You know the story. A great epic love, lovers crossed by star or circumstance, a tragic ending, and SOMEONE dies of a broken heart. You’ve seen it everywhere, from romance novel on top of romance novel, to Erik (The Phantom of the Opera) to Tristan and Iseult. And some even say that Padme died of a broken heart (even though she was clearly helped along by Anakin, when he, you know, crushed her windpipe with the Force.)
Yeah, that’s just sloppy writing. When Little Ann died at the end of Where the Red Fern Grows, Wilson Rawls at least had the respect for the audience to say that she stopped eating.
Well, it’s not as sloppy as one might think…
It’s not necessarily sloppy writing to say someone died from a broken heart.
You’re not about to tell me that people actually die of broken hearts.
Seriously? Like, seriously?
Yeah, dude. I’m about to tell you that people actually die of broken hearts.
Take a gander at this Japanese octopus trap.
This is called a tako-tsubo.
What does an octopus have to do with broken hearts? I mean, the World Cup is over.
I’d like to tell you a little bit about Takotsubo Cardiomyopathy (cardio = heart, myo = muscle, path = feeling/suffering), also known as Stress Cardiomyopathy…
…Or Broken Heart Syndrome.
Takotsubo was first described in case reports from Japan, but has since become more widely recognized. It’s a fascinating condition in which a strong emotional shock causes your heart to do…well, this:
Here’s a picture that shows basically what’s going on in that video.
We’re looking at a cross-section of the left ventricle of the heart. The ventricle on the right is relatively normal, and the ventricle on the left is suffering from Takotsubo. Basically, the apex, or tip, of the left ventricle balloons out in a way that you usually don’t see except from a heart attack. But in this condition, the coronary arteries that feed the heart are wide open.
The condition is called Takotsubo because the ventricle is said to resemble a Japanese octopus trap. The base of the ventricle, up near the atria, continues to function normally.
It’s not entirely clear exactly what causes this to happen. There’s some evidence that a significant increase in the levels of circulating catecholamines (the “fight-or-flight” hormones released by the sympathetic nervous system) may contribute to the development of the syndrome through any one of a number of proposed mechanisms.
A person suffering from Takotsubo will feel many of the symptoms of a heart attack. They’ll have chest pain or discomfort behind their sternum, they’ll get short of breath. Their electrocardiogram, the squiggly lines that show the patterns of the electrical activity in the heart, will look an awful lot like a heart attack. Enzymes that are released when heart muscle is damaged can be found in small quantities in their blood. And the person suffering from Takotsubo transiently goes into heart failure (a condition in which the heart is too weak to serve as an adequate pump for the fluid in the body.)
Interestingly, though (and most unexpected if you’re going to go from the fictional literature rather than from the medical literature), the majority of people who develop Broken Heart Syndrome survive it. The mortality rate is said to be around 8%. When a person dies from Takotsubo, it’s usually from a ventricular arrhythmia (= a dangerous change in the rhythm of the heartbeat), which is often observed during periods of heart failure. If the person survives the acute attack, it ends up being a transient condition that doesn’t seem to leave too much of a lasting impact.
Patients with Takotsubo are treated with supportive measures, basically making sure the heart gets help pumping if it needs help pumping. This can be done with drugs that encourage the heart to beat harder, or even artificial pumps that give the heart an extra bit of help with the squeezing.
So, how should I use it in a story?
First of all, make sure you actually want your character to “die of a broken heart”. I gotta say, it really got me when Little Ann crawled to the grave of Old Dan and perished there…but whenever I see that particular plot point anywhere else, it’s a major eye-roll hazard. So make sure you’re willing to take the risk. And then, please, please, PLEASE do something new, interesting and different with it. Don’t just use it to get rid of a pesky character that you don’t know how to kill.
Once you’ve committed to Takotsubo as your character’s mechanism of demise, consider selling it like the medical condition that it is (within reason, depending on the level of medical technology/healing magic in your secondary world.) Consider listing a few of the classic symptoms of Takotsubo. Have your character get short of breath, with wet sounds near the bases of the lungs. Give them a tight, squeezing feeling right behind their sternum. Then, have them die suddenly when their heart goes into a fatal arrhythmia. And make sure to weave a nice, solid, character-oriented scene around them to send them off.
Extra points if there’s an octopus in the room.
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If you use this as if it were real medical information, it’ll break my heart.