A broken heart: It's the stuff of folk songs, the stuff of true love. There are plenty of couples who have died within weeks, months, or even days of each other. Johnny Cash's death certificate listed "complications from diabetes," but his fans know otherwise -- he passed away just months after June's death.
Doctors will tell you, "broken heart syndrome" or stress-induced heart failure is a medical condition -- and a perfect example of the heart's power and vulnerability, writes Mimi Guarneri, MD, a practicing cardiologist and author of the book, The Heart Speaks. "The condition seems to be caused by high levels of hormones that the body produces during severe stress, which can be temporarily toxic to the heart."
In her book, Guarneri weaves the latest medical knowledge with her own personal experiences -- hoping to spur conversations that pull people out of their stressful lifestyles. She wants to help them cope better with life-threatening emotions like grief, anger, anxiety, stress.
"I want people to start looking at their lives and see how these events, this stress, grief, anger has affected their health," she says.
Journey Into the Heart
Guarneri's own journey to understand the all-too-fragile heart began in childhood.
"On an evening when I was 8 years old, my vivacious 40-year-old mother told me she had pain in her chest, then got into bed and died of a heart attack," she writes. "My father's subsequent death from heart disease at 50, almost a decade later, was surely hastened by this tragedy in our family. Heart disease, with its layers of grief and guilt, stress and love, had blasted a hole through the center of my own family."
In her book, Guarneri introduces the relatively new science of psychoneuroimmunology, known in scientific circles simply as PNI. It is a study of the relationship between the nervous system, emotions, and immunity that has developed over the past decade -- an effort to understand how mind and body communicate, and the impact on our health.
This mind-body network has been studied over the past three decades. Until recently, however, some of the only measuring tools to show this link were EKGs, blood pressure, and blood tests of stress hormone levels.
When we experience anger or other emotions, it triggers a cascade of negative reactions throughout the body, says Guarneri. "We know that when we're angry, our bodies are surging with stress hormones that raise our blood pressure, heart rate, and stress hormone levels," she tells WebMD.
"When we give beta-blockers [medications] to slow the heart down, we're giving medication to stop stress hormones," she says. Her goal is to teach people to gain control over that stress and help them cope better without the drugs -- to learn to heal their own hearts.
A sophisticated form of technology called functional MRI has provided deeper insights into the mind-body connection, says Guarneri. Through functional MRI, scientists can see in real time what has seemed so elusive -- that the thought-emotion centers of the brain are inextricably linked with the rest of the body, including the heart.
"This is one of the truly fascinating arenas of medicine," she tells WebMD. "We knew it intuitively, that mind and body were talking but now we are getting the science behind these things. We're just getting the medical technology to really understand it."
Guarneri cites 140 medical studies and other writings -- a fraction of what's out there, she says -- shedding light on what she calls the "whole heart," which doctors and researchers must address to better serve their patients.
"They are the layers that don't appear on a stress test or electrocardiogram, that are not taught in medical school: the mental heart, affected by hostility, stress, and depression … the emotional heart, able to be crushed by loss and grief … the intelligent heart, with a nervous system all its own … the spiritual heart, which yearns for a higher purpose … and the universal heart, which communicates with others," she writes.
What Is the Heart, Really?
The ancient Greeks and Chinese believed the spirit resided in the heart. To the Egyptians, the heart was an inner book, storing a person's entire life - emotions, ideas, and memories. In the past century, scientists stripped the heart of its poetry; it was a mechanical pump, requiring extraordinary measures to fix.
Like those before her, Guarneri learned in medical school to block her emotions and treat the heart as a broken machine.
However, several memorable patients -- Russ, Paul, and Jean, whose stories are
told in the book -- opened her eyes to the value of looking deeper. She saw their vulnerability in the face of heart disease. "They didn't walk into my office on their own volition but were ushered in, ashen and terrified, having had a sobering glimpse of their own mortality," Guarneri writes.
She saw the effects of overwork, bad diet, loneliness -- the tensed faces, clenched fists, desperation, and anger. It was the beginning of her journey into mind-body medicine, the science that investigates the mind as an essential element in health and well-being.
"Behind every human being there's a life, a family, a history, and environment," Guarneri tells WebMD. "We're not just microbes on a plate; not everything can be fixed with Lipitor or a diuretic. It's not to say that those things aren't important. But in health care, we have lost the concept that we're dealing with human beings."
She also learned that patients were trying things like acupuncture to relieve stress. They asked questions she couldn't answer: How can I sleep without sleeping pills? How can I manage stress without sedatives? How can I lower blood pressure without taking medications that make me impotent?
In time, Guarneri founded the Scripps Center for Integrative Medicine in La Jolla, Calif., where patients can get such treatments as acupuncture, biofeedback, healing touch, massage, mindfulness-based stress reduction, and "stress mastery" -- as well as sophisticated Western interventional cardiology treatments.
"I am not an alternative medicine doctor," she tells WebMD. "I look at the whole person -- mind, body, spirit -- and use the best of Western medicine and alternative medicine, the best of both worlds."
Mehmet Oz, MD, is director of cardiovascular services at Columbia University Medical Center in New York. He's been on Oprah, making the case for mind-body medicine; for bringing Eastern philosophies into Western medicine, especially yoga, massage, and guided imagery tapes.
"My patients wear headphones during open heart surgery … listening to tapes that prompt them to breathe deeply, feel less pain, feel less anxiety," he tells WebMD. "We know that patients have awareness during surgery. ... These tapes help them cope with the stress of surgery."
Consumers Driving the Movement
Health consumers and frustrated patients are pulling the nation's medical community into arenas of spirituality and alternative medicine, says Guarneri. "People are dissatisfied with conventional treatments. They're moving to treatments that are more conducive to their belief systems… and they believe that stress and their environment affect their health," she tells WebMD.
One government study showed that Americans were making twice as many visits to alternative and complementary providers, compared with primacy care doctors. The practices ranged from deep breathing and progressive muscle relaxation to hypnosis, guided imagery, and meditation.
Michael Irwin, MD, professor of psychiatry and biobehavioral sciences at UCLA's Geffen School of Medicine, is also director of the Cousins Center for Psychoneuroimmunology. It's a research center named for the late Norman Cousins, a journalist who, in the late 1970s, introduced Americans to the concept of holistic healing -- that positive emotions can impact one's health.
"There has been increased interest in how the body communicates -- specifically, how the immune system communicates -- with the brain," Irwin tells WebMD. He is investigating the link between emotions and immunity. As scientists have found with many diseases including heart disease, the process of inflammation is a central player.
"People who are depressed -- and who have heart disease -- are more likely to have higher levels of cytokines, molecules that are linked with immunity and with inflammation," he explains. "There's good evidence from animal studies that increased levels of cytokines put people at risk for depression, which becomes a vicious cycle that leads to greater heart disease."
Through functional MRI, researchers "can examine very precisely how people respond to a change… exactly how their brain activity is altered when they relax or if they have higher cytokine levels," explains Irwin. "As a medical doctor, I want to know how these findings affect my patients -- and people with heart disease may be more sensitive to stressors. Depressed people are more sensitive to stressors. Until we understand that, we can't develop new treatments."
Irwin's studies have looked at the effects of tai chi on the immune system, he says. A new grant from the National Institute on Aging will be used to study effects of tai chi in improving insomnia by improving inflammation and cytokine levels.
The Little Brain
But here's the reality of our lives: When we're flying down the freeway -- and someone cuts in - the first reaction is to blast the horn, yell a few choice words. "We've all seen men go into road rage, a totally instinctive reaction," says Guarnier.
When we react on instinct, it's the amygdala region of the brain doing the driving. That's the brain center that stores old memories, she explains. "When someone pushes your buttons, you react immediately; you're reacting to something else that happened long ago. When it's such a quick reaction, you haven't had time to process."
In her book, Guarneri talks about the "heart brain" -- the heart's ability to communicate with the rest of the body. The heart is a gland that produces hormones and chemicals, like dopamine and adrenaline, which are involved in emotions, she explains.
"While we may believe the brain is our decision maker and ruler, the 10-ounce heart is more powerful than we ever imagined -- functioning as a sensory organ, hormone-producing gland, and information-processing center," she writes.
At the Institute for HeartMath, a nonprofit research and education organization, researchers have studied the heart-brain communication system. That research shows that it's possible to retrain how your heart-brain connection to produce a more stable heart rhythm, Guarneri explains.
Negative emotions like rage and frustration will trigger changes in the heart rhythm, creating a chaotic heart pattern that adversely affects the whole body, she explains. However, positive feelings like appreciation and love can produce a stable heart rhythm, which trains other organs to function optimally, she adds.
HeartMath has developed a core technique to do just that called Freeze Frame. When in a stressful situation, you must stop the moment "as if you're freezing a frame in a movie," says Guarneri. Then consciously shift to a positive emotion in order to reverse the effects of hostility or stress.
"People who are able to practice this self-management technique are able to generate consistent changes in their heart rhythm," she writes. "By consciously shifting to a positive emotion, they can reverse the negative effects on the heart."
"If you're in an angry, frustrated state, your body is producing stress hormones that are creating a chaotic heart rhythm," Guarneri explains. "There's an outpouring of adrenaline and cortisol that increases heart rate, blood pressure, and make platelets stickier, all of which can cause a heart attack."
"An animal reacts on instinct," Guarnier tells WebMD. "Reining that in ... that's what separates us from dogs."