A cautionary tale for lovers this Valentine's Day: A new Johns Hopkins study reveals that a broken heart can do more than make you weep - it could land you in the emergency room.
Hopkins cardiologist Ilan Wittstein and his colleagues found that overwhelming emotional stress, frequently sparked by the loss of a loved one, can lead to a passing, but potentially fatal heart malfunction that mimics a heart attack.
Although vague, anecdotal reports of "broken heart" syndrome have circulated for years, the Hopkins study, published today in The New England Journal of Medicine, is among the first to document a physical link between heartache-induced stress and real heart problems.
The new research is also helping to fill in a scientific picture of what happens inside the body when relationships end, either because of death, divorce or getting dumped.
One of the most painful experiences in human existence, lost love has long been the province of poets and playwrights, rather than MDs and Ph.Ds. "I look at the hand you held," an anonymous Japanese poet wrote, "and the ache is hard to bear."
"You feel defeated and lonely and lost," agrees Glen Breining, 43, a coffee shop owner from Hampden who isn't afraid to admit that he's shed a tear or two over girlfriends past.
While that's all behind him - he's been happily married for four years - Breining says that when someone you care about walks away, it can leave lasting scars: "You wonder all your life: What did I do wrong?"
The arrival of brain scanning technology is penetrating that angst and gradually helping scientists understand the neural circuitry underlying some of these intense emotions.
"It's a hot area," says psychiatrist Samet Kose of the Medical University of South Carolina.
In a study published in December in the American Journal of Psychiatry, Kose and his colleagues showed for the first time what happens in the brains of women after a rocky romantic breakup.
The study, he says, was prompted as much by personal interest as professional curiosity: It started when a young visiting researcher was suddenly dumped by his girlfriend back in Germany.
The jilted lover became fixated on understanding what might be going on in his ex's head, Kose says. So he and his colleagues recruited nine female volunteers who had just been through traumatic breakups and were having difficulty getting their ex-boyfriends out of their minds.
Researchers placed the women inside a functional magnetic resonance imaging machine, or fMRI. The device, which measures blood flow in the brain, showed less activity in areas associated with motivation and attention span and more blood flowing to areas associated with grief.
While the results themselves weren't totally unexpected, Kose says research such as this might ultimately help head off bigger psychological problems later on, such as clinical depression.
Brain scans, he says, might someday show which jilted lovers will benefit from medical intervention and which will get better on their own.
Meanwhile, it turns out that even the language we use to describe the loss of a loved one may be rooted in biology.
"We say, `I have a broken heart' and `I feel hurt,'" observes Naomi Eisenberger, a social psychologist at the University of California, Los Angeles. Now it's becoming clear why.
Eisenberger and her colleagues asked 13 volunteers to play a three-way computer-based ball-tossing game while their brains were being scanned. Each was told he would be playing against two other humans.
In reality, the computer was the only other player. Sometimes, the computer played real three-way catch. At other times, it deliberately excluded the human subject - a case of classic rejection.
The researchers found that the emotional pain people feel when they are rejected taps the same pain circuits in the brain - the anterior cingulate - that are triggered when someone bangs his head or skins a knee.
"It's the part of the brain that says `ouch,'" says Eisenberger.
In the area of the heart itself, Hopkins researchers first began to suspect that intense emotions might cause physical problems in 1999.
Their interest in the possible connection arose almost by accident. During his shifts in intensive care, Wittstein started to notice women arriving in the ER complaining of shortness of breath and chest pain - classic signs of a heart attack.
But when doctors ran the standard battery of tests on each patient, "we started seeing things that didn't add up," Wittstein says.
An X-ray examination of each patient's blood vessels, for example, showed none of the expected blockages in arteries feeding the heart. Blood tests revealed normal levels of troponin, a protein pumped out by cardiac cells after a heart attack.
But not everything was normal. Ultrasound scans revealed that the middle and upper parts of each patient's heart muscle were thumping abnormally.
Blood tests also showed a dramatic spike in stress hormones such as adrenaline and noradrenaline - as much as 34 times normal levels.