Joshua Wynne, M.D., M.B.A., M.P.H., executive associate dean, professor of medicine, and practicing cardiologist.

Rosanne McBride, Ph.D., a  clinical psychologist and assistant professor of

family and community medicine.

Heart and Soul

Exploring the similarities and connections of our emotional and physical hearts

More and more studies are showing that our emotional hearts and our physical hearts are connected.  North Dakota Medicine's Amanda Scurry sat down with Joshua Wynne, M.D., M.B.A., M.P.H., executive associate dean, professor of medicine and practicing cardiologist, and Rosanne McBride, Ph.D. (Psychology ‘95), a clinical psychologist and assistant professor of family and community medicine to discuss the similarities and connections of our hearts. 

ND Medicine:  Does our physical heart react to what our emotional heart is feeling?

McBride:  Absolutely.  Studies have shown that the human experience of an emotion occurs in part because of the brain and the heart interacting.  For example, when you experience a negative emotion such as anger or sadness, your brain sends the heart a signal and your heart's rhythm tends to become more erratic.  These changes in the heart rhythms are recognized by the emotional centers in the brain as stressful or negative

feelings.  This interaction of signals between the brain and the heart contribute to the physical feelings we experience in the heart area of our body when we are sad, grief stricken, and so on.  On the other hand, heart rhythms are smoother in response to positive emotions and experiences and contribute to the warm feelings we experience in the heart area when we are, say, in love.  The heart is letting the brain know that it feels good.  There are even some treatments to improve cardiac rhythms that involve having patients recall positive experiences that elicit warm feelings-also called emotion-focused techniques. 

Wynne:  Emotions and psychological factors may have profound influences on the heart.  An example of this is personality types.  Two types of personalities have been found, Type A and Type B.  Type A personalities are time focused, goal orientated, and work obsessed.  They are also more likely to have underlying emotions that include anger and hostility.  Type B personalities roll with the punches and are much more laid-back.  Type A personalities are more associated with heart disease than Type B.  The flip side of that association, however, is that being a Type A personality may actually help you to treat heart disease.  Type As tend to be more committed to their treatment plans, spend more time in cardiac rehabilitation, and are more intense about exercise.

ND Medicine:  What effect do personal relationships, like being in love, have on our emotional heart and our physical heart?

W:  People who are married seem to fare better from a health perspective than those who are not, not only from a heart disease standpoint, but from all-cause mortality.  The idea being, that it appears that people who have robust social networks and feel fulfilled in their jobs, do better. 

M: Helen Fischer at Rutgers University is an anthropologist who studies the chemistry of romantic love.  She studied a large number of couples who had been in a relationship for at least seven months.  She had them look at a neutral picture and a picture of their partner and then did MRI scans on them.  She found increased dopamine activity in their brains when they looked at a picture of their partner. 

One of the things that scientists are finding is that during this romantic, more lustful stage of love, the brain is awash in dopamine.  Dopamine is a chemical in the brain that gives you energy, makes you feel good, makes you feel like you can stay up all night-like what many people describe when they fall in love-"we stayed up all night and watched the sun come up".  So, when you are talking about falling in love, this is one of the things that is going on in your brain. 

Other studies have shown that in addition to increased dopamine, people experiencing romantic love show decreased levels of serotonin, another brain chemical.  Interestingly, one study compared "lovesick" people with individuals diagnosed with obsessive-compulsive disorder.  They found decreased levels of serotonin in the brain, which is characteristic in obsessive-compulsive disorder, in both the obsessive-compulsive group and the lovesick group and not in a control group.  In the end, the authors of the study said that it is difficult to differentiate between the brain activity of the "lovesick" individuals and those with obsessive-compulsive disorder.  This might help to explain why people in love can't get their mind off their lover.  

On the other hand, if a person stays in a relationship over a longer period of time, the dopamine level gradually decreases and the brain chemical or neurohormone that then comes into play is oxytocin, which is sometimes called the "attachment hormone" which is released in response to touch, hugs, etc.  Animals like dogs, cats, and birds are used in therapeutic and institutional settings like nursing homes in order to improve the emotional well-being of those residing there.  A recent study was done looking at animal therapy effectiveness using dogs and measured blood pressure and the levels of several hormones, including cortisol (the hormone released during stress) and oxytocin in both humans and dogs.  After allowing a period of time in which the people interacted with the dogs, they found decreased blood pressure, decreased cortisol levels and increased oxytocin levels in the person as well as increased oxytocin levels in the dog. 

Human beings in long-term relationships have higher levels of oxytocin, which as I said before is called by some the "attachment" or "bonding" hormone.  Studies have found higher levels of the hormone oxytocin in animals in the wild that mate for life, and if the oxytocin receptors in the brain are blocked in these animals, they tend to roam. 

Also interesting is that scientists have started looking at the oxytocin levels of autistic people because people with autism have profound difficulties with social relationships and interactions. 

Some recent experiments treating autistic people with oxytocin have shown improvements in their social interaction.   The bottom line is that it appears that oxytocin affects the quality and longevity of relationships and visa versa--relationships affect the body's release of oxytocin.  Hugs are good for us!    

ND Medicine:  Can our hearts break?  If so, can we die from it?

W:  There is a cardiac syndrome called the acute apical ballooning syndrome.  This was first described in the Japanese literature and was called Takotsubo Cardiomyopathy because the damaged heart looks like the trap Japanese use to trap octopus (which is called takotsubo in Japanese).  This fascinating and uncommon condition is typically found in young to middle-aged women who appear to have what looks like a heart attack.  What is unusual about this syndrome is that it typically occurs after intense emotional stress, and the patients have normal coronary arteries without the expected blockages. With this condition, the damaged heart returns to normal function over time, which would be very unusual in a "normal" heart attack.  It has been reasonably

demonstrated that the condition is due to really high levels of hormones in the blood that appear to damage the heart. The hormones are released by the glands in direct response to an intense emotional experience such as bereavement.  Thus, this condition is almost literally a broken heart and although mortality is lower than with a regular heart attack, people can die from it.  The good news is that complete recovery is the rule.   

ND Medicine:  What benefits does exercise have on our physical and emotional hearts?

W:  One of the critical components in a weight control or weight loss program is exercise.  Weight reduction can have other secondary positive effects.  First, there is the simple mechanical one:  Your knees wear out more if you're heavier, so you'll improve that with weight loss.  Two, blood pressure control is better and easier.  Third, diabetic control is better.  Lower blood pressure and better diabetic control can have direct beneficial effects on cardiovascular health. 

People who exercise feel better and in some cases are better.  Exercise positively influences the quality of life and to some degree the quantity of life.               Many people who exercise say, "I like to exercise because I feel the high from it."  Most of us who exercise know what they mean.  When people feel better, they tend to exercise more.  Now what leads to what?  Are they feeling better because they're exercising or are they able to exercise because they are feeling better?

M: Endorphins are naturally occurring opiates in the brain.  Exercise not only counteracts the effects of stress, but it makes us feel good because it results in an endorphin release in our brains.  

W:  That's right.  They are naturally occurring hormones that are elevated during exercise and they have opiate-like activities on the brain. They are a mediator of why you feel better after exercise.  That "runner's high" is attributed to high levels of endorphins and similar compounds.

M:  Also, although more well-controlled studies need to be done, many studies are showing strong evidence that regular exercise can decrease the symptoms of depression because of its effects on the release of certain brain chemicals as well as interactions between the central and peripheral nervous systems. 

W:  One of the biggest benefits of exercise is with depression.  Exercise has been shown to have an effect of improving depression.  The problem is that when we're depressed, one of the things you don't do is exercise, because you don't feel like it.  When people feel better, they exercise more.  So, to some degree, it is the horse and cart.  Which comes first?  Are they feeling better because they are exercising?  Or are they exercising because they feel better?

The data are not clean, but it does appear that exercise can have physically beneficial effects in addition to the psychological benefits.  It isn't that you just feel better.  You probably are better.  Now, how much of that is mediated by actual conditioning and how much is through emotions and endorphins is not known.  But we do encourage sensible exercise for everyone, but especially people who already have cardiac problems.  We know they will feel better and they probably are better, so exercise is good for both physical and emotional well being.

ND Medicine:  Do our physical and emotional hearts like sex? 

M:  Many studies are showing that this whole concept of falling in love is something that is hard-wired in our brains and driven by survival factors.  Scientists are finding that certain aspects of who we are attracted to are hard-wired in terms of body proportions, facial features and proportions, and age such that our brains are hardwired to pick up on the primary age of fertility for example.  Obviously, relationships are more complex than this but there is substantial evidence that aspects of human attraction are deeply rooted in our survival instincts.      

Another example of this "hardwiring" is a study that had heterosexual women sniff men's sweaty t-shirts and rank them from the most pleasant smell to the least pleasant smell.  They found that the t-shirts that smelled the "best" were those from a man who was the most genetically different from themselves.  One of the theories used to explain this is that the most genetically dissimilar couple would provide two immune systems that would be the most different.  In terms of their offspring, this would allow for better survival because it would combine aspects of both immune systems.

W:  From the standpoint of heart patients, one of the things that we talk about if someone has had a heart attack is an exercise prescription.  But one of the things physicians and other health care providers sometimes don't talk about, because it is very private, is when is it OK to resume normal sexual relations.  Patients and their partners are a little uncomfortable talking about it, but it needs to be discussed.  The good news is that for most heart disease patients, with common sense and some guidance they can resume this normal part of life.

ND Medicine:  How do you teach our medical students to take into account both the physical and the emotional heart?

M:  Our students learn a lot about cardiac anatomy, physiology, pathology and so on, but because we have a patient-centered curriculum, students really get at the core of another aspect of healing that involves the relationship between the doctor and patient.  In talking with people from other medical schools, it would appear that we're well ahead of the game in teaching patient-centered care in terms of our course-work and PCL cases.  Further, the organization and processes of this curriculum send a message to our students that our institution places a high value on relationship- or patient-centeredness. This by itself creates a powerful learning experience for the students in terms of the implicit message it conveys.  Namely, that the relation-ship between the doctor and patient is a central aspect of good medical care.

W:  Just like there are two sides to the brain, there are at two

aspects to illness-the physical and the emotional.  One of the things that we do particularly well in this school is that we try to address both aspects.  You wouldn't want to have a doctor who is a wonderful communicator but didn't know how to take care of a heart attack, for example. 

But similarly, you don't want a doctor who knows all about the latest treatment for a heart but doesn't talk with the patient about resuming sexual intercourse, for example.  Our school has traditionally focused on the behavioral aspects of health and illness.  With our patient-centered learning curriculum, it enables the students to use a holistic approach with the patient, integrating both physical and emotional care. 

One of beauties of patient-centered learning is that the questions about the case under study come from the students themselves.  A natural out-growth of this learning process is the students come to understand not only what causes heart disease and how we treat it, but they also understand the patient's reaction to it, the psychological issues for the patient, the emotional issues for the families, and the attendant stresses on relationships.  The students learn not only about heart disease, but also about the person in whom that heart disease resides.  That person has emotions, fears, baggage, and relationships.  The students have to know the principles of biochemistry, they have to know the drugs that we use to treat disease, but they also have to know the dynamics of relationships and the importance of emotions.                       

-Amanda Scurry

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