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
- 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.
(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?