How intense grief increases your cardiac risk

28 Sep

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:
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  • 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)

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

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See also:
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13 Responses to “How intense grief increases your cardiac risk”

  1. Shari Jones September 16, 2015 at 5:23 pm #

    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

    • Carolyn Thomas September 17, 2015 at 8:24 pm #

      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…

      Like

  2. EmpoweredMind February 3, 2015 at 5:43 am #

    There are many cases reported that strong positive or negative emotions such as happiness or sadness can result in heart attacks.

    Like

  3. Brian October 8, 2014 at 6:17 am #

    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.

    Like

  4. Nitro Mama October 4, 2014 at 5:55 pm #

    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!

    Like

    • Carolyn Thomas October 4, 2014 at 7:23 pm #

      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…

      Like

      • Elizabeth Y., RN, BSN October 4, 2014 at 7:30 pm #

        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.

        Like

  5. Elizabeth Y., RN, BSN October 4, 2014 at 1:54 pm #

    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.

    Like

    • Carolyn Thomas October 4, 2014 at 2:32 pm #

      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!

      Like

  6. Joan Jahnke October 2, 2014 at 8:10 am #

    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

    • Carolyn Thomas October 2, 2014 at 3:03 pm #

      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…

      Like

  7. Just Suze September 28, 2014 at 2:22 pm #

    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

    • Carolyn Thomas September 28, 2014 at 4:17 pm #

      Thanks so much for sharing this, Suze. I sometimes wonder if the link between grief and our cardiovascular health is similar to that of preeclampsia (and other pregnancy complications) – in which doctors are still not sure if these cause the cardiac problem, or simply reveal the underlying problem.

      Like

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