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← How your emotions change the shape of your heart

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Showing Revision 7 created 09/10/2019 by Brian Greene.

  1. No other organ,
  2. perhaps no other object in human life,
  3. is as imbued with metaphor
    and meaning as the human heart.
  4. Over the course of history,
  5. the heart has been a symbol
    of our emotional lives.
  6. It was considered by many
    to be the seat of the soul,
  7. the repository of the emotions.
  8. The very word "emotion" stems in part
    from the French verb "émouvoir,"
  9. meaning "to stir up."
  10. And perhaps it's only logical
    that emotions would be linked to an organ
  11. characterized by its agitated movement.
  12. But what is this link?

  13. Is it real or purely metaphorical?
  14. As a heart specialist,
  15. I am here today to tell you
    that this link is very real.
  16. Emotions, you will learn,
  17. can and do have a direct
    physical effect on the human heart.
  18. But before we get into this,

  19. let's talk a bit about
    the metaphorical heart.
  20. The symbolism of the emotional heart
    endures even today.
  21. If we ask people which image
    they most associate with love,
  22. there's no question that the Valentine
    heart would the top the list.
  23. The heart shape, called a cardioid,
  24. is common in nature.
  25. It's found in the leaves,
    flowers and seeds of many plants,
  26. including silphium,
  27. which was used for birth control
    in the Middle Ages
  28. and perhaps is the reason why
    the heart became associated
  29. with sex and romantic love.
  30. Whatever the reason,

  31. hearts began to appear in paintings
    of lovers in the 13th century.
  32. Over time, the pictures
    came to be colored red,
  33. the color of blood,
  34. a symbol of passion.
  35. In the Roman Catholic Church,
  36. the heart shape became known
    as the Sacred Heart of Jesus.
  37. Adorned with thorns
    and emitting ethereal light,
  38. it became an insignia of monastic love.
  39. This association between the heart
    and love has withstood modernity.
  40. When Barney Clark, a retired dentist
    with end-stage heart failure,
  41. received the first permanent
    artificial heart in Utah in 1982,
  42. his wife of 39 years
    reportedly asked the doctors,
  43. "Will he still be able to love me?"
  44. Today, we know that the heart
    is not the source of love

  45. or the other emotions, per se;
  46. the ancients were mistaken.
  47. And yet, more and more,
    we have come to understand
  48. that the connection between the heart
    and the emotions is a highly intimate one.
  49. The heart may not originate our feelings,
  50. but it is highly responsive to them.
  51. In a sense, a record of our emotional life
  52. is written on our hearts.
  53. Fear and grief, for example,
    can cause profound cardiac injury.
  54. The nerves that control unconscious
    processes such as the heartbeat
  55. can sense distress
  56. and trigger a maladaptive
    fight-or-flight response
  57. that triggers blood vessels to constrict,
  58. the heart to gallop
  59. and blood pressure to rise,
  60. resulting in damage.
  61. In other words,
  62. it is increasingly clear
  63. that our hearts are extraordinarily
    sensitive to our emotional system,
  64. to the metaphorical heart, if you will.
  65. There is a heart disorder
    first recognized about two decades ago

  66. called "takotsubo cardiomyopathy,"
    or "the broken heart syndrome,"
  67. in which the heart acutely weakens
    in response to intense stress or grief,
  68. such as after a romantic breakup
    or the death of a loved one.
  69. As these pictures show,
    the grieving heart in the middle
  70. looks very different
    than the normal heart on the left.
  71. It appears stunned
  72. and frequently balloons into
    the distinctive shape of a takotsubo,
  73. shown on the right,
  74. a Japanese pot with a wide base
    and a narrow neck.
  75. We don't know exactly why this happens,
  76. and the syndrome usually resolves
    within a few weeks.
  77. However, in the acute period,
  78. it can cause heart failure,
  79. life-threatening arrhythmias,
  80. even death.
  81. For example, the husband
    of an elderly patient of mine

  82. had died recently.
  83. She was sad, of course, but accepting.
  84. Maybe even a bit relieved.
  85. It had been a very long illness;
    he'd had dementia.
  86. But a week after the funeral,
    she looked at his picture
  87. and became tearful.
  88. And then she developed chest pain,
    and with it, came shortness of breath,
  89. distended neck veins, a sweaty brow,
  90. a noticeable panting
    as she was sitting up in a chair --
  91. all signs of heart failure.
  92. She was admitted to the hospital,
  93. where an ultrasound confirmed
    what we already suspected:
  94. her heart had weakened
    to less than half its normal capacity
  95. and had ballooned into
    the distinctive shape of a takotsubo.
  96. But no other tests were amiss,
  97. no sign of clogged arteries anywhere.
  98. Two weeks later, her emotional state
    had returned to normal
  99. and so, an ultrasound confirmed,
  100. had her heart.
  101. Takotsubo cardiomyopathy has been linked
    to many stressful situations,

  102. including public speaking --
  103. (Laughter)

  104. (Applause)

  105. domestic disputes, gambling losses,

  106. even a surprise birthday party.
  107. (Laughter)

  108. It's even been associated
    with widespread social upheaval,

  109. such as after a natural disaster.
  110. For example, in 2004,
  111. a massive earthquake devastated a district
    on the largest island in Japan.
  112. More than 60 people were killed,
    and thousands were injured.
  113. On the heels of this catastrophe,
  114. researchers found that the incidents
    of takotsubo cardiomyopathy
  115. increased twenty-four-fold in the district
    one month after the earthquake,
  116. compared to a similar
    period the year before.
  117. The residences of these cases
  118. closely correlated with
    the intensity of the tremor.
  119. In almost every case,
    patients lived near the epicenter.
  120. Interestingly, takotsubo cardiomyopathy
    has been seen after a happy event, too,

  121. but the heart appears
    to react differently,
  122. ballooning in the midportion,
    for example, and not at the apex.
  123. Why different emotional precipitants
    would result in different cardiac changes
  124. remains a mystery.
  125. But today, perhaps as an ode
    to our ancient philosophers,
  126. we can say that even if emotions
    are not contained inside our hearts,
  127. the emotional heart overlaps
  128. its biological counterpart,
  129. in surprising and mysterious ways.
  130. Heart syndromes, including sudden death,

  131. have long been reported in individuals
    experiencing intense emotional disturbance
  132. or turmoil in their metaphorical hearts.
  133. In 1942,
  134. the Harvard physiologist Walter Cannon
    published a paper called "'Voodoo' Death,"
  135. in which he described
    cases of death from fright
  136. in people who believed
    they had been cursed,
  137. such as by a witch doctor
    or as a consequence of eating taboo fruit.
  138. In many cases, the victim, all hope lost,
    dropped dead on the spot.
  139. What these cases had in common
    was the victim's absolute belief
  140. that there was an external force
    that could cause their demise,
  141. and against which
    they were powerless to fight.
  142. This perceived lack of control,
    Cannon postulated,
  143. resulted in an unmitigated
    physiological response,
  144. in which blood vessels
    constricted to such a degree
  145. that blood volume acutely dropped,
  146. blood pressure plummeted,
  147. the heart acutely weakened,
  148. and massive organ damage resulted
    from a lack of transported oxygen.
  149. Cannon believed that voodoo deaths

  150. were limited to indigenous
    or "primitive" people.
  151. But over the years, these types of deaths
    have been shown to occur
  152. in all manner of modern people, too.
  153. Today, death by grief has been seen
    in spouses and in siblings.
  154. Broken hearts are literally
    and figuratively deadly.
  155. These associations hold true
    even for animals.

  156. In a fascinating study in 1980
    published in the journal "Science,"
  157. researchers fed caged rabbits
    a high-cholesterol diet
  158. to study its effect
    on cardiovascular disease.
  159. Surprisingly, they found that some rabbits
    developed a lot more disease than others,
  160. but they couldn't explain why.
  161. The rabbits had very similar diet,
    environment and genetic makeup.
  162. They thought it might have
    something to do with
  163. how frequently the technician
    interacted with the rabbits.
  164. So they repeated the study,
  165. dividing the rabbits into two groups.
  166. Both groups were fed
    a high-cholesterol diet.
  167. But in one group, the rabbits
    were removed from their cages,
  168. held, petted, talked to, played with,
  169. and in the other group,
    the rabbits remained in their cages
  170. and were left alone.
  171. At one year, on autopsy,
  172. the researchers found
    that the rabbits in the first group,
  173. that received human interaction,
  174. had 60 percent less aortic disease
    than rabbits in the other group,
  175. despite having similar cholesterol levels,
    blood pressure and heart rate.
  176. Today, the care of the heart has become
    less the province of philosophers,

  177. who dwell upon the heart's
    metaphorical meanings,
  178. and more the domain of doctors like me,
  179. wielding technologies
    that even a century ago,
  180. because of the heart's exalted
    status in human culture,
  181. were considered taboo.
  182. In the process, the heart
    has been transformed
  183. from an almost supernatural object
    imbued with metaphor and meaning
  184. into a machine that can be
    manipulated and controlled.
  185. But this is the key point:
  186. these manipulations, we now understand,
  187. must be complemented
    by attention to the emotional life
  188. that the heart, for thousands of years,
    was believed to contain.
  189. Consider, for example,
    the Lifestyle Heart Trial,

  190. published in the British journal
    "The Lancet" in 1990.
  191. Forty-eight patients with moderate
    or severe coronary disease
  192. were randomly assigned to usual care
  193. or an intensive lifestyle
    that included a low-fat vegetarian diet,
  194. moderate aerobic exercise,
  195. group psychosocial support
  196. and stress management advice.
  197. The researchers found
    that the lifestyle patients
  198. had a nearly five percent reduction
    in coronary plaque.
  199. Control patients, on the other hand,
  200. had five percent more
    coronary plaque at one year
  201. and 28 percent more at five years.
  202. They also had nearly double
    the rate of cardiac events,
  203. like heart attacks,
    coronary bypass surgery
  204. and cardiac-related deaths.
  205. Now, here's an interesting fact:

  206. some patients in the control group
    adopted diet and exercise plans
  207. that were nearly as intense
    as those in the intensive lifestyle group.
  208. Their heart disease still progressed.
  209. Diet and exercise alone were not enough
    to facilitate coronary disease regression.
  210. At both one- and five-year follow-ups,
  211. stress management
    was more strongly correlated
  212. with reversal of coronary disease
  213. than exercise was.
  214. No doubt, this and similar
    studies are small,

  215. and, of course, correlation
    does not prove causation.
  216. It's certainly possible that stress
    leads to unhealthy habits,
  217. and that's the real reason
    for the increased cardiovascular risk.
  218. But as with the association
    of smoking and lung cancer,
  219. when so many studies show the same thing,
  220. and when there are mechanisms
    to explain a causal relationship,
  221. it seems capricious to deny
    that one probably exists.
  222. What many doctors have concluded
    is what I, too, have learned
  223. in my nearly two decades
    as a heart specialist:
  224. the emotional heart intersects
    with its biological counterpart
  225. in surprising and mysterious ways.
  226. And yet, medicine today continues
    to conceptualize the heart as a machine.

  227. This conceptualization
    has had great benefits.
  228. Cardiology, my field,
  229. is undoubtedly one of the greatest
    scientific success stories
  230. of the past 100 years.
  231. Stents, pacemakers, defibrillators,
    coronary bypass surgery,
  232. heart transplants --
  233. all these things were developed
    or invented after World War II.
  234. However, it's possible

  235. that we are approaching the limits
    of what scientific medicine can do
  236. to combat heart disease.
  237. Indeed, the rate of decline
    of cardiovascular mortality
  238. has slowed significantly
    in the past decade.
  239. We will need to shift to a new paradigm
  240. to continue to make the kind of progress
    to which we have become accustomed.
  241. In this paradigm, psychosocial factors
    will need to be front and center
  242. in how we think about heart problems.
  243. This is going to be an uphill battle,

  244. and it remains a domain
    that is largely unexplored.
  245. The American Heart Association
    still does not list emotional stress
  246. as a key modifiable risk factor
    for heart disease,
  247. perhaps in part because blood cholesterol
    is so much easier to lower
  248. than emotional and social disruption.
  249. There is a better way, perhaps,

  250. if we recognize that when
    we say "a broken heart,"
  251. we are indeed sometimes talking
    about a real broken heart.
  252. We must, must pay more attention to
    the power and importance of the emotions
  253. in taking care of our hearts.
  254. Emotional stress, I have learned,

  255. is often a matter of life and death.
  256. Thank you.

  257. (Applause)