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How to mend a broken heart

Bil Kirmani

14 Feb 2021

Bil Kirmani, Consultant Cardiac Surgeon and RCS England Fellow

Heart disease affects half a billion people worldwide. It carries a personal burden of mortality and morbidity, but also has wider implications on healthcare resource utilisation. Treatments for these cardiac conditions begin with lifestyle modifications and medical management but sometimes progress to requiring surgical intervention.

The epidemiology of a broken heart is less well known but is likely to have a lifetime incidence in excess of 100%. The ancient Sumerians (c. 4500 BC) were the first to document the metaphor when they supplicated to Inana to ‘pour oil on my heart that aches’. Thousands of years later, the allegory was set to music in Psalms, which sang of [words] ‘that break my heart’, opening the floodgates for millennia of plagiarism by the likes of Jimmy Ruffin, Elton John, the Backstreet Boys, Beyoncé, and Passenger, among others.

As with so many folklore maladies, there’s some truth tied up in all the poetry. Neurohormonal or vagal pathways connecting brain and body, amygdala-mediated systemic inflammation, and catecholamine surges have all been implicated in heartbreak. Whatever idiopathic pathophysiology exists that connects our mood to our heart, it is more than just a metaphor. Psychological stress may be as important a risk factor in cardiovascular disease as hypertension or smoking. Certainly, in takotsubo cardiomyopathy, severe emotional stress such as the death of a spouse causes dramatic left ventricular apical akinesis, mimicking a myocardial infarction right down to the ST changes. Tradition has it that ‘time heals all wounds’, however, and this stress-related cardiomyopathy is usually transient, resolving over several months.

Bil Kirmani artwork by Angus Carolan

Bil Kirmani performing heart surgery, by Angus Carolan

This month sees the Feast of Saint Valentine, patron saint of lovers and beekeepers. Whether or not you are participating in romance (or apiculture), Valentine’s Day is as good a checkpoint in the year as any to tend to matters of the heart. What ails you might be a cumulus of small sorrows or a single monolithic sadness… it will be as unique to you as your DNA, but its face will be familiar to others. The pall of 2020 has cast a long shadow for many of us, particularly in healthcare. As well as the curious conundrum of our regular work disappearing and a new, grim busyness evolving out of it, we all coped with our own pandemic hardships: relationships strained by isolation, illnesses or bereavements, financial worries, work stresses and countless missed milestones in a year best torn out of the history books.

Not as a cardiac surgeon, therefore, but as a fellow veteran, I have some suggestions on how to tend to your psychological well-being. I understand your scepticism: I, too, scoffed when the (non-clinical, non-surgical) speaker at a Resilience Course suggested we make time to do what makes us happy. My rage was misplaced: finding time to find myself in the quagmire did help. When your work-life balance tips over and you sacrifice your recreation time, you become like the shared computer at work: memory expended and paralysed by the simplest of tasks.

So... how to break the cycle? First: acknowledge that something has to change to preserve your mental health. It can feel like a big step, and many of us worry what implications this will have on our professional standing, but it opens doors rather than closes them. NHS Employers has a number of wellbeing services and your trust, union and indemnity body are likely to include these, too. The College also has a 24/7 Confidential Support and Advice Service.

Some of these services lead on to more professional help and others signpost you to techniques to get back on track, like apps to help you regain clarity of thought. Being reminded of the benefits of exercise and diet on psychological wellbeing can feel patronising when we are overwhelmed by graver responsibilities… but we’re typically better at handing out this advice to our patients than we are at taking it ourselves. When you’re feeling broken, even if you don’t believe it at first, it’s useful to be reminded that it’s okay for you to leave work behind you literally and metaphorically at the end of the day. When you choose to leave those ‘urgent’ tasks for the night and spend some time with an orphaned hobby, you’re investing in headspace that will help you plough through those urgent jobs more efficiently – and more cheerfully – the next morning.

Very few NHS services are built around the contribution of single individuals, and those fragile services that are, shouldn’t be. There is always enough scope for you to take the time that you are legally entitled to: your evening, your weekends, your holidays, shared parental leave, or less-than-full-time working for whatever reason. After all, even Atlas took a break from carrying the weight of the world on his shoulders.

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