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Broken Heart Syndrome on the Rise During Pandemic: A Conversation with Dr. Balu Natarajan, MD & Joshua Magariel, LCSW

31 Jul 2020, Posted by Seasons in Community

Over the last two weeks, news outlets from across the country have been posting a similar headline: “Broken Heart Syndrome on the Rise During Pandemic.” The journal JAMA Network Open published findings from the Cleveland Clinic that during the COVID-19 pandemic there has been a significant increase in patients diagnosed with stress cardiomyopathy, reaching 7.8% compared with pre-pandemic incidence of 1.7%, the release states. 

We sat down with Seasons Chief Medical Officer Dr. Balu Natarajan, MD, and National Director of Patient Experience Joshua Magariel, LCSW, to learn more about broken heart syndrome, stress cardiomyopathy, and how Seasons Hospice & Palliative Care is creatively responding to the unique needs in our communities.  

What was your first reaction to hearing this news? 

Dr. Natarajan: I’m grateful that strong institutions such as the Cleveland Clinic are taking the time to study and highlight this phenomenon.  What’s particularly important to appreciate are the study authors’ references to contributors, such economic and emotional issues, societal problems and potential loneliness and isolation. 

Joshua Magariel, LSCW: I first learned the news from my wife who heard it on a popular radio show here in Chicago. I’m always excited when psychology and science make it to the level of general conversation. I’m very familiar with broken heart syndrome, or stress cardiomyopathy, in my work. The reality is that this is a very real phenomenon with significant emotional and physical health risks. To say the least, I’m glad we’re having this discussion.  

What’s your experience with broken heart syndrome? 

Dr. Natarajan: I’ve actually seen this among a few relatively young athletes I’ve taken care of in the past. These are folks who are able to achieve a lot and are incredibly fit, but an intense period of stress overwhelms their physical being, including their heart.  Eventually, their heart fails. 

Joshua Magariel, LSCW: I remember hearing my mother say that my Grandpa Pat died of a “broken heart.” He died unexpectedly about six months after the death of my Grandma Aggie who had died just days before their 50th wedding anniversary. With time and curiosity, I learned the difference between heartbreak and stress cardiomyopathy that is born out of significant loss. Looking back, I still believe that my Grandpa Pat died from the emotional pain and stress of having lost the love of his life.  

How do you understand broken heart syndrome? 

Dr. Natarajan: Takotsubo cardiomyopathy, or Broken Heart Syndrome is a weakening of the heart’s main pumping chamber, caused by severe emotional or physical stress.  The stressor could include an unexpected illness, the loss of a loved one, a serious accident, or even a natural disaster such as a hurricane.  Financial loss and intense fear can be major stressors as well. What’s amazing is that in most affected individuals, their coronary arteries reveal no significant plaque buildup. The main symptoms are chest pain and difficulty breathing. 

Joshua Magariel, LSCW: I think Dr. Natarajan’s explanation is helpful to our discussion. We need to understand that emotional stress can cause dysfunction or failure in the heart muscle. To build on that, we know that caring for a loved one with advanced illness is physically and emotionally stressful. We also know that the loss of a loved one is physically and emotionally stressful and painful. One of the reasons Seasons is so important in our communities is our role in supporting patients and families living with advanced illness and loss.   

What are some ways we can reduce some of the isolation and increase emotionally connection during this unprecedented time? 

Dr. Natarajan: Human beings need other human beings, with rare exception.  We have to find creative ways to communicate with one another, be it via video, telephone, or even through the exchange of handwritten letters!  Anything we can do creatively to make contact with those close to us will help remind us that we’re not alone.  Each contact helps reduce that intense fear and social isolation. 

Joshua Magariel, LSCW: Building on Dr. Natarajan’s response, I want to highlight two areas of focus for us to help decrease a sense of isolation. The first is to increase your formal support systems (faith communities, mental health counselors, etc.). Meeting with a therapist or counselor regularly can decrease our feelings of isolation and increase a general sense of emotional connection in our lives.  

The second area of focus is to create what’s called an “enduring sense of connection” to those we’ve loved and lost. We’ve learned that while death means our loved ones are no longer physically here, the love that we feel for them continues to live in our hearts. Seasons helps patients and families create an enduring sense of connection through our Legacy and bereavement programming.  

How do you suggest for folks who might be concerned about themselves or someone in their life? 

Dr. Natarajan: See your healthcare provider for help!  In rare cases, medication may be needed. Invest in self-care, which might mean taking a walk, exercise, or meditation.   Think hard about ways to manage stress.  If working for 12 hours straight at a computer increases your stress levels, then make sure you have enough breaks to refuel during those 12 hours! 

Joshua Magariel, LSCW: The general advice is to ask for help and find support. Whether your needs are financial, medical, or emotional there are formal and informal support systems out there to help you. At Seasons we support patients and caregivers who are faced with the challenges of living with advanced illness and loss. Seasons has Patient & Family Resources on our website. There you will find free on-demand educational videos and articles. 

What do you say to those who might be avoiding doctors’ offices or hospitals because of the pandemic? 

Dr. Natarajan: I cannot tell you how many people in my private practice just assumed we’d be closed. They suffered with shoulder pain and knee pain for 3 months, instead of calling! And they’re not even chronically ill.  Not only will people staying away from doctors be reflected in Broken Heart syndrome, it will be a disaster for those with Organic Heart syndrome!! 

Joshua Magariel, LSCW: Your physical and emotional health are very important, and you are more at risk for bad health outcomes by not going to a doctor or seeing a therapist. Doctors and hospitals have worked very hard since the pandemic started to ensure you will be safe. Please seek help if you are experiencing any of the symptoms connected with stress cardiomyopathy.  

Dr. Balu Natarajan is the Chief Medical Officer and Joshua Magariel, LCSW, is the National Director of Patient Experience with Seasons Hospice & Palliative Care.