The tale of the doctor with the broken heart

Expect to see a lot more sad, puzzled stories like this in the months to come

Dr. Kimberly Becher seems like a very good human being.

I’m not being sarcastic.

Dr. Becher is a family medicine physician in West Virginia who spent the best part of a decade caring for underserved and poor patients in a county that didn’t have a single stoplight, much less a hospital.

She grew up not far from that county, became the high school valedictorian, got out and came back. Okay, fine, her Twitter feed is somewhat annoyingly woke, but she comes by it honestly.

I know all this about Dr. Becher (except the part about her Twitter) because the New York Times saw fit to write a long profile of her today, entitled “A Rural Doctor Gave Her All. Then Her Heart Broke.”

The article explains how in April 2021, Dr. Becher “suddenly felt as if she were having a heart attack. She left for the emergency room, barely able to see, her blood pressure dangerously high.”

Her tweet from April 24, 2021 offers more details: “250/125 with runs of vtach [ventricular tachycardia], troponins trending up, cath [cardiac catherization], ICU.” No wonder she wound up in intensive care - that blood pressure reading is an immediate cardiovascular emergency all by itself.

Fortunately, Dr. Becher was only 41 at the time of the crisis, and she was in good shape - she had been training for a marathon. She recovered fully, although she has given up on distance running.

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But what caused Dr. Becher’s heart problems?

She was given a diagnosis of “Takotsubo’s cardiomyopathy,” sometimes called “broken heart disease.” Essentially, Takotsubo’s is a temporary weakening of the heart’s left ventricle, usually said to be caused by extreme stress. One paper describes it as “mimicking” a heart attack “but with only minimal release of cardiac enzymes.”

While Takotsubo’s can affect anyone, it most often develops in elderly women, often after they have suffered a severe emotional crisis such as the loss of a spouse. As Dr. Becher told the Times:

Takotsubo’s is typically caused by severe acute stress, something traumatic and abrupt. Mine was just from going to work every day and seemed super lame to me in the moment.

After all, Dr. Becher had been caring for underserved patients for years. She and the article both blame fights over Covid vaccinations - an interesting theory given that West Virginia had such HIGH vaccination rates in early 2021 the Centers for Disease Control actually lauded it.

Another crucial element of a Takotsubo’s diagnosis is that it is what physicians call a diagnosis of exclusion. Essentially, diagnoses of exclusion are given to patients as a last resort, when more conventional diagnoses do not fit. There is nothing wrong with them, but they are inherently somewhat unsatisfying - more prone to error than diagnoses that have stronger laboratory biomarkers.

As Becher described her illness on April 24: “Current diagnosis=takotsubo, literally from the #moralinjury of my job… I definitely had a moment of embarrassment at the diagnosis.”

So was there anything else that could have caused Dr. Becher’s sudden cardiac event - any new factor known to cause heart problems, especially in younger adults in good health?

Perhaps. And yet it goes not merely dismissed but completely unmentioned in the Times’s piece about her.

You’ve probably guessed by now what it might be.

Let’s all be thankful Dr. Becher has made a full recovery.