How intense grief increases your cardiac risk

by Carolyn Thomas    @HeartSisters

Emelyn_Story_Tomba_(Cimitero_Acattolico_Roma)My Dad died young in 1983, at just 62 years of age. His was the first significantly meaningful death I’d ever been exposed to, and my personal introduction to the concept of grief and bereavement in our family. My father died of metastatic cancer, lying in a general med-surg hospital ward bed, misdiagnosed with pneumonia until five days before his death, cared for (and I use those two words charitably) by a physician who was so profoundly ignorant about end-of-life care that he actually said these words to my distraught mother, with a straight face:

“We are reluctant to give him opioids for pain because they are addictive.”

This pronouncement was made on the morning of the same day my father died. But hey! – at least Dad wasn’t an addict when he took his last breath nine hours later.   

In fact, it was watching firsthand how death happened in an acute care medical facility that convinced me there just has to be a better way to shuffle off this mortal coil. This conviction later propelled me to accept a position at the famous Victoria Hospice Society, where they know a thing or two about death and dying.

And like most hospice and palliative care experts, my VHS colleagues also know about grief and bereavement, and have taught me so much over the years.

So it was not a leap to learn that grieving can actually have a devastating effect on one’s heart health.  Boston researchers, for example, found that the incidence rate of acute myocardial infarction (heart attack) immediately following the death of a loved one was significantly elevated, particularly within the first 24 hours following that death(1).

As cardiologist Dr. Richard Fogoros explained in his regular About Health column:

“During the first 24 hours of the bereavement period, the risk of heart attack is increased 21-fold, and the risk remains substantially elevated (5 – 10 times normal) for at least a week or two after a loved one has died. 

“The acute increase in cardiovascular risk that occurs with bereavement is especially significant in anyone who already has cardiovascular disease or whose risk factors have placed them into a high-risk category.”

The depression, anxiety, and other strong emotions associated with grief may be partly responsible for this spike in heart attack risk, says the Boston study’s lead author Dr. Elizabeth Mostofsky at Beth Israel Deaconess Medical Center and the Harvard School of Public Health, both in Boston.

She explains that grief-related stress can:

  • increase blood pressure
  • increase heart rate
  • raise levels of stress hormones like cortisol
  • constrict blood vessels
  • disrupt cholesterol-filled plaques that line the coronary arteries

Any one of these changes can raise the risk of heart attack, according to Dr. Mostofsky who explains that such changes make blood stickier and therefore more likely to clot:

Acute stress tends to increase levels of the hormones known as catecholamines which causes platelets to stick together. If a plaque bursts, the resulting clot is more likely to cut off blood to the heart.”

The Boston research team also found that it wasn’t just grief over the loss of the closest of relationships that may affect heart health. In fact, they saw similar outcomes with study participants who had reported losing a parent, child, spouse, or sibling – as well as a close friend or even a more distant relative.

How can you help somebody who is grieving during that critical time immediately following the death of somebody important to them?

According to Victoria Hospice, the intensity of grief reactions can be deeply affected by:

  • the specific circumstances or nature of the death
  • lack of support or understanding by those around us
  • competing demands and responsibilities
  • multiple losses occurring around the same time
  • a history of depression, anxiety, trauma, abuse or addiction
Here are some helpful suggestions from Victoria Hospice if you are dealing with particularly difficult or complicated grief:
  • Seek and accept offers of practical and emotional support (e.g., prepared meals, transportation, non-judgmental listening).
  • Look for ways to honour the memory of the person who has died.
  • Find people and places where you can freely and safely express your feelings,  or record your thoughts and feelings privately through journaling or audio recording.
  • As much as you can, be patient with and kind to yourself. Remind yourself that you are in a difficult situation and that you’re doing the best that you can.
  • Remind yourself as well that you are the best expert about your own grief. Your grief is what you say it is because you are the one experiencing it.

In addition, Victoria Hospice offers these useful recommendations for how to be helpful to somebody you know who’s grieving a significant loss:

Acknowledge the loss as soon as you can after you get the news. Don’t let fear that you won’t say or do the right thing hold you back from talking with the bereaved person. Simply say that you are sorry to hear of the death, mention the person by name, be willing to listen to what the bereaved person may say. Ask how you can be helpful, or offer some assistance in a way that feels comfortable for you.

Be genuine by being yourself. Your connection with the bereaved person should be a continuation of your usual relationship with them. If you are a close friend, they will want and expect caring contact from you. A bereaved person will not want anyone to assume an unfamiliar intimacy now. Your sensitivity and dependability can make a difference to how understood and supported they feel.
Reach out to offer support. Be there by making regular contact. Many bereaved people find it hard to reach out or are concerned about being a burden on friends and family. Your initiative in keeping in touch will be appreciated.
Understand that everyone grieves in their own way and at their own pace.  How we grieve is a result of our personality, our past history of loss and the relationship that we had with the person who has died. Accept the bereaved person’s evaluation of the significance of the loss and the depth of their feelings. Remember that there is no right or wrong way to grieve.
Learn more helpful ways to support the bereaved in this Victoria Hospice brochure called Things To Remember When Supporting a Grieving Person.
Finally, heartbreaking grief can cause two unique cardiac problems, warns Cleveland Clinic cardiologist Dr. Marc Gillinov.  One is a heart attack as discussed above, but the second is a condition called Takotsubo cardiomyopathy or Broken Heart Syndrome as I’ve written about previously. This condition mimics a heart attack. It has long been considered by physicians as usually temporary, and brought on by extremely stressful situations ranging from the death of a loved one to a severe asthma attack, a car accident or even major surgery. But recent research reported in the New England Journal of Medicine suggests it actually follows physical exertion slightly more often than emotional events. The study described Taktsubo as “an acute heart failure syndrome with substantial morbidity and mortality”. It is NOT a heart attack. (2)


(1)   Mostofsky E, Maclure M, Sherwood JB, et al. Risk of acute myocardial infarction after the death of a significant person on one’s life. The determinants of myocardial infarction onset study. Circulation 2012; DOI: 10.1161/CIRCULATION AHA.111.061770. 
(2) Christian Templin et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015; 373:929-938. September 3, 2015. DOI: 10.1056/NEJMoa1406761

 NOTE from CAROLYN: I wrote more about this issue in my book “A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017).


Q:   Have you or somebody you know experienced cardiac issues following intense grief?


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18 thoughts on “How intense grief increases your cardiac risk

  1. I lost my husband to cancer.
    …They removed his entire stomach,
    …They removed part of his esophagus
    …They removed part of his pancreas.

    Before the operation he was on a new kind of Chemo Therapy.
    It was tried in Germany and deemed successful for some people.
    The chemo dosage was 3 times that of a normal dosage usually given to patients.
    They talked my husband into taking these treatments.
    My husband wanted to live so of course he said yes.
    BUT.. He lost so much weight on this amount of Chemo treatment. He looked like a HOLOCAST victim in a German war camp.
    My heart was breaking.
    The chemo did help with killing a lot of the cancer but was killing him in another way, a weight loss of around 100 Lbs. He was so thin , I just cried all the time. He no longer looked like the beautiful man I was married to for 44 years. He was so frightened with everything happening to him.
    After the operation they said there were no metastases and he actually started eating more.
    They stopped the chemo for a few weeks after his operation.
    A month later he went to get his stitches out but they could not remove them because of a fluid build up around the stitches.
    They told him to go to his own doctor to have the stitches removed at a later date, but only could be removed if the fluid was gone.
    We went to our family doctor and he removed the stitches, with all the fluid still there.
    On the way home he cried out in the car get me home quick, I am in lot of pain.

    When we got in our house he rushed into the washroom and screamed out in pain, call an ambulance my insides are coming out of the wound His large bowel was protruding out of his wound.
    Another operation to be done on him.
    This was so heartbreaking.

    Then a month later , he came down with pneumonia. But then decided he had Tuberculosis and was put in isolation for a week.
    Only to determine he had an abscess on his lung.
    Then he was he for another two months and he was acting very strange one morning.

    His arms were flailing all over the place and, his pupils disappeared only showing the whites of his eyes.

    I was terrified and called an ambulance They said his blood sugar was so low he almost died. I cannot begin to tell you how frightened I was. They gave him something to drink to bring his blood sugar to a normal level.

    When it was back to normal, I asked him if he could remember what happened to him .

    He told me he became very very dizzy.
    He did not want to go to the hospital, so I called another ambulance the next morning to take him there.
    He was diagnosed with cancer all through his liver.
    Then was told he was going to die.
    .I literally fell apart and felt like I was going to pass out.
    He died 3 days later. My whole world came to an end. HE WAS MY ANGEL AND WE LOVED EACH OTHER SO MUCH.
    I COULD NOT ACCEPT HE WAS REALLY GONE AND 4 years later I still have not accepted I will never have him in my life again.
    I cry every single day and long for his love.
    He was a gentle, kind caring human being, who always thought of others before himself.
    He was handsome with the most beautiful personality .

    When I first met him I knew I was instantly in love with him as said he was with me. It was love at first sight.


    1. Connie, I’m so sorry for your tragic loss, and for the way your husband went through so much before he died. Cancer is a terrible and cruel diagnosis, and it can be extremely traumatic for family members to witness the worst of the suffering. Cancer treatments like chemo have to be strong enough to kill those deadly cancer cells, while stopping just short of killing the patient. I wish there were a better way.

      You have lovely warm memories of your years together when he was healthy – no wonder you miss him so much. I hope you will re-read the information (in the article above) from Victoria Hospice about dealing with grief and loss, and especially their advice “You’re doing the best that you can…”

      I also hope that you will be able to seek help from a professional therapist, pastor or other resources trained in bereavement counselling – which can be so healing. After four years, you can’t bring him back, but you certainly deserve some peace for yourself. Meanwhile, read this article on “refueling” by my friend Kath Murray, a longtime hospice nurse and educator.

      Good luck to you… ♥


  2. I absolutely believe this. My husband died five weeks to the day after a botched surgery and I really thought in the days after his death that I would die. I was under so much duress I couldn’t sleep or eat for weeks afterwards.

    Liked by 1 person

    1. Valerie, I’m so sorry for your tragic loss. No wonder you couldn’t sleep or eat for weeks. The pain and shock must have been almost too much for one human being to bear. My condolences to you and your family…


    2. My heart goes out to you.
      I sent my story in today and the heartache never ever goes away.
      I know I will cry every single day I til I pass from this world.


  3. I was diagnosed with Takotsubo in July of 2015. In April I lost my nephew suddenly and unexpectedly, 28 days later I lost my brother (my nephew’s father).

    By all accounts it would be assumed that this was the cause of the syndrome, however it was the tipping point. That is why I am commenting. It is not always a sudden onset of heart attack symptoms. Nine months prior I had to quit my career after 15 years with the same company due to chronic back pain and autoimmune issues. The stress of leaving my career, a relationship break-up, a move due to income change brought on the initial symptoms that I wrote off as part of my new health issues. I began being short of breath, sweating all the time and fatigue. I had Dr. visits and mentioned these symptoms and with a family of heart issues they always listened to my heart but that is as far as it went.

    My advice is that it can happen if you are under 50, active, as well as a strong person and adjusting to life’s up and downs but chronic severe pain as well as major life changes and yes finally the sudden loss of loved ones can cause this condition gradually worsening.

    Don’t let a Dr. tell you that your symptoms are probably early menopausal symptoms… I finally found a Dr. that did an EKG right in his office (and by this point I did have chest pain). The damage was prolonged, therefore my Cardiologist says that my heart may never completely heal, but with medication I am gaining stamina. Ask for an EKG if you are sweating without reason, short of breath or fatigued .

    Liked by 1 person

    1. Shari, what a tough year this has been for you and your family. Thanks for telling us your story – a good reminder that we know our bodies, and we know when something is “just not right”. Your symptoms – interrupted by several months – sounds similar to another heart patient with Takotsubo I wrote about here. Best of luck to you…


  4. Thanks for sharing. Gaining an understanding into potential causes of heart disease (especially those lesser known or even controversial) is incredibly insightful into long-term treatment across the cardiovascular spectrum.


  5. My mother died of cancer at 59, three years later my father at 64 had a massive heart attack. He survived and died at 76 after suffering for several years from vascular dementia. (He stopped taking his blood pressure medicine at age 68) Two weeks before she died, I phoned her doctor to ask for morphine. The doctor was reluctant to prescribe it, my brother got on the phone and said “we all know she will die soon, she can’t become an addict”. the doctor came to the house and saw for herself how my mother was suffering and prescribed the morphine. Prior to that my mother was given Darvon! Worthless!


    1. How lucky that your mother’s doctor came out to the house to see this suffering for herself. Many docs, sadly, have been ill-informed about opioids at the end of life. I’m hopeful this is changing…


      1. It is changing at the Skilled Nursing Facility level of care. There are protocols we follow now once a patient or their family decide it’s time. Titration dosing for optimal End of Life Care in the least invasive manner as possible.


  6. How about the stress of working in End-of-Life Care (Hospice)? My unit at work has Hospice rooms, so we are providing Rehab and sending people on one end of the hall and keeping the dying comfortable on the other end. Some days are so sad and stressful.

    Being selfish, but I wonder how to protect myself (and my heart) and still be able to function day to day.

    Thanks Carolyn, just thinking out loud.


    1. When I worked in hospice palliative care, I called the nurses our “hospice angels” for the amazing and important work they do for both patients and families. Rachel Naomi Remen, in her wonderful book Kitchen Table Wisdom, once wrote: “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” I think you might like this helpful resource about refueling written by my friend Kath Murray, a longtime hospice nurse and educator. Meanwhile, keep up the good work, Elizabeth! P.S. You are NOT being selfish – you’re being smart!


  7. Excellent post and a life event known around the World when one spouse dies and the other can follow close by in time.

    It happened in a similar situation in our family a year ago. 91 o/o Dad died peacefully in his chair and was found by his wife who has a significant history of CAD. I warned that Mom needed careful watching and then two days after Dad’s death she went down with an MI; her rescue was because attentive family reacted quickly. She recalls little about the funeral, her MI or about all the family that surrounded her.

    Six months later, after a big move and lifestyle change, she had another MI.

    Today she is frail but looking forward to her 91st birthday. The family plans on keeping her quiet, well and in a stable environment.

    There is a reason for the old, old saying “died of a broken heart.”

    Hugs Joan

    Liked by 1 person

    1. Nice to hear from you, Joan. What a compelling story! Like the researchers found, having a prior history of heart disease made Mom particularly vulnerable to another cardiac event, this time grief-related. Throw in a big move (= another loss) and no wonder! Hope she is doing well and will enjoy her 91st birthday milestone…


  8. Oh Carolyn, I had a heart attack in July of 2002. My father had died in May of that very same year. Yes, I had been having symptoms for years (misdiagnosed as anxiety) and had had pre-eclampsia during my second pregnancy. However, I will always believe Pop’s death was a contributing factor.

    I was in my parents’ house, helping my mother sort through his possessions. I picked up a book off his nightstand (Angela’s Ashes). It still had a bookmark in the center, and I thought it was sad that he hadn’t finished the story. Suddenly, I broke out in a cold sweat, got tunnel vision, and sharp pain in my jaw, neck, and shoulder. Not surprisingly, the ER doc said I needed a dentist. Luckily for me, the dentist recognized a heart attack.

    I’m sorry for your losses. I can empathize; I remember my own grief at the loss of my father.

    Liked by 1 person

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