Commentary on “Did Jesus Die of Takotsubo Cardiomyopathy? A Medical Revisiting of the Gospels

Informed by Emanuela Marinelli, whom the authors thank, the following observation seems appropriate in reference to two very recent papers not in full agreement with each other. There are two possible etiologies for the death of Jesus: Takotsubo cardiomyopathy and/or stress-induced heart disease. Ref.1 hypothesizes Takotsubo pathology 4,5 as the etiology for the death of Jesus. Takotsubo cardiomyopathy is a particular non-ischemic pathology still not fully understood, is much more frequent in elderly women and often it is of a transitory nature. It resembles a heart attack but does not have lesions to the coronary arteries nor to the heart and leads to a ballooning of the left ventricle, with a widened base and a narrow neck similar to the Japanese octopus trap. It is considered a partial paralysis of the left ventricle of the heart. Ref.2, based on results of Ref.3, hypothesizes that Jesus, already during the Last Supper, was suffering from stressinduced heart disease (the neuroendocrine system increases the production of catecholamines and cortisol causing an increase in blood pressure and heart rate leading to spasms of the arterial vessels) which produces myocardial infarction even in the absence of coronary obstructions and dyslipidemia. These spasms, that also occur in young individuals, produce myocardial necrosis, and in the present case, likely resulted in cardiac tamponade from hemopericardium as the cause of death.6,7 In fact, Jesus likely began to develop this stress induced heart disease when, about twenty hours before His death, He was in the Cenacle next to Judas, the traitor. This pathology continued to develop during the hematohidrosis in the Gethsemane and later when He was beaten, scourged (with more than 370 wounds), crowned with thorns, when He carried the heavy cross on Mount Calvary and was crucified. The very high frequency of heartbeats due to stress, accentuated by tonic and clonic contractions, hypovolemia, orthostatic collapse and uremia likely caused a significant effusion of blood into the pericardial cavity producing hemopericardium from ruptured myocardium with subsequent congestive cardiac tamponade and immediate death after a strong chest pain. This is also in accordance with the Bible account: "With a loud cry, Jesus breathed his last." (Mark 15:37, New International Version). The Bible also states that “Instead, one of the soldiers pierced Jesus’ side with a spear, bringing a sudden flow of blood and water.” (John 19:34). This is in accordance with the blood contained in the hemopericardial sac decanted after a few hours from death when the red corpuscular part of the blood settled on the bottom leaving the serous part at the top. The spear that perforated the pericardium from below caused the outflow of "blood" first and "water" (the serum) later. Thus, stress-induced heart disease may also be an etiology for Jesus’ death.