Efferth Thomas, Banerjee Mita, Paul Norbert W
Department of Pharmaceutical Biology, Johannes Gutenberg University, Mainz, Germany.
American Studies, Dept. of Philosophy and Philology, Johannes Gutenberg University, Mainz, Germany.
Int J Cardiol. 2017 Mar 1;230:262-268. doi: 10.1016/j.ijcard.2016.12.129. Epub 2016 Dec 22.
The cardiac impact of psychological stress historically and socially understood as boundary experiences of human life has long since become an icon. From the aching heart to the sudden death provoked by awe, horror, grief, anger, and humiliation on one side and extreme enchantment, enthusiasm, and excitement on the other, the broken heart has become a globally recognized and powerful metaphor present from folklore to popular culture to high literature and back to everyday communication. In medicine, the "broken heart syndrome" is described as a relatively new nosological entity that has been used synonymously with the term tako-tsubo or stress cardiomyopathy. Among those three terms, however, the broken heart most vividly draws the connection between conditions under which lived experience triggers cardiac damage and conversely, cardiovascular death occurs. According to Hassan and Yamasaki (2013) [1] and quite apart from the general perception medical notions of the broken heart indeed go back to at least 1967, when Rees and Lutkins studied the death rate among 903 relatives of patients who died in Wales. They found that 4.8% of bereaved close relatives died within a year of bereavement compared with 0.68% of a non-bereaved control group. Among widows and widowers, the mortality rate was even 10 times greater than that of the matched controls. After the first year of bereavement, however, mortality rates of relatives of a deceased person did not differ significantly from the control group Rees and Lutkins (1967) [2]. Similar findings were published by Parkes et al. (1969) [3] following up on 4486 widowers at the age of 55 for 9years following the death of their wives in 1957. During the first six months after the spouse had died, the mortality rate of the widowers was 40% above the rate of married men of the same age. While it seems plausible to accept the etiological role and pathogenic impact of personal loss, the pathogenic processes causing death remained relatively blurred. We will explain, why inaccurately stressing the fact that the broken heart and/or tako-tsubo syndrome would be a relatively new way of looking at stress-related cardiomyopathy as outlined by Yoshikawa (2015) [4] and why attaching stress-related cardiomyopathy to culturally powerful yet value-laden metaphors, might obstruct pathways to a better understanding, prevention and clinical management of the disease. By looking at narrative understandings and clinical representations of the broken heart, we aim to highlight the need for a more contextualised view of the broken heart syndrome in order to facilitate multi- and transdisciplinary approaches aiming at its prediction, prevention, and treatment.
从历史和社会角度来看，心理压力对心脏的影响被理解为人类生活的边界体验，长期以来已成为一个标志性概念。从心痛到因敬畏、恐惧、悲伤、愤怒和羞辱，以及另一方面因极度着迷、热情和兴奋引发的猝死，心碎已成为一个全球公认且极具影响力的隐喻，从民间传说到流行文化，再到高雅文学，乃至日常交流中都有它的身影。在医学领域，“心碎综合征”被描述为一种相对较新的疾病实体，与术语“应激性心肌病”或“章鱼壶心肌病”同义使用。然而，在这三个术语中，“心碎”最生动地描绘了生活经历引发心脏损伤的情况与心血管死亡之间的联系，反之亦然。根据哈桑和山崎（2013年）[1]的研究，且抛开一般认知不谈，心碎的医学概念实际上至少可以追溯到1967年，当时里斯和卢特金斯研究了威尔士903名患者亲属的死亡率。他们发现，4.8%的丧亲近亲在丧亲后的一年内死亡，而未丧亲的对照组死亡率为0.68%。在寡妇和鳏夫中，死亡率甚至比匹配对照组高出10倍。然而，在丧亲的第一年之后，死者亲属的死亡率与对照组没有显著差异（里斯和卢特金斯，1967年）[2]。帕克斯等人（1969年）[3]也发表了类似的研究结果，他们对1957年妻子去世后的4486名55岁鳏夫进行了9年的随访。在配偶去世后的前六个月，鳏夫的死亡率比同年龄已婚男性高出40%。虽然接受个人损失的病因学作用和致病影响似乎是合理的，但导致死亡的致病过程仍然相对模糊。我们将解释为什么不准确地强调心碎和/或章鱼壶综合征是看待应激性心肌病的一种相对较新的方式（如吉川（2015年）[4]所述），以及为什么将应激性心肌病与文化上强大但充满价值判断的隐喻联系起来，可能会阻碍更好地理解、预防和临床管理该疾病的途径。通过审视心碎的叙事理解和临床表征，我们旨在强调需要对心碎综合征有更情境化的观点，以便促进旨在对其进行预测、预防和治疗的多学科和跨学科方法。
