Sarah Died of "Broken-Heart Syndrome"

The Bible tells us that Sarah died suddenly, shortly after Abraham’s binding of Isaac. According to Midrash Tanchuma Parashat Vayera, 23:5, Sarah died when Satan told her that her son Isaac died at the Akedah. “Satan visited Sarah in the guise of Isaac. When she saw him she asked: “What did your father do to you, my son?” He replied: “My father led me over mountains and

through valleys until we finally reached the top of a certain mountain. There he erected an altar, arranged the firewood, bound me upon the altar, and took a knife to slaughter me. If the Holy One, blessed be He, had not called out, ‘Lay not thy hand upon the lad,’ I would have been slaughtered.” He had

hardly completed relating what had transpired when she fainted and died.” Another version of this is found in Pirkei d’Rabbi Eliezer, chapter 32. “When Abraham returned from Mount Moriah in peace, the anger of Sammael (Sa-

tan) was kindled, for he saw that the desire of his heart to frustrate the offering of our father Abraham had not been realized. What did he do? He went and said to Sarah: Hast thou not heard what has happened in the world? She said to him: No. He said to her: Thy husband, Abraham, has taken thy son Isaac and slain him and offered him up as a burnt offering upon the altar. She began to weep and to cry aloud three times, corresponding to the three sustained notes (of the shofar), and (she gave forth) three howls corresponding to the three disconnected short notes (of the shofar), and her soul fled, and she died.” Based on these midrashic accounts, Rashi on Genesis 23:2 too

indicates that the juxtaposition of Sarah’s death with the Akedah is that when she heard that Isaac was slaughtered at the Akedah, and she died.

This may be the earliest recorded case of Takotsubo cardiomyopathy:

commonly known as broken-heart syndrome or stress-induced cardiomyopa-

thy. Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress.1, 2, 3

Dr. Joshua Backon, now retired, was affiliated for over 33 years with the Hebrew University Faculty of Medicine. He is Executive Director of the Jewish Bible Association.

Takotsubo syndrome (TTS), triggered by intense emotional or physical

stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4–5%) owing to cardiogenic shock, myocardial rupture, or lifethreatening arrhythmias.4, 5

There is an increased incidence of Takotsubo cardiomyopathy in women

with menstrual irregularity (21% vs. 0%) or amenorrhea (3% vs. 0%).6 In a paper in the Jewish Bible Quarterly, I had suggested that Sarah suffered from polycystic ovary syndrome.7

NOTES

1. Y. Sethi. H. Murli, O. Kaiwan et al. “Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management.” Journal of Clinical Medicine 2023, 12(1):125. 2. J. Salamanca, F. Alfonso. “Takotsubo syndrome: unravelling the enigma of the broken heart syndrome? – a narrative review.” Cardiovascular Diagnosis and Therapy. 2023, 13(6):1080 – 1103.

2. H. Z. Brandspiegel, R. A. Marinchak, S. J. Rials, P. R. Kowey. “A Broken Heart”. Circulation 1998, 98:1349.

3. A. A. Manolis, T. A. Manolis, A.S. Manolis. “Takotsubo Syndrome and Sudden Cardiac Death.” Angiology 2023, 74(2):105-128.

4. K. C. Wu, I. S. Wittstein. “Ventricular Arrhythmic Risk in Takotsubo Syndrome: Clinical Subtype Matters.” Journal of the American College of Cardiology. 2022,8 (12) 1511–1514 6. E, Salmoirago-Blotcher S. Dunsiger, H. H Swales, et al. “Reproductive History of Women with Takotsubo Cardiomyopathy.” American Journal of Cardiology 2016,118:1922-1928. 7. J. Backon, “A new interpretation of akarah . . . Ein lah valad (Gen. 11:30) based on the Talmud: unattached follicle.“ Jewish Bible Quarterly 2012, 40:265-267.

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