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Of Heartbreak, Octopus Traps, and One Fast Horse

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February being American Heart Month just kinda makes sense. Cobwebs and carved pumpkins are, culturally, how we recognize October. Cornucopias and cooked turkeys are how we recognize November. Pretty lights and wintry decorations are how we recognize December (and also October and November). And in February, we put hearts absolutely everywhere. They're the shape of our candy boxes and lollipops, they're adorning every little trinket you find in the mall, and they're splashed across every circular ad.

It's worth bringing up, of course, that the heart shape we know and love bears absolutely no resemblance to an actual human heart — maybe don't click that if you're eating — but we'll get to that later.

Of course, there's also a second half of February, and that half is every bit as much American Heart Month as the first half — only this half has discount candy. So now that it's the 15th and we’ve got that Valentine’s Day stuff out of the way (and the aforementioned discount candy in hand), let’s talk about something we didn't really want to hear about before yesterday: broken hearts.

I promise we’ll get more uplifting at the end.

The idea of being broken-hearted is ingrained so thoroughly into our lexicon that we don’t pause to give it the term itself much thought anymore. It’s in the Bible (Psalm 69:20, “Scorn has broken my heart and left me helpless”), it’s in the writings of Poe (specifically the poem “A Dream,” if we’re not going to count “The Tell-Tale Heart”), and countless scribes have written about it on bathroom walls since time immemorial. It’s also in, like, every. Song. Ever.

Obviously, the most common use of the term “broken heart” conveys a deep emotional pain, the sort of depression or anguish that leaves what feels like a pit in the chest — a physical manifestation of a mental dilemma. We’ve all been there, I think. And of course, anybody who would try to tell you that emotional pain isn’t just as legitimate as physical pain should be roundly ignored … but the link between the two is much more genuine than you might realize.

Enter, Broken Heart Syndrome.

It’s also known as Takotsubo Cardiomyopathy, or Stress Cardiomyopathy, and it’s a temporary weakening of the muscles in the heart brought on by the emotional rigors of a stressful or difficult situation. It’s been talked about elsewhere on the Penn Medicine site, so we won’t dive too far into it here, but it’s a fascinating and potentially very serious example of “mind over matter.”

(It’s neither here nor there, but the word “Takotsubo” actually comes from the Japanese term for an octopus trap, which is similar in shape to the human heart. Before finding that out, I didn’t even realize there was such a thing as an octopus trap.)

Hearts can break in many other ways, though, and it all too frequently ends in tragedy. Some of these ways are simply beyond our control, but some — including heart disease, which kills well over half a million Americans per year, according to the American Heart Association — can be prevented or treated through basic lifestyle decisions, as we discussed in this blog two weeks ago and several of our physicians discussed in the Philadelphia Inquirer last week.

Sometimes, though, we can do something about a broken heart. We can replace it with a donor heart, as we’ve done more than 1,000 times since 1988. We can even replace it with an artificial heart, which I wrote about in a blog post last year. It’s easy to forget that solutions like this are brand spanking new in terms of the overall human experience, but we’re only approaching the 50th anniversary of the first human heart transplant. As I alluded to in that blog post from last year, we’re capable of doing things now that would have been considered science fiction just decades ago. When a heart breaks in a way that ice cream and Netflix can’t fix, we’re more prepared than ever before to help patients through it.

When the racehorse Secretariat (stay with me, here) died in 1989, a necropsy revealed its heart was nearly three times the normal size, and we all know how that worked out for Secretariat. Where a larger-than-normal heart can sometimes be a tremendous benefit for a racehorse, in humans it’s called cardiomegaly and can be a symptom of something much more dangerous.

Of course, if you were talking about your friend or loved one and said they have “a big heart,” chances are you’re just referring to them being compassionate or charitable. It’s another example — similar to the whole “broken heart” thing that got us down this road in the first place — of our romanticizing of the heart. Just as we consider the physical construct of the brain and the not-so-physical construct of the mind to be two different but not fully separate things, we consider the physical construct of the heart to be something different, albeit not fully separate, from the other, not-so-physical "heart."

That physical construct of the heart should probably get more credit, though. For all the ways in which its fragility can impact our lives or the lives of those we care about, we should remember that the average human heart will beat more than 2.5 billion times through the span of an average human life. That's a tough number to even wrap your mind around, but it's happening. Like, right now. In you. The heart really is special. It is, as the announcer in that clip from earlier called Secretariat, “a tremendous machine.” Are you sleeping? It’s hard at work. Are you sitting at your desk? It’s hard at work. Are you running a marathon? It’s working overtime.

It takes care of us. And American Heart Month is all about making sure we take care of it.

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