In my last article, I told the story of Donald and Anne who after 62 years of marriage, died within a couple of days of each other. People said that Donald had died of a broken heart, and there is now evidence to show that romantic notion may have actual scientific credibility.
While the syndrome is more of a medical concern than a psychological one, it is important that we recognize the potentially life threatening implications of this in order to be able to identify those who may be at risk.
Broken heart syndrome can be life threatening in some cases. Without repeating the information in the last article, people with “stress cardiomyopathy” can have similar symptoms to patients with a heart attack including chest pain, shortness of breath, congestive heart failure, and low blood pressure. The difference is that the heart cells of patients with stress cardiomyopathy are “stunned” by the adrenaline and other stress hormones but not killed as they are in heart attack. Typically these symptoms begin just minutes to hours after the person has been exposed to a severe, and usually unexpected stress.
The good news is that this condition improves very quickly, so with proper diagnosis and management, the heart completely recovers within a couple of weeks in most cases without any permanent damage.
But enough of the medical information, which as a layman in the medical field I gleaned from a John Hopkins University research study.
Where do funeral directors and counsellors fit in here? I think part of our “preventative medicine” has to be in recognizing the individuals and families who may be at risk for “broken heart syndrome.” I realize that an article on how to help PREVENT funerals is probably not going to win the award for Editorial of the Year, but nonetheless here we go!
Cardiomyopathy is most often triggered by stress, when a flood of adrenaline actually causes a “ballooning” in the left ventricle. So, it is important to begin by understanding what “stress” is.
“Stress” refers to the body’s response to things it perceives as abnormal. These abnormalities can be physical such as high body temperature, dehydration, or low blood sugar; it can be emotional AND physical, such as receiving bad news that an accident has occurred or a loved one has passed away.
I have the privilege of conducting a training programme with Victim Services in my community, and I am constantly emphasizing how important it is to take just a few minutes and simple strategies to try to in some way “prepare” the person who receives a notification call. Police officers themselves tell me this is the most difficult part of their job, and while many confront that difficult challenge with great sensitivity, there are still some who motivated by their own discomfort, just blurt out the information and escape as quickly as possible.
The stress of being confronted by unbelievably horrendous news causes the body to produce various hormones and proteins which are meant in normal circumstances to help cope with the stress. Known as the “fight or flight” syndrome, the body produces large amounts of adrenaline to help that person either defend him/herself against physical harm, or to run faster to escape the danger or threat.
With stress cardiomyopathy, the heart muscle is “overwhelmed” by a massive amount of adrenaline that is suddenly produced in response to stress. But scientists studying ‘broken heart syndrome’ have found the condition may actually have a protective purpose by stopping the organ being pumped with too much adrenaline. Known as “Takotsubo cardiomyopathy” the reaction causes the heart to assume a balloon-like appearance caused by the bottom of the heart not contracting properly. Researchers now suggest the body changes its response to adrenaline by switching from its usual role in stimulating the heart to actually reducing its pumping power to protect the heart from being overstimulated by the particularly high doses of adrenaline the body releases during stress.
Dr Alexander Lyon, of the Imperial College London, said: “Currently insights from this work show that takotsubo cardiomyopathy may be protecting them from more serious harm … the most important thing is to recognize the condition, and not to make it worse by giving patients more adrenaline or adrenaline-like medications.”
So how can we help? First it is important to recognize those who might be vulnerable to this situation. As in any crisis, the most important aspect is helping restore a sense of balance and equilibrium. Sustainment techniques help lower anxiety, guilt and tension and provide emotional support to the person who may be overwhelmed by a situation such as the loss of a loved one. They demonstrate interest, a desire to help, understanding, expressions of confidence in their abilities or competence, and reassurance concerning matters about which the person has anxiety.
Reassurance helps to “calm down” the crisis situation. Oh I know, some of you may be saying, “Yeah! Yeah! Reassurance!” … while wondering when I will get to the nitty-gritty of what to do. But stop for a moment and reconsider. When a person is in a crisis, where the adrenalin is pumping to the extent that is flooding the heart is hardly the time to make “snap out of it” statements or introduce strategies that often just increase the tension. You have to get the person to defuse before they explode. Here are a few possibilities:
Listen. Listen some and then listen some more. Listen with your heart and your eyes, not just with your head and your ears. Much of this type of communication takes place through nonverbal means, such as nods, smiles, attentive posture, and murmurings. This technique lessens the client’s anxiety and gives the client the feeling that he or she is in a place where help will be forthcoming. Listen for any indication of bodily as well as emotional complaints. Hear the person’s struggles and challenges. Listen to learn what they need to know and what they need to accomplish to “get through.”
Normalize. Use their OWN words and descriptions to feed back to them where they are in the crisis. As serious as this is, we need to help them know that what they are experience is normal for this stage in the situation. The struggles of today can be overcome. However, it is also important to normalize but not minimize. Yes the reaction is normal but you also have to acknowledge that this is probably the most difficult experience of life. Validation of BOTH these realities brings reassurance and encouragement.
Educate. Let other people involved in the situation know that these circumstances COULD result in broken heart symptom. While you and I may not be medically qualified to make that diagnosis, is the medical staff on hand aware of takotsubo cardiomyopathy? Could you point out to them that before they utilize some of the traditional methods and medications, that this COULD be a possibility? Could we find ways to train nursing home staff, paramedics and other front line workers such as police officers on notifications of the dangers in certain situations? Could we let the person at risk know some of the things they need to do when the symptoms are evident. Admittedly, this may be more effective after the situation has stabilized, and the reassurance is probably going to be the best intervention at the time.
2. Restoring Balance
The initial albeit limited goal of crisis management or grief counselling is to avert catastrophe and restore the person to a state of balance. The way to help restore balance is by helping the person to see the whole picture. Many times after a death, all people can focus on is that one aspect … e.g. “my loved one has gone, and I won’t be able to survive without them.” That concern is understandable, but it is not the whole picture. They need to understand that this response is normal, but their fears and concerns will be diminished as they see and discover ways and even reasons to live beyond this experience.
3. Re-establishing Support
Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress, as can physical activity and relaxation therapy. People at risk of the “broken heart symptom” need to find other people to whom they can open their heart, not just in a romantic way, but just knowing that there are people who care about them, and for whom they can care. This is where a community support group can be helpful, to reassure the person that they are not alone
For some people, the loss seems just too great to bear. Our opportunity is to show them is that it doesn’t have to be so, and that with our support they can find the ways to go on. I tell people, “It’s always too soon to quit.”