a plebe from the United States Naval Academy Class of 2024 (Photo by: Navy Petty Officer 2nd Class Dana Legg).

Resilience and ‘Holiday Hearts’

As for overall TFF, “it’s well accepted that stress will in the long term shorten your life due to cardiovascular disease, and in the short term can actually provoke cardiac arrest,” Haigney said. “One of the major things we know about stress is it has a lot to do with your job environment.”

Two people working the same number of hours in the same job may have very different health experiences, he explained. If one feels valued and has some autonomy, for example, they will work with a sense of purpose. If the other feels simply like a cog in the machine with minimal value, they run a substantially higher risk of a heart attack or some other negative health outcome.

That’s a reminder for commanders, but is also instructional for the outlook of the soldier, sailor, airman or Marine.

“A lot of this stuff that your coach taught you in high school turns out to be true, that your attitude really determines your fate in a very real way with your heart,” Haigney said.

The military’s long-time focus on resilience helps with this, according to published reports, including one from the RAND Corporation, prepared for the Air Force in 2013.

“By focusing on resilience, the Armed Forces aim to expand their care to ensure the well-being of military personnel and their families through preventive measures and not by just treating members after they begin to experience negative outcomes (e.g., depression, anxiety, insomnia, substance abuse, post-traumatic stress disorder, or suicidal ideation),” the report reads.

More recently, the Army’s October 2020 report on Holistic Health and Fitness said resilience “is the ability to face and cope with adversity; adapt to change; and recover, learn, and grow from setbacks. Resilient soldiers can better leverage mental and emotional skills and behaviors that promote enhanced performance and optimize their long-term health.”

A more common condition than Broken Heart Syndrome during December, January, and February is called “Holiday Heart Syndrome.” It is when patients have significant increases of irregular heartbeat, or atrial fibrillation, usually associated with binge eating or drinking (or both) around Christmas, New Year’s, and Valentine’s Day. It can happen to people with or without underlying heart conditions, and to those who exercise regularly. Atrial fibrillation can lead to a stroke, Haigney said, and becomes more common as you age.

“Part of it is probably because you don’t sleep well when you’ve had too much to drink, and any predisposition to sleep apnea, or obstructed breathing, can trigger atrial fibrillation,” he said. “Not neglecting your body is critical. Maintaining some degree of exercise, eating as well as you can, and avoiding binge behaviors ... will facilitate a recovery.”

Haigney is quick to point out that he is not a psychiatrist, but that from a TFF standpoint, ideological and spiritual fitness practices will help you when it comes to avoiding these conditions.

Counseling, too, he said, is “an incredibly important and often overlooked treatment. For people who have had a loss, they need to talk to somebody about it. Often, family members and friends don’t know what to say. Telling people to move on and not ruminate about it, that’s often not helpful. But having a professional involved can make a huge difference. ... It’s something that people in the military are not quick to resort to.

“Unfortunately, the idea that you should just ‘shake it off’ and get on with your life is pretty prevalent in the military,” Haigney said. “That’s a bad idea. I don’t think that’s a strategy that succeeds.”

For more on the holistic aspects of TFF, click here; for TFF through the lens of social fitness, click here.

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