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Seasons of The Heart: A Merry Christmas Coronary

(credit: Integrative Practitioner .com Dec. 1, 2017)

Holidays harken songs of glad tidings for all: heartfelt sentiments are sent in cards, and gifts are given as tokens of affection. However, despite the seeming good cheer, multiple studies have found an increased number of heart attacks during the holiday season.

According to one study published in the journal Circulation, during a 12 year period, there were consistently more deaths from ischemic heart disease during the winter months than the summer months.

“Ah ha!” you might say. “The cold weather is the culprit.”

Alas, no. This research group reported that about a third more deaths from ischemic heart attacks were recorded in December and January than June through September in Los Angeles County, California. Palm trees, not pine trees, are decorated for Christmas in the Los Angeles winter and, although colder than the summer, are still mild compared with other climates.

Robert A. Kloner, author of the editorial accompanying the research, quotes the study, writing, “When we plotted daily rates of death from ischemic heart disease in Los Angeles County during November, December, and January, we were struck by an increase in deaths starting around Thanksgiving, climbing through Christmas, peaking on New Year’s Day, and then falling, whereas daily minimum temperatures remained relatively flat during December and January. We postulated that this peak in cardiac deaths during holidays might result from other factors, including the emotional stress of the holidays, overindulgence during the holiday season, or both.”

Stress induces over-reactivity, on both the body and the mind. Holidays are harbingers of excitement. Emotional excitement is, well, exciing. A heightened sensation of excitement could be simply too much for some people to bear. In 2005, the Johns Hopkins University School of Medicine and its Heart Institute published a study in The New England Journal of Medicine, which found that some people may respond to sudden, overwhelming emotional stress by releasing large amounts of catecholamines—notably adrenalin and noradrenalin—into the bloodstream, along with their breakdown products and small proteins produced by an excited nervous system. These chemicals can be temporarily toxic to the heart, effectively stunning the muscle and producing symptoms similar to a heart attack, including chest pain, fluid in the lungs, shortness of breath, and heart failure.

These types of heart attacks, also known as Takotsubo cardiomyopathy, differ from typical heart attacks in that, while they are real and potentially deadly, they often recover. They are otherwise known as “Broken Heart Syndrome” in the study. “After observing several cases of ‘broken heart syndrome’ at Hopkins hospitals—most of them in middle-aged or elderly women—we realized that these patients had clinical features quite different from typical cases of heart attack, and that something very different was happening”, said Iian Wittstein, MD, a cardiologist at the university hospital.

The patients were previously healthy with few risk factors for heart disease, no blockages in the arteries supplying the heart, and the blood tests failed to reveal typical signs of heart attack such as highly elevated levels of cardiac enzymes that are released into the bloodstream from damaged heart muscle. Additionally, MRI’s confirmed that none of the stressed patients suffered irreversible heart muscle damage. The stressed patients improved dramatically and had complete recovery within two weeks.

In an effort to obtain more clarity on these findings, the researchers in this study went on to collect detailed histories and conducted several tests over four years, including blood work, echocardiograms, electrocardiograms, coronary angiograms, MRI scans, and heart biopsies. The results suffice to affirm my choice of emotional stress as a causative factor.

“On a total of 19 patients who came to Hopkins between November 1999 and September 2003, all had signs of an apparent heart attack immediately after some kind of emotional stress, including news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance, and a car accident,” according to researchers.

Interestingly, the initial levels of catecholamines in the stress cardiomyopathy patients were two to three times the levels among patients with typical heart attack, and seven to 34 times normal levels.

The obvious take-away here is that stress stuns the heart. It’s a shock. While at first glance, the holiday season seems steeped in goodwill, there are manifest reasons for the opposite feelings to emerge. In my clinical practice, I see people stressed out with the prospect of entertaining relatives that they are not in good relationship with. There is the anticipatory anxiety of domestic violence, fierce arguments, and alcohol abuse. In fact, these are among the stressors cited in this study on Takotsubo cardiomyopathy.

There are also financial pressures, the need to give beyond your means.

And, there is the heart breaker that rears its ugly head during the holidays, the absence of loved ones. Whether it is due to the grief over their loss or the loneliness that it brings, loss and grief are heart-stunning attacks.

These studies and practical observance show the dynamic relationship between the heart and emotions that bears consideration. Allopathic medicine will advise the normal precautions for heart attacks:

  • Bundle up in winter months to prevent blood vessels to constrict, blood pressure to elevate, and blood to become more prone to clotting

  • Don’t overindulge in alcohol or bad food combinations

  • Stick to a regular exercise plan

  • Don’t slack off your normal medication or forgo your scheduled doctor appointments

That is all good, standard advice. Unless you have a family doctor who knows you and your emotional proclivities, and is wise enough to know the risk factors for you during the holidays, chances are that you won’t get any guidance on that front.

Mimi Guarneri, MD, FACC, a world-recognized expert in integrative cardiology, discovered this truth after years in allopathic medicine. She wrote in her book, The Heart Speaks, “each heart has its own biography, language, and method of revealing its truth, if we know how to listen.”

From my perspective as a trained classical homeopath and a doctor of chiropractic, the language of the body, mind, and spirit are gleaned from deep, compassionate listening. Receiving the narrative will lead you to the source of the pain.

“Homeopathy is the art of unravelling the mysteries and symbols, of interpreting in the light of external features of appearance and demeanor, and the language of symptoms and signs, the inner reality of a patient. The same analytic process is used to unlock and understand the inner mystery or healing power of a remedy. The shamans of ancient and primitive cultures were weavers of myth, magic and medicine. They were aware that behind the tangible world of forms and events lies a deeper, unseen, timeless reality, embodying an absolute truth of which the manifest world is but a symbol. In contemplating an earthly object or happening, they were consciously in the presence of its spiritual counterpart. Similarly, homeopathic provings enable us to peer behind the veil of physical phenomena and view this higher dimension.” —Anonymous

From my perspective as a classical homeopath, I looked at the totality of symptoms from the features of Takotsubo cardiomyopathy and repertorize the rubrics according to homeopathic principles. A rubric is the heading in a homeopathic repertory that labels the symptom, syndrome, and characteristics, as well as the medicines that induce the symptom. The rubrics selected were:

  1. Physical: chest pain, respiration difficult, heart failure

  2. Mind: ailments from shock, bad news, loss, grief, climacteric (factoring in female patients who were post-menopausal)

The top three remedies for Takotsubo cardiomyopathy were:

  • Aconite

  • Arsenicum

  • Phosphorous

A detailed review of the Homeopathic Materia Medica of each of these remedies will reveal the characteristics that match those of state of the individual patient who is suffering. The similimum is specific to each individual patient, thus every person who suffers from this cardiomyopathy will require a different remedy particularly suited to them as a whole person. These mentioned are only to serve as a guideline.

The often arduous path of selecting the homeopathic similimum is the purview of the classical homeopath. It is also endemic to the art of doctoring. Guarneri makes a comment to this effect in her book, “The good news is that in reaction to the remoteness of contemporary medicine, there has been a resurgence of interest in the humanistic skills of old-fashioned doctoring.”

“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” —Frances Weld Peabody (1881-1927)

The concepts of compassionate caregiving, compassionate listening, and a compassionate presence are new in healthcare. They are not new to care giving, but they are new to implementation in mainstream medicine. This is precisely in response to the conundrum that modern medicine finds itself in when conditions like Takotsubo cardiomyopathy present themselves with an obvious emotional causation.

Compassion is a season of the heart as well. It must be harvested from an open mind, open will, and an open heart. A caregiver’s heart must be large enough to encompass all possibilities, devoid of prejudice or ego—simply that which is best for the person who is suffering. In homeopathy, we call this the art of an unprejudiced observer.

“Integrative healthcare was born of this concept. We are all in relationship to one another. We stand in awe of what might be when we work together. Despite differences in philosophy and evidence -based research, Wisdom is learning what to overlook.” —Wm. James

As we seek, in this season of the heart, the commonality, the thread that ties us all together, I am reminded of a term used in science, in systems theory, philosophy, urbanism, and even art. That term is “emergent properties”. It refers to those properties that arise from the collaborative functioning of a system. In other words, emergent properties are properties of a group that are not possible when any of the individual elements of that group act alone.

I await this holiday season to witness the emergent properties of our collaborative functioning. My only wish is that I don’t have a heart attack when it emerges.

“Sharing is a must to accompany our reasons If we truly intend to know all of heart’s seasons. No one, even I, knows all of heart’s many seasons.”

—Ben Gieske

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