'I Had 'Broken Heart Syndrome''

Exactly a year before I found myself in the hospital, my father had died after a fall at home. Regulations required an autopsy. Afterwards, I had to identify his body before it could be released for cremation. I sat in a dark office, and a photograph popped up inches from my face in rich color, on a huge, bright computer screen. I already knew my father was dead, of course, but I didn't know how changed, how murdered he would look days later, shrouded in a light blue tarp with an opening like a shower cap's so I could see his face.

Months later, while driving to a party, I received a phone call from our 19-year-old daughter. She had run down a hill in platform sneakers and broken her ankle in three places. She was screaming in pain as several intoxicated friends helped her into a car to take her to the emergency room. I drove four more hours while my husband took pictures of the front and back of our insurance card to send to her most responsible companion. By the time we arrived at her dorm, I had had a spontaneous subconjunctival hemorrhage—when blood vessels burst under the surface of the eye—and looked like I'd been punched.

Those experiences—a father's death, a child's pain—were both ordinary life events and yet utterly heartbreaking. As I see it, heartbreak isn't just sorrow; it's sorrow plus shock.

Unrelatedly, 10 months after my father died, I learned that because of a chronically slow heart rate, I would need a pacemaker. Part of the work-up included a pharmacologic stress test, in which a chemical injected into a vein would force my heart to beat faster and harder. In the nuclear cardiology suite, there was a festive atmosphere. The Google doodle that day—February 8, 2019—celebrated the 225th birthday of Friedlieb Ferdinand Runge, who isolated caffeine from coffee beans. The cardiology fellows were swigging large iced coffees from the hospital Starbucks. "Caffeine is the antidote," one of the fellows explained. "As soon as the test is over, get a big cup of coffee and you'll feel a lot better."

The moment the infusion began I found myself panting like a dog. I felt intense pain in the left side of my neck. "Go get a big cup of coffee," the fellow reminded me. I was afraid to stand up. In the busy cafeteria, shaking, I imagined dropping my cup of boiling coffee, burning myself and everyone around me. The test was normal, and I was cleared to get a pacemaker.

Frankly, that test was as stressful, at least in the moment, as identifying my father's body. In both cases, I was woefully underprepared for how I would actually feel. Though the medical examiner was professional, and the cardiology fellows knowledgeable and kind, they were all oblivious to my emotional state.

Five days after the stress test, I got my pacemaker. Afterwards, I had to stand for a chest X-ray, and a little flicker of chest pain quickly became crushing. Finally, my heart was stunned. Within minutes I had had a bedside echocardiogram, which showed that my left ventricle had ballooned into the shape of a takotsubo, a traditional Japanese octopus trap, and could no longer pump effectively. I had developed takotsubo cardiomyopathy, a potentially fatal disease of the heart muscle nicknamed "broken heart syndrome."

As a psychiatrist, I knew that takotsubo cardiomyopathy emerges from the relationship between the heart and the brain. Sometimes known as stress cardiomyopathy, takotsubo is believed to be induced by a flood of catecholamines—"fight or flight" hormones—that stun the heart muscle.

Every patient's own case is special, but it seemed uniquely poignant to me that I did not develop takotsubo during the preceding year, which was marked by heartbreaking shocks.

So once I was out of the critical care unit, I had time to think about it. Like every patient, I asked myself, "Why me?" To be sure, I was a nervous 57-year-old woman, a typical takotsubo patient. Clearly pacemaker implantation was the immediate triggering event, but the psychiatrist in me sees the entire previous year's events as a run-up to the most consequential catecholamine surge of my life.

I pondered the exact nature of heartbreak in takotsubo. I have read case reports in the medical literature of takotsubo occurring in response to severe emotional distress, often in older women like me. Some scenarios include marital discord, domestic violence, and learning that a child has died. For me, I believe it was less about having my heart broken—though in the previous year, I had certainly experienced that—and more about my attempts at stoicism as a practicing physician.

The theme that connects those events was my own idea of the "perfect physician" I should be—a brave, competent doctor who never lets anyone down. I identified my father's body because I couldn't let my mother do it, and I did it alone because during my medical training I had seen plenty of dead bodies, so I didn't think it would be that shocking. I rushed to my daughter's bedside because when there is a medical emergency, you go, even though I should have pulled over until my husband and I had calmed down and made a plan. And finally, after my pharmacologic stress test, I got my own coffee, because I was told I needed an antidote before I collapsed, but nobody had offered to bring me any.

After that test, I went to my office and saw patients. I was a patient, but I couldn't allow myself to behave like one. As a physician, I expected myself to muscle through emotionally charged situations, and keep working, and I did—at great cost to my health.

There is credible evidence that chronic stress primes the heart to be vulnerable to catecholamines. I feel certain that the worst stressor for me wasn't heartbreak; it was stoicism. By the time I landed in the interventional cardiology suite, my heart was primed to break.

Since that time, I've committed to a healthier heart. Like most people with broken heart syndrome, my heart recovered after a few weeks, so I'm active. I stopped working in a psychiatric emergency room, where feeling threatened was part of the job. Now, I worry less about how a doctor is supposed to behave, and listen more to my body when it is trying to tell me something.

Anne Skomorowsky is a psychiatrist in New York City and the author of The Carriers: What the Fragile X Gene Reveals about Family, Heredity, and Scientific Discovery, available from Columbia University Press and on Amazon.

All views expressed in this article are the author's own.