“What do you know about Takotsubo?” asked Nell, putting down the newspaper. “There’s an article about an unexplained death that some think might represent that syndrome.”
Nell’s mother, an Emergency Department nurse, said, “I’ve only seen one case so far, and the doctor referred to it as a broken heart cardiomyopathy.” She went on to share what she knew about this interesting and rare condition.
Takotsubo is a Japanese word describing a distinctively-shaped fishing pot used for trapping octopus. The label broken heart cardiomyopathy refers to the fact that the left ventricle of the heart takes on the shape of this fishing pot when major stressors impact the heart, likely due to the secretion of stress hormones. The syndrome was first described as a case study in Japan. Although a rare syndrome, several reports or cases have surfaced recently in other countries. In some of the cases involving an individual with reported or suspected Takotsubo (or broken heart syndrome) the person survived in the short term, although long-term prognosis is unclear. In other cases, the syndrome resulted in the death of the individual.
Society often speaks poetically and sometimes blithely of a “broken heart” but as is so often the case with metaphors there is some basis in fact. Takotsubo cardiomyopathy (also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, Gebrochenes-Herz-Syndrome, and stress cardiomyopathy or broken heart syndrome) is the label that describes a heart event in the absence of any significant coronary artery stenosis. Several cases have been cited in the literature and it has been suggested that emotional stress may have precipitated the symptoms that mimic acute coronary syndrome. Some of the instances reported included:
The brain and body are an integrated system. They rely on a series of chemicals to carry out all of its essential functions. Neurotransmitters and hormones are the chemicals that control every system and process within the body. These chemicals are powerful, especially the stress hormones of adrenalin, norepinephrine, and cortisol.
Adrenalin
Adrenalin is responsible for a whole host of changes in the brain and body including providing energy to take necessary action. Temporarily it increases mental alertness, impacts moods, and helps one tolerate physical exercise. And when the demand for adrenalin exceeds what the adrenal glands can product, a whole cascade of undesirable consequences can result ranging from chronic fatigue and dark circles under the eyes to increased sensitivity to chemicals and toxins and brown spots on the skin. Some individuals exhibit behaviors designed to pump out additional adrenalin engaging in everything from arguing to physical fighting.
Norepinephrine
Norepinephrine is both a neurotransmitter and a hormone. As a result, its role within the body is essential to normal body and brain function, playing a significant role in how the body responds to stress. The body’s “fight-or-flight” response is coordinated by both adrenalin and norepinephrine (or noradrenaline). Secreted by the adrenal medulla glands, norepinephrine is more involved with maintaining normal body functions like heart rate, blood pressure and sugar levels than responding to perceived threats. In the brain it impact areas that regulate sleep, attention, learning, and emotions. It stimulates both the emotional and cognitive centers of the brain and when produced in normal amounts, can create a sense of well-being, as well as euphoria.
Cortisol
Cortisol is essential for life. Either too little or too much can result in problems. One of tis jobs is to maintain the lower parameters of blood sugar (insulin regulates the upper parameters). Cortisol will actually elevate in an attempt to bring up a drop in blood sugar back into a normal range. Since the brain requires an ongoing supply of glucose and gets most of its energy from glucose, the maintenance of adequate blood levels is a top priority of this stress hormone. There is some evidence that managing cortisol is learned over a period of repetition of from several months to years (e.g., some people create chaos in order to release cortisol). It requires a minimum of four months to address cortisol imbalances.
When stress hormones are released, they impact every cell in the body. A little goes a long way. When stress hormones are poured out in high doses, they can create an internal tsunami, so to speak. In the presence of major stressors (including internal physiological stress due to imbalance), these stress hormones can cause the left ventricle to balloon out, which interferes with the smooth functioning of the heart.
Takotsubo is likely just another example of the close connection between neurons in the brain and neurons in the heart. It points out the potential value of having solid and effective stress-management techniques in place and of having a good support system available in times of severe stress.
“How do dog whistles work?” asked the young man.
“They work,” replied the vet, “by emitting sounds above 20,000 Hz. Dogs can hear those sounds while people cannot.”
The vet went on to explain that the normal higher limit of adult human hearing is about 20,000 Hz (Hertz) or cycles per seconds while the lower limit is about 20 Hz.
“And a cat’s purr?” asked the young man. The vet laughed.
“Cat purrs generally fall within the range of from 20 to 50 Hz so most are within the capability of the human ear. Your dog must know the word ‘cat’ because his heart rate just increased.” The young man nodded, laughing.
“I suppose you’ve heard of infrasounds?” asked the vet. This time the young man shook his head.
Infrasounds are low-frequency sounds, lower than the normal limit of human hearing. They consist of a very long wave that goes between particles and molecules rather than bouncing off them. High-intensity infrasoundsextend in the megahertz range and well beyond but their frequency level is below 20 Hz. Sometimes you can hear part of the sound and just sense the infrasound. Sometimes you can only feel the infrasound.
“I know about them,” continued the veterinarian, “because infrasounds are prevalent among creatures in nature. Hippopotamuses, alligators, and giraffes reportedly use infrasounds to communicate over considerable distances. Sumatran Rhinoceros produce infrasounds as low as 3 Hz with similarities to the song of the humpback whale. Elephants trumpet at 15-35 Hz and as loud as 117 decibels, the sound traveling distances up to six miles. The infrasounds are used to coordinate the movement of herds and allow mating elephants to find each other. Elephants also produce infrasounds that travel through solid ground and are sensed by other herds using their feet, although the herds are separated by hundreds of miles. Elephants have bet low-frequency (infrasound) hearing than any other mammal tested so far.
“I had no idea!” exclaimed the young man. ‘”That’s absolutely fascinating. Actually, I heard a comment recently that I didn’t understand until now. Recent research by Jon Hagstrum of the US Geological Survey suggests that homing pigeons use low frequency infrasounds to navigate.”
“And then there is the roar of the tiger,” said the vet. “Tiger roars can be both heard and felt.”
The roar of a tiger contains audible sounds and infrasounds of 18 Hz and lower—which can penetrate solid objects like walls, permeate buildings, pass through mountains, and travel for miles. Its prey feels the infrasounds in addition to hearing the threatening roar—usually the last thing the victim hears—which can reach 114 decibels a few feet away (25 times as loud as a gas lawn mower). The infrasounds can paralyze its prey, which helps the tiger catch it. Sometimes the creature dies of fright before the tiger can kill it. Humans can feel the tiger’s roar, too, a sensation that can cause momentary paralysis, even in trainers who have worked with tigers for years.
Human beings react to both loud sounds and infrasounds, pouring out stress hormones that impact both brain and body in a myriad of differing ways. Physiologically, stress hormones are about survival, which always comes first. Always. Other functions take second or third place. When stress hormones are released, they shut down any function or process that is not immediately required: digestion stops, immune system function slows, libido decreases, and so on. Extreme levels of stress hormones can increase one’s risk of stroke and, in rare cases, even cause death.
Hormones are secreted all the time, dribbling out bit by bit. The body also attempts to rebalance itself all the time. Therefore it seems logical that (unless the damage is so severe it cannot be reversed) learning how to manage stressors effectively may help (at least going forward) to help the body be healthier. So will any strategy that can help the body rebalance itself easily, effectively, and accurately.
Some evidence exists that actions you take and behaviors you exhibit today can impact the immune system four to twenty-four months later. Learning to manage stressors now can positively impact your brain and body down the line. If you plan to be alive in the future, do something now that will impact your life positively up two years from now.
And remember the roar of a tiger….
If there’s a will there’s a way.
—Old English Proverb and an old Chinese Saying
“Well,” the caller said, “I got my test results back and my hormones were as unbalanced as a broken teeter-totter. I used the hormone-replacement crème for a whole month and I don’t really feel much different. Guess that was a wasted endeavor!” His voice was adamant.
I couldn’t help chuckling—to myself, of course. Hormone imbalances typically develop over time and expecting them to rebalance in a mere thirty days is often an indication of unenlightened and unrealistic expectations.
“Tell me what you know about your own pregnancy,” I said. “What were you told or what have you gleaned over the years?”
“How much time do you have?” he responded. “My mother had a horribly stressful pregnancy with me. My father didn’t want a child, at least not less than a year after their marriage, and he made no bones about telling everyone how upset he was. I guess my mother cried the whole nine months and consistently refused to consider an abortion. Good thing for me!”
What an unfortunate gestational history. In order for a person to live a healthy and productive life, hormones must be in balance. Imbalances occur when the normal rhythms of hormonal production and utilization are disrupted in order for the individual to survive. In terms of physiological importance, survival comes first. Always. Then other functions follow. When a pregnant woman is stressed, especially if she perceives a hostile environment, the fetus experiences an increased susceptibility to stress and sex hormones along with any toxins that are circulating in the mother’s body.
For a child who experienced a stressful pregnancy, he or she may require higher levels of stress just to activate the release of cortisol. Waiting to do things until the very last minute may be indicative of this. (For a female fetus, a stressful pregnancy can actually result in the child developing a more reactive brain and nervous system, which can increase her reactivity to stress over a lifetime.)
“What do you know about the first few years of your infancy and early childhood?” I asked.
“I know I had colic,” he said. “Horrible colic. Some nights I cried all night. I guess that prevented my parents from having good sleeps, which made my father even more irritable. He abandoned us when I was about seven months old.” (Colic during early infancy can be a symptom of food intolerance, which may align with hormonal imbalances.)
I explained that negative stress is cumulative; as are levels of stress hormones, such as adrenalin. When the stress hormone cortisol is high, the immune system is negatively impacted. When cortisol is too low, it interferes with the body’s ability to even mount an appropriate stress response. And when both cortisol and DHEA are low, the individual may be in a state of maladaptation or hormonal dysregulation.
At this point the caller interrupted to say that he’d been taking an oral form of testosterone but, again, hadn’t noticed much improvement.
“That may be because hormones taken orally tend to flood the brain and body,” I said. “This can trigger the body to shut down its own production of those hormones due to negative feedback related to overloading, which can result in perpetuating the imbalance rather than helping to resolve it.”
Rather than ask another question, I took a risk and just said, “According to Dr. Michael Borkin, an eminent authority on hormones, 100% of males over the age of 50 will experience some form of erectile dysfunction. It tends to be a symptom of cardio-vascular problems. Think of erectile dysfunction as the canary in the coal mine. Unfortunately, an average of eighteen months passes before the individual seeks medical assistance, by which time his hormones may be even further out of balance.”
There was a long silence on the other end of the line, broken by my saying,” Check your test print out. If progesterone levels are high, that may correlate with erectile dysfunction.”
“So how long would I need to be using these transdermal crèmes?” he asked.
“You don’t develop hormonal dysregulation in a few days or weeks,” I answered, “so it can take a long time to help the body recover and rebalance. A simple trauma, for example, can impact hormonal balance within four to twenty-four months. The effects of a traumatic fall may show up about four months later as the beginning of symptoms of dementia. It generally takes a minimum of 120 days of transdermal-crème use before any improvement is noted. And sometimes you may not have even noticed you had any symptoms because they’ve been around for such a long time you’ve become accustomed to them and assume this is just the price of being an adult in this culture.”
His next question was whether he would need to continue using transdermal crèmes for the rest of his life. “That would depend on the individual,” I replied.
Some individuals have used this strategy for several months to a year, retaken saliva tests, and been able to go on a maintenance crème with only annual retesting. Individuals who have been on such a program for the past fifteen years report they feel great and believe this strategy has helped them slow down the onset of symptoms of aging.
“Hey,” the caller said, “if that’s what it takes I’ll stop subsidizing the restaurant industry so frequently and so heavily and eat more meals at home. That’ll help pay for the testing and the crèmes.”
Good for him, I thought, as I shut off my phone. And the old proverb came to mind: If there’s a will there’s a way.
