‘Broken heart,’ Mozart effect and microvascular heart disease

In town this week is Prof. Sabino Iliceto, head of the cardiac, thoracic and vascular sciences of the University of Padova in Italy. It’s one of the oldest universities in the world where scientists like Galileo and Copernicus once roamed its corridors several centuries ago.

Its medical school is also the oldest in the world, and Professor Iliceto and his team of researchers are the sources of many groundbreaking works contributing to the pool of knowledge on how to cost-effectively evaluate the human heart and circulation with various diseases.

What I admire most in Professor Iliceto, whom I had the privilege to collaborate with in a medical education program in the past, is his passion and advocacy to share his knowledge and expertise with colleagues around the world. He has developed and produced more than 200 educational courses updating doctors worldwide on the treatment of various cardiovascular diseases. These sources could be accessed through the Web.

This week, he gave three talks—two in Manila and one in Cebu. He discussed a very important topic which is frequently unrecognized and undiagnosed in patients with problems in the heart arteries. Usually when patients with chest pains (angina pectoris) consult their doctors, only obstruction of the big arteries on the surface of the heart is evaluated. These are the arteries being fixed by bypass surgery or angioplasty through the use of catheters inserted through the wrist or groin.

However, researches over the last 10 years have shown that these big arteries only comprise 5 percent of the heart circulation. The much bigger part of the heart circulation is in the tiny but numerous articles penetrating the heart muscles. They comprise the microcirculation of the heart and is the source of what is now called as microvascular heart disease (MVHD).

Just like in diseases which obstruct the big heart arteries, similar risk factors like high blood pressure, diabetes, cholesterol problems, overweight and obesity, and smoking are also the identified major culprits in MVHD. But other factors that may lead to MVHD are the loss of the protective effects of the female reproductive hormones (estrogen and progesterone) after menopause; drugs like shabu, ecstasy, cocaine and marijuana; and even severe emotional stress.

In fact cases of what is now called Takotsubo cardiomyopathy have been reported all over the world after a Japanese physician first reported the cases of relatively young females presenting with an unusual case of heart failure following an intense emotional stress such as breaking off with their spouses or boyfriends. Hence, it’s also called as the “broken heart” syndrome. Traumatic situations and intense fear have also been reported to cause it in some case reports.

We joked Professor Iliceto that we have a unique variant here in the Philippines, and it’s called “takot-asawa” heart failure due to intense fear of the wife. He joked back and said that “takot-asawa” heart disease is also prevalent in Italy.

The clinical importance of Professor Iliceto’s researches and lectures on MVHD is that physicians should always consider this problem when assessing and treating their patients for heart disease. Unfortunately, to this date, MVHD is usually unrecognized, undiagnosed; hence, inadequately treated.

This is unfortunate because getting the necessary information to find out if a patient has MVHD or not can be easily done with the equipment (2D echocardiogram) which is available in more than half of the hospitals we have all over the country. It just requires a simple, learnable technique which Professor Iliceto and his staff would gladly teach any heart doctor familiar with 2D echocardiogram who’d be willing to spend a few days in his heart laboratory.

By knowing the status of the heart microcirculation and if the patient has MVHD or not, the doctor can be better guided on how best to manage the patient. A lot of patients who are being referred for angioplasty or bypass surgery could perhaps be spared with a more thorough evaluation of the status of his heart’s microcirculation. MVHD cannot be treated by surgery, but it can be significantly improved by maximizing lifestyle changes, and with the use of effective and suitable medications. Professor Iliceto even shared the results of a pilot study they’re currently doing on the effect of listening to classical music on the heart.

Patients having severe chest pains and heart attack have shown significant improvement, on top of the effects of the medicines they were given, by simply listening for 20 minutes to the soothing sonatas of Wolfgang Amadeus Mozart. Parameters of improvement of the circulation both in the big arteries and the microcirculation have been demonstrated.

It’s really amazing. And the good part is, we don’t have to wait to have a heart attack. Even those with normal hearts, and mild heart disease can benefit from it.

So, excuse me, while I listen to Mozart’s “Symphony No. 8 in D Major.”