Broken Hearted

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The death of Debbie Reynolds Whom Died: December 28, 2016, Cedars-Sinai Medical Center, Los Angeles, CA just one day after her daughter Carrie Fisher passed away is a reminder of the crushing effect grief can have on the body. The 84-year-old Oscar-nominated performer reportedly suffered a stroke Wednesday.

The official cause of death has not yet been disclosed.

“She wanted to be with Carrie,” her son Todd Fisher told Variety.

“Broken heart syndrome,” or stress-induced cardiomyopathy is a very specific medical condition that has been well-documented in recent years. It can be caused by an intense emotional event, like the death of a loved one, giving a public speech, or even from a surprise birthday party. And many times broken heart syndrome has been blamed in cases when one spouse dies soon after the other.

According to Dr. Ilan Wittstein, assistant professor of medicine at the Johns Hopkins University School of Medicine, when the condition strikes, a part of the heart muscle is suddenly weakened and the heart isn’t pumping, becoming ineffective. However, the condition is usually treatable, and rarely fatal.

http://www.cbsnews.com/videos/could-broken-heart-syndrome-have-caused-debbie-reynolds-death/

“Grief is so complicated because there’s physiology, there’s self-care and then there are a lot of unknowns,” Dr. Sharonne Hayes, professor of medicine and cardiovascular diseases at the Mayo Clinic, told TODAY. “Medicine doesn’t entirely understand how grief and hope affect people’s life.”

Among her own patients, Hayes has seen a number of people suffer from broken heart syndrome. Both acute grief as well as chronic sadness can affect the heart, Hayes said. Grief increases some stress hormones, and it can raise blood pressure and heart rate.

Stress in general can also play a role in strokes. The hormones from stress can cause plaque that is already in the artery to rupture. Dr. Wittstein explains that there is a way for broken heart syndrome to cause a stroke. When a large portion of the front wall of the heart isn’t pumping as effectively the blood remains stagnant. Blood also has to be moving and if it doesn’t it begins to clot. The clot can then break loose and can go to the brain.

Stress also causes elevated blood pressure, which makes people more prone to strokes, it has been shown to increase inflammation, which is also a risk for cardiovascular disease. The more common kind of stroke, an ischemic stroke, is caused by a blood clot that blocks a blood vessel in the brain.

Self-care also plays a role in handling grief. Hayes, who was not involved in Reynolds’ treatment, but commented on the effect of grief in general, said it’s unknown what chronic medical conditions Reynolds might have had. Caregivers often don’t take very good care of themselves while at their loved one’s bedside.

“Did she skip medications? Not eat? Not stay hydrated?” Hayes noted. “That’s an element as well.”

Some of it may also be a will to live. People who are ill often have mental or emotional “targets” for living: “I want to make it through my kid’s birthday” or see them graduate or get married or celebrate Christmas. Take those targets away, and it’s a shock.

“I think spirituality and optimism and resilience has a part in this,” Hayes said.

http://www.nbcnews.com/health/health-news/broken-heart-syndrome-could-debbie-reynolds-have-died-grief-n701181

“I’ve seen estimates that about 1 percent of perceived heart attacks” are because of broken-heart syndrome, said Dr. Anne Curtis, chair of medicine at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, “and that seems about right. I think every cardiologist has seen cases. We tell people that many will return to normal or near-normal heart function.”

Ms. Reynolds’s did not, though the timing of her death may have just coincided with her daughter’s. In her 2013 memoir, Ms. Reynolds wrote about suffering a mini-stroke and partial kidney failure. In 2015, she was awarded an honorary Oscar but was too sick to attend the ceremony.

In interviews, Ms. Fisher had talked about how frail her mother was. “It’s a lot of times terrifying, but watching my mother, who’s incredibly resilient, coping with certain health issues that she’s had,” she told National Public Radio this fall. In an interview with People magazine in May, she said her mother had had a “spinal issue” but had “recovered amazingly.”

Ms. Fisher, 60, died on Tuesday after suffering a heart attack on a flight from London to Los Angeles a few days earlier. On Wednesday, Ms. Reynolds was rushed to an emergency room amid reports that she had possibly had a stroke.

Yet — if indeed a stroke was the primary cause of death, as her son, Todd Fisher said, a heart squeezed by the sudden loss of a beloved daughter could have contributed. The stunned organ, especially in a person who might have had any of the underlying cardiovascular infirmities of aging, could increase the likelihood of a clot forming and moving to the brain.

In a 2005 paper in The New England Journal of Medicine, doctors at Johns Hopkins University School of Medicine reviewed cases of 18 women and one man who landed in coronary care units in Baltimore, between 1999 and 2003, with chest pains and no signs of classic heart attack on exam.

Most were older, but one was 27 and another 32. The doctors, led by Dr. Ilan Wittstein, nicknamed the condition broken-heart syndrome and noted that it occurred not only after grief but after any sudden stress. All of the patients survived.

“We had people who’d been held up at gunpoint, who’d been up in front of a group to speak, who were severely claustrophobic and in an M.R.I. scanner, who were angry and in heated arguments,” Dr. Wittstein said in an interview.

Dr. Wittstein said that at the time the paper appeared virtually the only mentions of the syndrome were in Japanese medical literature. Now, he said, thousands of cases have been reported, and about 90 percent of them are women in middle age or older. One possible reason, he said, is that estrogen protects the heart’s smaller vessels — those most affected by stress hormones — and estrogen levels drop with age.

There have been cases of well-known couples dying in close succession.

The country stars Johnny and June Cash whom died within months of each other, after a long marriage. The former football star Doug Flutie’s parents died on the same day, both of heart attacks. To some medical experts, what Ms. Reynolds experienced is one of the greatest traumas of all.

“No one wants to change the order of nature, that is the first thing I thought when I heard,” said Dr. Victor Fornari, a psychiatrist at Northwell Health on Long Island. “A parent outliving a child — it’s one of the most unspeakable things there is.”

But can you really die of a broken heart?

“Broken heart syndrome — which is, in fact, a real thing — is when someone finds out some shocking news, typically terrible news, and there’s a massive release of these stress hormones that are released into the bloodstream, and the heart is then bombarded with these stress hormones,” said Dr. Matthew Lorber, a psychiatrist at Lenox Hill Hospital in New York.

“This could be the news, certainly, of a loved one dying, which is where the ‘broken heart syndrome’ name comes from. This could be the news of getting a divorce. This could be a boss coming in and telling you you’re fired — anything that can cause intense stress,” Lorber said.

The news doesn’t have to be bad; it could even be good news delivered in a sudden, shocking way, explained Lorber.

“Anything that causes a shock or startles can cause broken heart syndrome,” he said.

Here is more information from the American Heart Association:

Breakdown of a Broken Heart
Broken heart syndrome, also called stress-induced cardiomyopathy or takotsubo cardiomyopathy, can strike even if you’re healthy. (Tako tsubo, by the way, are octopus traps that resemble the pot-like shape of the stricken heart.)

Women are more likely than men to experience the sudden, intense chest pain — the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event. It could be the death of a loved one or even a divorce, breakup or physical separation, betrayal or romantic rejection. It could even happen after a good shock (like winning the lottery.)

Broken heart syndrome may be misdiagnosed as a heart attack because the symptoms and test results are similar. In fact, tests show dramatic changes in rhythm and blood substances that are typical of a heart attack. But unlike a heart attack, there’s no evidence of blocked heart arteries in broken heart syndrome.

In broken heart syndrome, a part of your heart temporarily enlarges and doesn’t pump well, while the rest of your heart functions normally or with even more forceful contractions. Researchers are just starting to learn the causes, and how to diagnose and treat it.

The bad news: Broken heart syndrome can lead to severe, short-term heart muscle failure.

The good news: Broken heart syndrome is usually treatable. Most people who experience it make a full recovery within weeks, and they’re at low risk for it happening again (although in rare cases in can be fatal).

Symptoms and patients

The symptoms are intense chest pain, shortness of breath and extreme changes in blood pressure. When the stress hormones barrage the heart, they actually change its rhythm — speeding and slowing the heart in succession — causing pain and leaving a person gasping for breath.

The syndrome is most commonly experienced by women — 90% of cases are in women — by people with a history of neurologic problems, such as seizures, and by people with a history of mental health problems.

Though a stress-based theory is probably correct, the precise cause of the syndrome remains unknown, according to Dr. Kevin R. Campbell, a cardiologist and assistant professor of medicine in the division of cardiology at University of North Carolina.

One form of the phenomenon is called Takotsubo syndrome, after the Japanese term for “octopus trap,” because the heart looks as if it is caught from below, its upper chambers ballooning as if trying to escape.

The sudden loss of a child or spouse, perhaps foremost among life’s cruelties, sets off “an overflow of stress hormones, and the heart can’t take it,” said Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York.

“It appears to be a massive heart attack,” but, she said, “the heart is literally stunned.”

The octopus trap can grab any heart, healthy or not, young or old, and most people survive, doctors say. The sudden flood of stress

“It’s really an interesting thing we don’t fully understand,” Campbell said, explaining that the condition was first described and studied in 1990 by Japanese researchers, who referred to Takotsubo syndrome.

“If you actually take a picture of the heart in the operating room, it looks dilated and balloon-like,” Campbell said, and that’s how the condition got its original name:

The heart is shaped like the Takotsubo pots used to catch octopus in Japan.

Despite a similar appearance to a heart attack, there’s a major difference in that patients with Takotsubo syndrome “don’t have any blockages in the heart,” he said. In fact, “the arteries look completely normal,” though the heart itself is dilated and ballooned and very weak.

Another important difference: Patients recover almost spontaneously over the course of days or weeks, Campbell said, adding that cardiologists commonly treat these patients with the same medicines used for heart attack.

Deadly cascade

Broken heart syndrome is often referred to as “stress-induced cardiomyopathy,”

where cardiomyopathy refers to a weakening of the heart muscle.

In rare cases of a weak heart unable to take the rapid changes induced by stress, broken heart syndrome “can lead to fluid actually getting into the lungs. It could lead to dangerous changes in blood pressure. It can even lead to heart attack, which can lead to death,” Lorber said.

Extreme stress can also result in a cascade of other physiological events ending with stroke.

“We know that stress can induce cardiac arhythmias — irregular rhythms in the heart — that can cause clots to be formed and thus produce large strokes,” said Dr. Paul Wright, chairman of neurology at North Shore University Hospital in Manhasset, New York, and Long Island Jewish Medical Center in New Hyde Park, New York.

Severe emotional shock “can cause constriction of the vessels of the heart, which can mimic a heart attack, which can cause cardiac rhythm abnormalities,” Wright said. A person could experience an ischemic stroke, in which a lack of blood flow deprives an area of the brain of nutrition.

“Extreme emotional stress can also cause rises or changes in blood pressure, which can result in hemorrhagic strokes,” Wright said. That’s when a blood vessel ruptures and bleeds into the brain tissue.

Heart health linked to mental health

Though broken heart syndrome is not completely understood, the stress-induced theory has earned support from doctors focused on mental health.

“In general, we know that there’s a tie between cardiac health — heart health — and mental health,” Lorber said. He added that people who have untreated depression and those with untreated anxiety disorders are “at a higher risk for having heart disease and heart attacks.”

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“The most likely reason for this is, depression and anxiety cause a release of stress hormones that get into the bloodstream and impact the heart,” Lorber said. “The more your heart is exposed to this, the more likely you are to have a heart attack.”

It’s more typical for broken heart syndrome to go away quickly, with no long-term consequences. Those who wander into an ER are treated symptomatically, their doctors simply verifying that they did not, indeed, have a heart attack.

With no lasting damage a month or two later, it’s simply a bad memory for most who suffer broken heart syndrome.

Still, a rare few do die of a broken heart. Though it’s not often, Lorber said, “you do hear about someone not wanting to live without their loved ones.”

HBO documentary moved up: By coincidence also, HBO had planned to air a new documentary, Bright Lights: Starring Carrie Fisher and Debbie Reynolds, in March. Now, following their deaths, the film has been moved up to Jan. 7 (8 p.m. ET/PT), HBO announced Friday.

The film, which had been received warmly at Cannes Film Festival, Telluride Film Festival and the New York Film Festival, is described as a story of complicated family love and “an intimate portrait of Hollywood royalty in all its eccentricity,” featuring vintage family films from the Old Hollywood era. The film was directed by Alexis Bloom and Fisher Stevens.

Meanwhile, another cable TV channel, Turner Classic Movies, announced Friday it will celebrate Reynolds with a 24-hour film tribute on Friday, Jan. 27, with a dozen films featuring Reynolds.

Also, fans can see her in her breakout role in Singin’ In The Rain on the big screen Jan. 15th and 18th as part of the TCM Big Screen Classics series in partnership with Fathom events.

Preview Debbie Reynolds, Gene Kelly & Donald O’Connor –

Good morning (with hun sub)