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Did you think that this was another sentimental heart-broken node?

No, broken heart syndrome is an actual medical condition. It is also known as stress cardiomyopathy, transient apical ballooning cardiomyopathy or Takotsubo cardiomyopathy.

I first heard about broken heart syndrome in church a few years ago. At the joys and sorrows time, there was an announcement that a church member had been transferred from our local hospital to a larger one. That she had an unusual heart condition, was on a heart-lung machine and was expected to recover.

I thought, another zebra. It must be my patient. Then I scolded that part of my brain for a while, saying that other doctors in town see rare things too.

The cardiologist called me two days later because it was my patient.

Broken heart syndrome was first called Takotsubo cardiomyopathy because tako tsobu is the name of a round octopus trap and the shape that the heart takes when it suddenly gives way. The heart suddenly weakens and the muscle balloons. This causes severe heart failure because the stricken heart muscle cannot pump correctly. There is chest pain and it looks like a heart attack, but when a cardiac catheterization is done, the vessels usually are not blocked.

The heart is stricken by stress. In my patient's case, she was the primary caregiver to her husband, who had cancer. It is often triggered by the death of a beloved spouse; a break up; extreme fear, severe illness or even winning the lottery. It was first described in Japan in 1990. It is 7.5 times more likely to occur in women then men, according to a study at the University of Arkansas by Abhishek Dehmukh MD. He found 6229 cases in US hospitals in 2007, with 761 of the patients being male. It is theorized that a sudden rush of stress hormones damages the heart so that it balloons and that microvascular blockages may play a role.

My patient was on a heart-lung bypass machine, to pump for her heart, for three or four days. Her heart recovered. She spoke to our church and said that as a caregiver she had to learn to take care of herself too.

The poets are right. Our hearts can break, with a mortality rate of 1-2%. Take care.

National Institutes of Health
Mayo Clinic
Johns Hopkins
American Journal of Roentgenology
Daily mail
A picture
Art and science

For Science Quest 2012.

Gravity is one of the four known fundamental forces of the universe. It is the one that determines which way is down - in some ways it is the most obvious and familiar of the forces, but it is only since Isaac Newton that people have really thought of it as being a force at all. Before that people just figured that stuff has a natural tendency to fall downwards, which is not quite the same thing; Newton's great insight was to realise that the observed universe starts making a lot more sense if we suppose that everything is attracted to everything else, and that the motions of the moon and the planets and our own Earth around the Sun can be explained by the exact same force that drops an apple to the floor.

Gravity is by far the weakest of the forces. To get an idea of just how weak it is compared to electromagnetism, consider how easy it is to pick up pieces of paper using the static electric charge on a comb that has just been through clean, dry hair: all it takes to overcome the entire gravitational pull of the planet Earth is those few electrons that have jumped from your hair to the comb. Yet gravity dominates at large scales, because electromagnetism has an in-built tendency to cancel itself out - positive charges are so strongly attracted to negative charges that they almost always appear together, and from a distance, the conflicting positive and negative pulls almost always balance each other out.

Gravity is strongly self-reinforcing, since it attracts everything to everything. This gives bulk matter a tendency to congregate and to collapse in on itself, which is one of the main reasons the cosmos orders itself into galaxies, stars, planets and clouds, with vast areas of mostly-empty space between them. Things tend to collapse into balls, on a big enough scale, or spin into discs. When a dust cloud collapses in on itself, its gravitational potential energy is converted into other forms of energy, much of it ending up as heat. This is why the centre of the earth is hot, and how stars get hot and dense enough to initiate nuclear fusion.

Every object in the universe is attracted to every other object in proportion to the mass of each object, and in inverse proportion to the square of the distance between them. That is, an object twice as far away will be attracted one quarter as strongly. This inverse square law is the result of the gravitational field spreading out in all directions from any body. It happens for exactly the same reason that when you look at something from twice the distance, it looks a quarter of the size, in the sense that it is half as wide and half as tall. The area of a sphere (or cube) is therefore in proportion to the square of the distance, and gravity spreads out in a sphere from its source.

At any point in space, the total strength of the gravitational field tells you how strongly it pulls on any unit of mass - the force applied per kilogram of mass, or equivalently the rate at which things accelerate. Right here on the surface of the Earth, everything is pulled downwards at the rate of about 9.8ms-2 (or equivalently, 9.8N/kg) - that is, ignoring drag, any falling object will fall 9.8 metres per second faster (or 22 miles per hour) for every second it falls. We can't ignore drag in the real world, of course, and in practice any given object will eventually reach a terminal velocity where the drag matches the force of gravity. This depends on the weight and shape of the object. For an adult human it is around 55 metres per second - that's more than 120 miles per hour. For a mouse it is less than a tenth of that, so it is probably true that mice can survive a fall from any height - depending on how they land. Cats appear to be slightly more likely to survive after they reach their terminal velocity (which is around about 7 floors down), presumably because they find their feet, stop panicking and very quickly get the hang of being their own feline parachute.

The fact that gravitational field strength can be measured as a rate of acceleration was one of the threads that led Einstein towards the General Theory of Relativity. He started considering what it might mean if gravity is in fact identical to acceleration, in the light of what the Special Theory of Relativity tells us about velocities - in particular, Minkowski's formulation of relativity in terms of spacetime. If velocity can be seen as a rotation in spacetime, and gravity can be seen as a rate of change of velocity, maybe gravity arises from a change in spacetime? Einstein figured out that if he supposed that spacetime is curved by the presence of any mass, he could use the equations of four-dimensional geometry that Riemann had worked out sixty years before, to produce something that looked very much like Newton's equations of gravity... until you looked at what happens near extremely massive bodies, or at subtleties like the way light curves around stars.

Einstein's conception of gravity has a number of very interesting consequences. One is that the distortion of spacetime around every massive body means that the closer you get to it, the more time slows down - so time passes measurably slower for us than it does for a satellite in orbit. The effect is small here, but around much more massive bodies, it would become far more noticeable.

Another rather odd consequence of General Relativity is that from a certain point of view, gravity is not a force at all - it is just what happens when things follow their natural trajectory along the most direct path through spacetime. Indeed, someone in freefall does not feel anything like a force of gravity - which is why astronauts in orbit feel weightless, although they have by no means escaped the pull of the Earth's gravity entirely. From the more familiar frame of reference of someone standing on the surface of a planet, of course, gravity looks very much like a real force - just as it makes sense for someone on a fast-spinning roundabout to treat centrifugal force as a real thing. Indeed, there are two ways of viewing the weightlessness of orbit. One is that being in orbit is like being in freefall, while moving sideways so quickly that you never touch down. The other perspective is that since you are moving around in an ellipse at just the right speed, you feel a centrifugal force that exactly matches the pull of gravity, cancelling it out. The distinction between 'fictitious' and 'real' forces is not clear-cut, and string theory suggests that all forces may in fact depend on one's frame of reference - which would make them, in some sense, fictitious.

Black holes and wormholes might also be fictitious, and they certainly sound unlikely when you first hear about them. In fact, though, black holes are almost certainly quite real, and wormholes are at the very least plausible. There is no apparent limit to the amount of spacetime curvature that general relativity allows, you see, and no known force in the universe which can resist a strong enough gravitational pull. That makes it seemingly inevitable that when sufficient mass collects in one place, it will eventually collapse into a gravitational singularity - a point, or ring, of infinite spacetime curvature, from which almost nothing can escape. Although we cannot observe it directly - conclusively proving the existence of an actual black hole is extremely difficult, even in principle - the signs are very strong that there is a black hole at the centre of our own galaxy, with the mass of more than four million suns. There is less reason to think that our universe contains actual wormholes, which is to say hyper-dimensional tunnels connecting two regions arbitrarily far apart in space and in time. However, they are at the very least a tantalising possibility suggested by the mutability of spacetime - nobody has been able to rule out that it might be possible to build one.

In daily life, of course, we usually don't have to think about relativistic gravity - in fact, as long as we stay close to the surface of the Earth, even Newton's universal gravitation is barely relevant. The main thing to know on Earth is that the gravity around here accelerates things downwards at about 9.8ms-2, which means that a 1kg weight gains 9.8J of kinetic energy for every metre it falls (or gains the same amount of potential energy for every metre you raise it up). Having said that, the effective strength of gravity on Earth actually varies from about 9.832ms-2 at the poles to about 9.780ms-2 at the Equator, so a 1000lb pumpkin at the North Pole would only be a 994.7lb pumpkin by the time you got it to the Equator. Even for interplanetary space missions, good old-fashioned Newtonian physics is generally enough to plan your trajectories around the solar system. It is true, though, that as soon as you are in orbit you will start gaining 38 microseconds on us every day. Granted, that is only one full second every 73 years - but 38 microseconds of time is also the equivalent of seven miles' worth of space, and sometimes that is important.


Further reading

Richard Feynman's Lectures on Physics are excellent on gravitation (see chapter 7 of volume one). You could read that for free on the internet, but that would be illegal. Most of this stuff is remembered from my undergraduate days; any time I was at all unsure I checked against various Wikipedia articles, whatever showed up in Google and/or people who sort of know what they're talking about. The stuff about falling animals turns out to be quite difficult to get hard figures on. The How Far Can An Animal Fall And Still Survive? node was handy, and this demonstration from the BBC was fairly persuasive, while this page has someone attesting that falling mice aren't always so lucky, and here is a source for the report that cats tend to fare a bit better if they fall even further than seven floors. Without this page I would probably have included the extremely plausible myth that the Global Positioning System wouldn't work at all without relativity.

Ethyl vanillin glucoside is one of the many many checmial additives which may be found in conventional cigarettes. Specifically those cigarettes which are manufactured by RJ Reynolds, the company which holds the patent for ethyl vanillin glucoside.

Unlike some chemicals which are added into to make the cigarettes more addictive, this one is put into the papers to make the smoke not smell like ass. How effective that aim is is wholly dependent upon one's tolerance for smoke.

A 1990 summary of studies by RJ Reynolds concluded that this chemical is mostly harmless in small doses, although it does admit that the average consumption exceeds the safety threshhold just a tad—albeit nomoreso than any other chemical additives in cigarettes. At most humans, will exhibit minor eye irritation from ethyl vanillin glucoside; no genetic toxicity was found. Each cigarrette's paper contains  270 µg of ethyl vanillin glucoside, or about (between 0.6% and 0.8% of the total paper's weight).

The chemical composition of ethyl vanillin glucoside is a one to one covalent bond between ethyl vanillin and glucose. The ethyl vanillin is released as a vapor as the cigarette burns the glucose into ash.


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