When Prose Meets Medicine: The Science Behind the Broken, the Incomplete and the Hardened Heart


Love hurts.
red paper block robot holding two halves broken heart

We are wired to experience incredible love and affection. But when that love is taken away, our reaction is a gut-wrenching pain, sadness and seemingly eternal loneliness.

Sounds Shakespearian, right? But this pain we feel is not just in our heads – it’s a scientific fact. Actually, all those feelings that people write songs about – the breaking, the hole, and the hardened heart – have very real, very serious medical correlations.

“Perhaps this is what the stories meant when they called somebody heartsick. Your heart and your stomach and your whole insides felt empty and hollow and aching.”
― Gabriel García Márquez

Unbreak My Heart?

Broken heart syndrome, also called takotsubo cardiomyopathy or stress-induced cardiomyopathy, can strike the healthiest among us. This is because it has nothing to do with what’s going on in your heart, and everything to do with what’s going on in your brain.

All of our thoughts and emotions are regulated by chemicals in our brain, specifically serotonin, dopamine and norepinephrine. But these chemicals are not regulated to the brain.

When under stress, these chemicals can cause changes in heart rate and blood pressure. “Historically, this was a survival mechanism,” explains Activ Doctors Onlines’ US Medical Director Dr. Howard Zahalsky, “When people were, say, being chased by a lion, the person whose body was able to respond quickly to danger usually survived.”

In today’s world, we (hopefully) aren’t being chased by lions. But, whether caused by the death of a loved one or romantic rejection, those stress chemicals are still the same.

“Sometimes the body can overdo it,” Dr. Zahalsky continues, “and cause damage to its own heart.”

The damage can be so thorough that broken heart syndrome can be mistaken for an actual heart attack. The symptoms, the readings on the EKG and even certain blood tests can come back positive for a heart attack!

In broken heart syndrome, the left ventricle of the heart gets stretched out. It’s believed that in broken heart syndrome, all the chemicals cause the microscopic tendons inside the heart that help the heart keep its shape stretch or even break. When the ventricle is stretched, it doesn’t squeeze as well, which results in drops in blood pressure, shortness of breath and, in some cases, death.

The good news? The damage caused by broken heart syndrome does heal on its own, assuming that the person survives the attack itself.

Prinzmetal angina

There’s a subset of broken heart syndrome that can be more serious. Under stress, spasms can occur in the arteries that bring blood to heart muscles, constricting or even closing off the flow of blood to the heart, which causes a different kind of heart attack.

It can be very difficult to tell the difference between a heart attack caused by traditional factors (like coronary artery disease), broken heart syndrome and Prinzmetal angina.

There’s a Hole it My Heart!

When a loved one leaves, people often describe the feeling as having a hole in their heart. But a hole in your heart is a very serious medical condition that cannot be caused by external stressors, like death or divorce. They are what’s called congenital heart defects, meaning something that someone is born with.

First, some quick heart anatomy.

Your heart has 4 chambers – two atria (upper chambers) that collect the blood that enters the heart, and two ventricles (lower chambers) that pump the blood out to the body.

When you have a hole in your heart, it allows the oxygenated blood to mix with the non-oxygenated blood, making the whole system less efficient. Think of it like watering down your gasoline. You’re just not going to get as far, as fast (assuming the whole engine doesn’t shut down on you).

Atrial Septal Defect

An atrial septal defect is a birth defect that causes a hole in the wall between the heart’s upper (atrial) chambers. A hole in the wall of the atria allows the oxygen-rich blood to re-enter the right atrium and back into the lungs (where it has just been). “Kinda like being sent back to end then of the line right before it’s your turn to get on the ride,” explains Dr. Zahalsky.

People with small atrial septal defects can go years without a diagnosis. They are often classified as the weak, or non-athletic, child, but don’t experience concrete symptoms of heart problems until they are in their 30s.

Ventrical Septal Defect

A ventricular septal defect is a common birth defect that involves a hole in the wall between the heart’s lower chambers. Because the ventricles are responsible for pumping blood to the rest of the body, a defect here is notable right away – usually within the first 2 months – either as a murmur (in the case of a small VSD) or heart failure (medium or large VSDs).

Patent Ductus Arteriosus

When a baby is developing they are completely reliant on their mother for a steady supply of oxygen. They even have a special artery that bypasses their lungs entirely and brings the mothers’ oxygenated blood directly to their heart to be pumped around. Efficient, right? Then, at birth, their body release chemicals that close that “bypass” artery and redirects the blood to get the oxygen from their lungs.

In a small percentage of people, the artery doesn’t close all the way. Patent ductus arteriosus requires immediate surgery to remedy. Fortunately, this surgery is usually completely curative.

Gonna Harden My Heart

If you harden your heart, then it cannot be broken, right? Sorry to tell you, but you’re better off risking the broken heart.

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is (thought to be) a genetic condition in which sections or the heart muscle becomes thicker than others. As sections of the heart become thicker, the heart is not going to squeeze and, more importantly, not relax as well. The heart has to fully relax in between pumps in order to fill up with blood to pump again.

There is no treatment which can reverse the changes of the heart muscle. We can only manage the symptoms.

Cardiac amyloidosis

Amyloidosis is a group of diseases in which clumps of proteins called amyloids build up in body tissues. It can affect several different organs, including the heart.

An excess of amyloid is associated with conditions like myeloma (a blood disorder) and scleroderma. In the past, cardiac amyloidosis was thought to be an untreatable and rapidly fatal disease. However, the field is changing rapidly. Many patients can now expect to survive and experience a good quality of life for several years after diagnosis.

How Can Activ Doctors Online Work for You?

Most of the conditions we’ve covered today are very rare. If you’re diagnosed with a rare or unusual condition, you want to speak with someone who’s the best in their field. If you live in a small town or rural community and don’t know where to turn – we can help.

Personal Health Record

Many people with rare conditions find it hard to keep track of all the different tests they’ve undergone. A personal health record keeps all those results at the tips of your fingers, avoiding unnecessary duplicate tests and saving your time and money.

Second Medical Opinion

Finding out you have heart disease, especially a rare heart disease, can be scary. Activ Doctors Online can put you in touch with thousands of experts in the United States and around the world, so you can know that you aren’t just getting advice from whoever’s available in the neighborhood, but doctors that are at the top of the field.

A second opinion can help ease your mind by confirming you have been diagnosed properly and that you are getting the correct treatment.


Whether you’re recovering from broken heart syndrome or managing a rare heart condition, sometimes going to the doctor is stressful! And as any pamphlet on heart health can tell you, stress is no good for your heart. If your doctor participates, you can directly connect though our video conferencing system without having to go into the office. No driving, no waiting, and – most importantly – no stress!

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