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Sanjay Gupta MD

Broken Heart Syndrome May Be Ultimate Link Between Body And Mind; Recent Summit At Cleveland Clinic Brings Brain-Heart Connection To Forefront; Studying Time And Life Rhythms Of The Body; Exercise Could Mean Better Grades

Aired June 24, 2006 - 08:30   ET


ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Elizabeth Cohen, sitting in for Dr. Sanjay Gupta.
This morning, we're talking about some amazing science that shows a link between your heart and your brain. You'd be surprised how much your emotions actually impact your heart. For instance, you've heard of a broken heart or heartache from grieving. Well, as Dr. Gupta reports, a big enough emotional shock has been shown to literally stop your heart.


DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT (voice-over): Two years ago, Karen and Denny Schillings took a family trip on a pontoon boat, much like this one in the Baltimore Harbor.

DENNY SCHILLINGS, FATHER: Suddenly we're all under the water and under the boat.

GUPTA: Karen thrashed below the murky water under the boat struggling to reach the surface. Denny had already reached the surface, but no sign of the Schilling's daughter Corrine and her boyfriend, Andrew.

Karen and Denny Schillings were rescued and Karen treated for hypothermia at Johns Hopkins.

KAREN SCHILLINGS, MOTHER: Then later in the evening, Denny came back in to tell me that they had called off the efforts that night to find Andrew and Corrine. And not too long after that is when the chest pains started.

GUPTA: Karen's first thought, I'm having a heart attack.

(on camera): When it comes to chest pain, numbness down the arm, as physicians that's the one thing that you sort of immediately react to because that's a heart attack.

K. SCHILLINGS: That's right.


GUPTA: But they were saying sounds like a heart attack, looks like a heart attack, but not a heart attack.

K. SCHILLINGS: I knew something wasn't going right, that something was happening that they hadn't seen before.

GUPTA (voice-over): What they were seeing was called broken heart syndrome.

DR. ILAN WITTSTEIN, JOHNS HOPKINS: Now a person can come in with all the same signs and symptoms of a heart attack. But unlike a heart attack where there's permanent damage done to the heart muscle, with broken heart syndrome you really have a temporary dysfunction of the heart muscle.

GUPTA: It's caused by a sudden stress or trauma. And unlike a traditional heart attack, people with broken heart syndrome have no evidence of heart disease. Dr. Ilan Wittstein was a consulting physician on Karen Schilling's case.

WITTSTEIN: She experienced stress perhaps on multiple levels. The physical stress of being under water, being in freezing cold temperature, the absolute fear of trying to survive the drowning episode.

GUPTA: Cases like Karen's illustrate the profound impact that the brain and emotions can have on the heart.

DR. JAMES YOUNG, CLEVELAND CLINIC: We know that there is clearly a link between emotions, emotional stability, and well-being.

GUPTA: Karen has not had any heart problems, any episodes whatsoever since Corrine's funeral.

K. SCHILLINGS: There are a lot of things about this that may be of -- changed my perspective on life. I'm happy that Corrine and Andrew are together, because that's what they wanted. So that's a good thing.

Also, the idea that I should live my life now to make Corrine proud. And that's what I've tried to do.

GUPTA: Dr. Sanjay Gupta, CNN, reporting.


COHEN: Thanks, Sanjay.

Well, the idea of the brain-heart connection has been studied for decades, but a recent summit at the Cleveland Clinic brought even more experts and research to the forefront. Getting us up to date with this emerging field is Dr. Anthony Furlan. He's head of the Stroke and Neurological Intensive Care at the Cleveland Clinic.

Welcome, doctor.

DR. ANTHONY FURLAN, CLEVELAND CLINIC: Thank you, Elizabeth. COHEN: I want to ask you -- broken heart syndrome looks in many ways like a heart attack. So how do you diagnose broken heart syndrome? And what's the danger if it's not diagnosed?

FURLAN: Well this syndrome, although it's been described maybe as long as 100 years ago is now only being increasingly recognized thanks to some work done at Johns Hopkins. This tends to occur in middle-aged women who have been subjected to some acute emotional distress of some sort.

It can be a sadness, or it can be a happiness, but it's an acute, very dramatic emotional event. And this precipitates sudden heart failure in the prone individual. And this presents as sudden trouble breathing, sudden shortness of breath. And they present to the emergency room with this syndrome.

So the first step is for the emergency room to recognize that this occurs. And there are some very specific hallmarks that should lead the physician to recognize that they may be dealing with this broken heart syndrome.

COHEN: Doctor, we've got a viewer question now about the links between emotions and the heart. Walter from New York writes this. "I am 36 years old and suffer from palpitations quite often. I've had a full cardiac workup showing no problems. I've been very anxious lately and wonder if there is a link between anxiety and heart maladies." Doctor, what do you think?

FURLAN: Well, I think we've all experienced a rapid heartbeat and sweaty palms when we're put under stress, such as giving an interview that -- or stage fright. I mean, there are many examples of this.

The fight or flight phenomenon when you're under stress. And one component of that is a rapid heart rate. If you're anxious about something or concerned, your heart rate tends to be more rapid.

This is because the brain, of course, which controls the emotions like anxiety is also linked to the heart through what we call the autonomic nervous system. And an involuntary response when someone is anxious or scared is to trigger what's called the sympathetic component of this autonomic nervous system. And that makes your heartbeat faster.

Now palpitations, rapid heart rate are benign in the vast majority of individuals. We all experience this occasionally. And in most people, it's nothing to be concerned about. If they're persistent, however, and frequent, then you should consult with your physician to make sure it isn't a more serious rapid heart rate problem.

COHEN: Doctor, do men and women handle stress differently? And what kind of an impact does that have on the heart?

FURLAN: Well, that's an interesting question. I mean, the answer is yes, men and women do handle stress differently. The broken heart syndrome that we talked about briefly is much more common in women, for example. And in particular, post menopausal women.

And this suggests that at least in this particular heart-brain interaction, hormones play a significant role. And yes, we hear that women are more right-brain oriented. Men are more left-brain oriented. I think this applies to the emotions as well.

COHEN: Well, let's get to another e-mail now. This one is from Fabiano in Connecticut. He writes, "Please explain the relationship between depression, inflammation and heart health." Doctor, I think many people want to know. Does depression affect the health of your heart?

FURLAN: Very definitely. I think depression affects your sense of well-being in general, not just your heart, but vascular disease in particular. Patients who have a stroke, patients who have heart failure, patients who have a heart attack can for significant depression. And this can affect how well patients recover, how well they comply with their medication program, how well they're complying with their rehabilitation program.

Now interestingly, some recent studies have suggested there's more to depression in heart disease and vascular disease in general than just the mood, the emotion.

There's some very interesting studies suggesting that depression, through this autonomic nervous system, can influence inflammation in the body. And inflammation is now thought to be the central problem in leading to hardening of the arteries or atherosclerosis.

And so, there's this very interesting link between stress, depression, the autonomic nervous system, inflammation and triggering events like heart attack and stroke.

COHEN: Well, stay with us, because we're looking at a new buzzword in medicine after the break.

UNIDENTIFIED FEMALE: It could help treat sleep disorders, asthma, even help predict strokes.


UNIDENTIFIED MALE: Therapy is all about timing.

UNIDENTIFIED MALE: And we always say this is a joke that it's all about timing.


UNIDENTIFIED FEMALE: A new frontier in medicine after the break.

And later, could this be the new-age classroom? Find out why some experts say it could extend children's lives.

First, today's quiz. What time of day do most heart attacks occur? The answer, coming up.


UNIDENTIFIED FEMALE: Checking the quiz, we asked, what time of day do most heart attacks occur? The answer -- they strike three times more often in the morning than at night.

COHEN: Now just as timing matters with heart attacks, we also know it matters with testicular cancer. It seems to be diagnosed more often in the winter rather than in the summer.

And of course, there's the study of sleep and some forms of depression, all relating to seasonal or sometimes individual rhythms. It's called chronobiology, or the study of time and life rhythms of the body.

Dr. Sanjay Gupta is back now with a look how this timing can help in diagnosing even in treating and preventing disease.


GUPTA (voice-over): Two years ago, the peaceful life Diane Klenke was accustomed to began to slowly fall apart. It started with mild discomfort in her abdomen then...

DIANE KLENKE, CANCER PATIENT: I was doubled over in pain. I was just miserable.

GUPTA: She was rushed to the hospital. And hours later, doctors were still pouring over her case.

KLENKE: But I said tell me what's going on. Well, we see something we want to check out further.

GUPTA: The news was grim. Diane's pancreas and liver had been hijacked by cancer. One tumor was the size of a grapefruit. Doctors told Klenke that not even chemotherapy could help her. She had mere months to live.

You're thinking at that time was what? I mean, were you think OK, you know, maybe it is time to get my affairs in order.

KLENKE: I wasn't willing to give up yet. I thought I've got too much to live for. I've got -- my daughter was pregnant. And I had another daughter just engaged. And I thought I want to be here.

GUPTA: With few options left, Klenke tried something called chronotherapy.

DR. KEITH BLOCK, BLOCK CENTER FOR INTEGRATIVE CANCER TREATMENT: Chronotherapy is all about timing. Nine genes are the molecular timekeeper for our entire physiology. Just like flowers open up, you know, when it's light out in the morning and close up at night, we have entire physiological rhythms that are being adjusted through the day and night and through the seasons.

GUPTA: With chronotherapy, patients are quizzed about their habits, sleep patterns, diet, exercise -- all things that impact the body's internal clock.

Chemo drugs are pumped in on a precise timetable based on that information, synchronized to the body's internal rhythms. So instead of a daily dose at say 10:00 a.m. every day, Diane received chemotherapy while she slept, when her healthy cells were dormant and her cancer cells were active.

BLOCK: We can actually time drugs so that they'll diminish a lot of the side effects. And at the same time, it can also boost the effectiveness of the therapies.

GUPTA: Timing is not just for treating cancer. It can also be used to help diagnosis heart disease and stroke. Using our internal clocks as a guide, we know now that stress hormones soar in the morning, as does blood pressure in the afternoon. Those fluctuations may explain why heart attacks are so common in the morning and strokes during midday.

Chronotherapy helps when doctors can time blood pressure readings so they're measured throughout the day, instead of just once. Using internal cues, we may one day predict stroke.

EARL BAKKEN, NORTH HAWAII COMMUNITY HOSPITAL: So when they have a normal blood pressure, when they go in to have it examined in the morning, but may have -- be hypertensive in the afternoon but never get measured in the afternoon.

GUPTA: Chronotherapy is used in a handful of medical facilities. It is now used to treat depression, sleep disorders and asthma.

It seems simple. We're not talking about changing the world here. We're not talking about new therapies. We're not talking about billions of dollars of drug research. We're talking about using a clock. Why isn't everyone doing this?

BLOCK: It's not convenient for the doctor to work around the patient's schedule. They really have to change their entire medical center to work around the patient's schedule instead of working really around the medical center's schedule.

GUPTA: Timing caused Diane's grapefruit size tumor to shrink to the size of a kidney bean. And...

KLENKE: They looked at my liver and said hey, the liver tumors are gone.

GUPTA (on camera): A lot of people say that's all quackery. You know what...

KLENKE: Oh, absolutely not. Absolutely not.

GUPTA: You're living proof that it isn't?

KLENKE: I'm living proof that it isn't.

GUPTA (voice-over): For now, Klenke is relishing her new lease on life and being around for her family.

Dr. Sanjay Gupta, CNN, reporting.


COHEN: Thanks, Sanjay.

Talking us through this new science is Dr. Anthony Furlan. He's head of Stroke and Neurological Intensive Care at the Cleveland Clinic.

Doctor, is chronotherapy something people can just go to their doctor's office and ask for at the next visit?

FURLAN: Oh, I don't think so. I think this is a very emerging field that most practicing physicians are only vaguely familiar with.

COHEN: And so if you go and ask for chronotherapy in most places they're just going to tell you, you know, we don't do it here?

FURLAN: Well, not only that. Most typical physicians would probably consider this a fringe therapy or almost a quack therapy, if you will. That's how it's been sort of viewed by the traditional medical industry, I would think.

COHEN: And how much science is there showing whether or not chronotherapy works?

FURLAN: Well, there's a tremendous amount of science that the body runs on clock rhythms. In fact, you can take this down to the cell level. If you look at individual cells, especially in the brain and the heart, for example, they have little oscillator clocks within the cell. Many of these are genetically driven so that a particular cell will be turned on or off at different times during the course of the day or even seasonally.

And that means whatever the cell does will be turned on or off depending on what time of day it is, what season it is. And if that cell makes hormones, for example, it can influence hormone levels like insulin levels. Diabetic responses to insulin may differ depending on the time of the day.

We just heard how cancer therapy drugs may be more or less effective, depending on the time of day they're administered. So I think clearly what we call circadian rhythms, these oscillating clocks within the body, within cells in the body, clearly exist. There's a whole science of circadian rhythms that's developing.

But how to take that information and apply it to patient care is, I think, where we need more research.

COHEN: We're talking with Dr. Anthony Furlan. New frontiers in medicine after the break.

UNIDENTIFIED FEMALE: Two vital organs -- heart and brain. Discover the important messages they send to each other and to you. But first, this week's medical headlines in "The Pulse".


JUDY FORTIN, CNN CORRESPONDENT (voice-over): Americans as young as two years old are being urged to significantly cut bad fats from their diet. The American Heart Association's new guidelines say less than one percent of total calories should come from the trans-fatty acids found in many cookies, crackers, and bread. For the first time, they're also emphasizing physical activity and telling people not to smoke.

Basketball is making news, not just because of the NBA finals. It tops the list of sports with the most injuries. Loyola University researchers say more than half a million people were treated for basketball related injuries at emergency rooms last year. Bike riding, football, soccer, and baseball round out the top five.

Judy Fortin, CNN.



COHEN: If you missed any part of this weekend's show, or want to look up old shows, you can get free transcripts by going to Look on the left-hand side for the link.

We've been talking about some exciting new research being down on how our hearts and brains interact with one another.

With us this morning is Dr. Anthony Furlan, the head of Stroke and Neurological Intensive Care at the Cleveland Clinic.

Doctor, I want to ask you about a condition where people have holes in their heart. Does that put you at a greater risk of having a stroke, which of course occurs in the brain?

Now many people don't know that former Israeli Prime Minister Sharon had a hole in his heart. And he, of course, had a massive stroke earlier this year. Thousands of other people also have holes in their hearts. Should they also be worried about having a stroke?

FURLAN: Well, one of the most important connections between the heart and brain, Elizabeth, is stroke because about a quarter of all strokes are caused by a heart condition.

And if you're under the age of 50, the most common heart condition causing stroke is a patent framinavola, which is hole between the right side and the left side of the heart that about 20 percent of the population are born with.

And then the vast majority of people, they never even know they have it. So in most people, it's a benign condition.

But in a small percentage of patients, it will come to our attention because they have a stroke. Because it doesn't cause heart problems it causes stroke.

And the public became aware of this, of course, when Ariel Sharon recently had a stroke. Actually, his initial stroke was very minor. What caused the massive stroke and the brain hemorrhage was the treatment of the hole. Because while he was waiting to have the hole patched, which is one way we treat these holes, he was put on a strong blood thinner.

And the blood thinner, which was supposed to prevent a PFO- related stroke, caused leaking of blood into the brain, a brain hemorrhage. And so the treatment of the PFO actually caused the massive stroke, not the PFO itself.

COHEN: Dr. Anthony Furlan, thank you for being with us this morning. Great information about our hearts and our brains.

Stay with us.

FURLAN: Thank you for having me.

COHEN: Stay right where you are. We're going back to school right after the break.

UNIDENTIFIED FEMALE: Imagine a classroom without a single desk.


UNIDENTIFIED MALE: Learning is fun. And the fact you get healthy while you're doing it, we'll take that, too.


UNIDENTIFIED FEMALE: Kids dance and drive their way through school coming up on HOUSE CALL.


COHEN: Welcome back to HOUSE CALL. We've been talking about the links between your brain and your heart. And one thing we definitely know is that being active helps both. Exercise, of course, helps to keep your heart in shape, plus it increases alertness which if you're in school could mean better grades.

Dr. Sanjay Gupta checks out a new type of learning that could help the brain and the heart.


GUPTA (voice-over): This could be the school of the future, a place without walls or a single desk.

DR. JAMES LEVINE, MAYO CLINIC RESEARCHER: Is it possible to create a learning environment where children learn in a more dynamic exciting, fast moving way, and yet are healthy?

GUPTA: Researchers at the Mayo Clinic wanted to know. So they filled this athletic club with a bunch of elementary school kids from Minnesota and surrounded them with cool gadgets.

Children wore monitors to measure how many calories were burned, and to see just how much they moved while they were learning.

Students chose how they wanted to work in sitting bays, standing up, kneeling, or even getting down on the floor. Laptops and iPods played a big role. And wall monitors were set up for streaming video.

Everyone got their own white board for individual lesson plans. Mayo Clinic researcher Dr. James Levine headed up the study.

LEVINE: But now you have this huge space where you can draw, you can write, you can be creative.

GUPTA: Researchers even played around with the idea of giving students a hockey net to call their own.

LEVINE: Now you can learn in one. Learning is fun. And the fact you get healthy while you're doing it, we'll take that, too.

GUPTA: Students were able to dance around on their lunch break and get behind the wheel for mini breaks throughout the day. The local school district has given permission to build an experimental school based upon this model in Minnesota. Planners say it will be less expensive than your standard school, a flexible space that can be turned into a community center at night.

Levine says once the price of technology comes down, a deskless school won't be hard to do anywhere.

LEVINE: Theoretically, we could place everything you've seen here today in any space in the country within 15 minutes.

GUPTA: Dr. Sanjay Gupta, CNN, reporting.


COHEN: Thanks, Sanjay.

We're out of time this morning, but make sure to tune again next weekend when we're going behind the numbers in the wars in Afghanistan and Iraq, and discovering the new technologies in medicine that are helping soldiers survive their war injuries. That's next Saturday and Sunday at 8:30 a.m. Eastern.

Thanks for watching. I'm Elizabeth Cohen. Stay tuned for more news on CNN.