UPDATED: August 10, 2025
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The Broken Heart Syndrome
BLUF: You really can die from heartbreak, especially if you are a man.
Takotsubo cardiomyopathy or tako-tsubo syndrome (TTS), also known as stress cardiomyopathy or broken heart syndrome, is a transient heart condition that is typically induced by emotional distress such as grief or other sources of severe emotional pain.
Its name comes from the shape of a Japanese octopus trap, a ceramic pot that has an appearance similar to the apical ballooning of the left ventricle during systolic contractions. Technically known as left apical akinesia-dyskinesia dysfunction of the left ventricle with dilatation and basal hypercontractility in unobstructed coronary arteries, TTS was given its name Hikaru Sato in 1990, and a description of five cases was published in an article in 1991.
Patients with TTS often present in the emergency department with angina (chest pain), syncope (fainting), and dyspnea (difficulty breathing). The variable nature of its triggers, and its frequent mimicry of an acute coronary syndrome (ACS), make takotsubo cardiomyopathy both a diagnostic and a management challenge.
ACS is due to conditions that suddenly reduce or stop blood flow to the heart muscle, such as a myocardial infarction (MI), or “heart attack,” which can damage or destroy heart muscle tissue. ACS is often caused by a blockage in the coronary arteries due to plaque rupture and subsequent occlusive blood clot formation.
Electrocardiographic abnormalities such as T-wave inversion or ST-segment elevation are frequently encountered in TTS, mimicking an MI, but despite symptoms that might resemble an ischemic episode, TTS does not involve coronary artery obstruction. Unlike congestive heart failure, it is not associated with diastolic dysfunction, and hypertension is not a factor. There is also no evidence for an autoimmune basis. The syndrome is thought to more likely involve a psychoneuroendocrine inflammatory mechanism.
Takotsubo cardiomyopathy is much more likely to occur in women, with approximately 90 percent of cases found among female patients with an average age of 66 years. Fortunately, the syndrome is rare overall, accounting for only one to two percent of all suspected ACS cases. Its mortality risk is less than half that of an MI, but men have more than double the TTS mortality rate compared to women.
Atrial fibrillation is a frequent sequel of TTS, observed in about a fifth of patients with the syndrome. Congestive heart failure is the most common complication, occurring in more than a third of patients. Administration of a beta-blocker after a takotsubo cardiomyopathy diagnosis is associated with a 35 percent reduction of in-hospital mortality.
Loss and Grief
It is normal for human beings to form emotional attachments to people and things. Subsequently experiencing the pain of their loss makes grief an inevitable part of life. The grief that occurs following the trauma of losing a loved one, our home, a pet, or our way of life, should not be taken lightly. We might eventually come to feel like we’re handling it well enough, but if our grief hasn’t been resolved at a deeper level, it can come back to bite us. One of my readers shared a poignant example:
“My sister succumbed to it following the death of her husband and the tragic suicide of her nephew. She seemed to be on the emotional mend and was enjoying life. Then, while visiting her husband’s grave about a year later, she collapsed, was hospitalized, and never recovered. The official cause [of death] was Broken Heart Syndrome.”
Getting Help
Unresolved and prolonged grief can have a huge adverse impact on a person's ability to function well. It is typically characterized by intense and prolonged emotional pain that interferes with multiple aspects of our daily life. Grief that has not been worked through can be accompanied by intense feelings of sadness, along with maladaptive behaviors such as avoiding any reminders of the deceased. Physical manifestations of unresolved grief can include feeling numb, or having persistent fatigue, nausea, upset stomach, loss of appetite, or chronic headaches.
If you are struggling to cope with a loss, please reach out to a mental health professional such as a grief counselor or a bereavement support group. They can provide valuable guidance and facilitate your recovery. Suppressing, denying, or trying to ignore your feelings will only make them worse in the long run. It is essential for us to acknowledge our feelings of pain, fear, anger, and sorrow, and to fully experience them by screaming, shaking, crying, and beating on a pillow, until we reach a calm acceptance of our loss, and can move on with our life.
Respecting the Octopus
An octopus might seem like an unlikely teacher for matters of the heart, yet its life can offer us some hauntingly beautiful lessons about love and loss. An octopus can show us that love's commitment can be total, that loss is inevitable, and that both can be woven into the delicate fabric of the same fleeting moment.
The life of an octopus is a compressed version of our own cycles of tender attachments and the harsh reality of impermanence. If we pay attention and keep an open mind, we will be continually reminded that life's preciousness often lies in its very fragility and the ever-present risk of losing what we most cherish. As C.S. Lewis put it, following the untimely death of his beloved wife, “The pain I feel now is the happiness I had before. That's the deal.”
Outside of mating, octopuses are solitary creatures. For many species, reproduction takes place only once during their lifetime. After mating, both sexes begin a final decline that ends in death. A female octopus remains with her eggs, without leaving them to feed herself. She continually guards and keeps them oxygenated and free of debris, devoting herself entirely to the future of her offspring, even as her own body deteriorates. Once they have hatched, a mother octopus doesn't try to hold on to her young. She lets them swim away, into the great vastness of the ocean, never to see them again.
Protecting the Octopus
In literature, a sea monster, often described as a gigantic, aggressive octopus, is portrayed destroying ships and drowning sailors. The kraken of Norwegian folklore is a similarly maligned creature. A more positive view is found in the 2016 science fiction movie, Arrival, depicted the aliens as large, octopus-like creatures with greater intelligence than humans.
I want to make a case for protecting the earth's most intelligent invertebrate. An octopus is a cephalopod mollusc with three hearts. Two-thirds of its nervous system resides in its eight arms, allowing them to act independently with amazing dexterity. The arms also have the ability to regenerate if lost. An octopus is able to rapidly change its skin color, pattern, and texture, making it a master of disguise.
These remarkable animals display problem-solving abilities, tool use, memory, and can even engage in play. Studies show they can navigate mazes, open jars, and learn through observation. Their ability to experience stress and pain, and display emotions, signifies that they are sentient beings deserving of our ethical consideration, similar to what most humans have bestowed upon dolphins and great apes. It's worth noting that in Japan, dolphins are still slaughtered for their meat at the infamous cove in Taiji.
My own experience, after spending decades diving in the company of octopuses and cuttlefish, has convinced me that they possess both curiosity and a sense of humor. Winning an American and a British Academy Award for best 2020 documentary film, My Octopus Teacher follows the remarkable relationship between a wild octopus and the filmmaker:
Some nations, such as the U.K., have already extended animal welfare laws to include cephalopods, acknowledging this as an ethical human duty. In addition, octopuses play a vital role in marine ecosystems as both predators and prey. They help maintain the balance of ocean food webs by controlling populations of crabs, mollusks, and fish. Their decline has had a ripple effect, destabilizing ocean biodiversity and affecting the marine fisheries upon which humans rely.
The PBS Nature series has a wonderful documentary called Octopus: Making Contact. It follows a marine biologist as his relationship with a captive octopus develops. He provides evidence that the animal may actually dream, and shows that they display a personality and possess enough intelligence to develop tool-making skills.
Octopuses are increasingly targeted for commercial fishing, particularly in regions where demand for octopus meat is high. The countries with the highest consumption of octopus include Japan, South Korea, Spain, Italy, Portugal, and France. Octopus is a particularly popular seafood in Hawaii, where it is often labeled as heʻe (Hawaiian), or tako (Japanese), and is typically found on the menus of sushi restaurants across America and Europe.
The global consumption of octopus continues to increase, while pollution, habitat destruction, and climate change, especially the massive coral reef destruction due to warming oceans, threaten their environments and future survival. Compared to fish, octopuses have much shorter lifespans and reproduce only once, making their populations fragile and extremely vulnerable to over-fishing.
The rise of octopus aquaculture poses new ethical and ecological problems. Octopuses are solitary and highly intelligent, making their captivity inherently stressful. Farming them not only inflicts suffering, but also requires feeding them wild-caught prey animals, increasing the pressure upon already beleaguered marine resources.
Protecting octopuses ensures that future human generations can learn from and be inspired by these extraordinary creatures. Given all the uncertainties about the long-term effects of octopus exploitation, adopting protective measures now would align with the precautionary principle: It is far better to safeguard their welfare and habitats today, than wait for irreversible damage to occur in the future.
Bottom line: Please give this remarkable animal a break, and instead eat something less intelligent… like beans and brown rice.
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