{"id":2493,"date":"2015-02-04T09:49:47","date_gmt":"2015-02-04T09:49:47","guid":{"rendered":"http:\/\/revoscience.com\/en\/?p=2493"},"modified":"2015-02-04T09:49:47","modified_gmt":"2015-02-04T09:49:47","slug":"beethovens-arrhythmias-likely-inspired-some-of-his-masterpieces","status":"publish","type":"post","link":"https:\/\/www.revoscience.com\/en\/beethovens-arrhythmias-likely-inspired-some-of-his-masterpieces\/","title":{"rendered":"Beethoven\u2019s Arrhythmias Likely Inspired Some of His Masterpieces"},"content":{"rendered":"
\"Beethoven's<\/a>
Beethoven’s arrhythmias may have inspired passages in his greatest masterpieces<\/figcaption><\/figure>\n

Does the music we play come from the music of our bodies\u2014at work?<\/span><\/p>\n

Recent research on Ludwig von Beethoven says: likely.<\/span><\/p>\n

Zachary Goldberger made newspaper headlines in the mid-1990s as a student, when he conjured music out of heartbeats with his Harvard Medical School electrophysiologist father Ary; made a CD of them; and built an exhibit related to them at the Museum of Science. (The CD is still found on\u00a0Amazon<\/span><\/a>.)<\/span><\/p>\n

Now a cardiologist at Washington University, the younger Goldberger has published a headline-grabbing\u00a0paper<\/span><\/a>\u00a0on a related topic, this time with a Beethoven scholar and a medical historian. The trio have found three Beethoven compositions, forged during stressful times in the composer\u2019s life, to be arrhythmic in a way that mirrors his own probable arrhythmias, or premature ventricular contractions (PVCs).<\/span><\/p>\n

The paper has captured the imagination of musicians and medical types alike.<\/span><\/p>\n

It is \u201cexcellent, well-balanced and refers to relevant literature,\u201d emeritus University Hospital Bonn Department of Cardiology and Medicine chief Berndt Luedertiz told\u00a0Bioscience Technology<\/em>.<\/span><\/p>\n

Luderitz, an arrythmologist who invented many pacemakers, has\u00a0written<\/span><\/a>\u00a0on the topic. The new paper adds much to the idea that some of our music comes from rhythms we \u201chear\u201d inside, he said\u2014if, ironically, \u201cthis might be particularly in deaf composers like Beethoven and Smetana.\u201d<\/span><\/p>\n

\"Cardiologist<\/a>
Cardiologist Zachary Goldberger says some Beethoven passages are “musical echocardiograms.”<\/figcaption><\/figure>\n

\u201cLong before Einthoven recorded heartbeats through graphic representation of their electric potentials, or EKGs, Beethoven expressed them in musical notes,\u201d George Washington University cardiologist Tsung Cheng told\u00a0Bioscience Technology<\/em>. (Willem Einthoven, a Dutch doctor and physiologist, invented the first practical electrocardiogram in 1903 and received the Nobel Prize in (Medicine in 1924.) Cheng has also\u00a0written<\/span><\/a>\u00a0about the topic. He, too, believes music can evolve out of internal rhythms, although he is a \u201cmaybe\u201d on whether the deaf \u201chear\u201d them better. As for Goldberger, he says that \u201cof course\u201d he thinks the music of our bodies informs the music of our brains, he told\u00a0Bioscience Technology<\/em>. But the degreeto which musical\u00a0genius<\/em>\u00a0comes from internal \u201cmusic\u201d\u2014let alone from internal flaws like PVCs and deafness\u2014is unsettled.<\/span><\/p>\n

\u201cPart of Beethoven\u2019s genius, his sublimity, was to overcome adversity and transcend limitations with his art,\u201d Goldberger said. \u201cThis paper presents a speculation, and may offer a new dimension by which one can attend to Beethoven, as well as other works of music. We are listening to his music with a stethoscope. We invite the reader-listeners to approach these works with open minds and open ears, and form their own opinions. Most important is simply to listen to the music, which speaks for itself, and for all of us, in ways that need no translation (nor an ECG).\u201d<\/span><\/p>\n

Music as \u201coverture\u201d to medicine<\/span><\/p>\n

Music was the \u201c\u2018overture\u2019 to my career path into medicine,\u201d Goldberger said. He grew up studying classical piano, and had published two albums of solo piano compositions by the time he entered Brown University in 1994. One album was \u201cHeartsongs: Musical Mappings of the Heartbeat,\u201d by the Museum of Science, Harvard investigators and Boston University.<\/span><\/p>\n

\u201cWe were able to translate the cardiac interbeat interval fluctuations\u2014derived from Holter monitoring in both healthy subjects and those with heart disease\u2014into music,\u201d Goldberger toldBioscience Technology<\/em>. \u201cThe intervals were translated into numerical sequences which were then mapped onto the musical scale. The rise and fall of the melody (of which I had no control)\u2014not the rhythm\u2014reflects these interbeat intervals.\u201d<\/span><\/p>\n

What did they find?<\/span><\/p>\n

\u201cThe variation in healthy hearts produced a very complex, variable melody line,\u201d Goldberger said. \u201cPatients with severe cardiac disease (heart failure with reduced ejection fraction) yielded a melody line that was more monotonous in range and dynamics. A \u2018heartsong\u2019 from a healthy subject will sound slightly different than one from a patient with heart failure.\u201d<\/span><\/p>\n

That early connection between music and heartbeats \u201csparked my interest in medicine, and influenced my decision to become a cardiologist.\u201d<\/span><\/p>\n

The new Beethoven study<\/span><\/p>\n

Music lovers have long wondered if some of Beethoven\u2019s best came straight out of a cardiology text. An autopsy found no significant structural disease, \u201cbut many of the tools we now use to examine the heart at autopsy were not available in the early 19th century,\u201d the Goldberger trio wrote. \u201cCardiovascular disease could have been manifest in cardiac arrhythmias: abnormal, irregular rhythms of the heartbeat. These speculations cannot be proved with certainty\u2014indeed, the electrocardiogram was not part of routine clinical practice until well into the 20th century\u2014but a possible diagnostic tool may be provided in Beethoven\u2019s music.\u201d<\/span><\/p>\n

Many, including Luderitz and Cheng, have found indirect evidence of abnormal heart rhythms in Beethoven works. Goldberger\u2019s team found historical context for some of these\u2014including war rumblings and the abandonment of a patron\u2019s support. \u00a0They found much to back up \u201cthe notion that Beethoven may have been reflecting his own physical sensations in his compositions\u2014in other words, that he was, in a sense, setting an arrhythmia to music,\u201d they reported.<\/span><\/p>\n

\"shutterstock_175825835\"<\/a>Specifically, \u201cmusicologists, medical historians, and cardiologists\u201d have speculated that \u201cdistinct rhythmic motifs in the opening of Piano Sonata in E-flat major (Opus 81a) were `transpositions\u2019 of premature ventricular beats,\u201d Goldberger told\u00a0Bioscience Technology<\/em>. \u201cOur paper segues off this previous notion and attempts to amplify it by identifying other Beethoven works, which include \u2018arrhythmic\u2019 tempi. Was the composer mapping his own electrophysiologic dynamics onto musical scores? We reexamined Opus 81a to see why others felt that it was a direct arrhythmic transposition. Then we studied other works where \u2018arrhythmia\u2019 may be manifest: we examined the 5th<\/sup>\u00a0movement (Cavatina) of the String\u00a0Quartet in B-flat major (Opus 130) composed in 1825, and Piano Sonata in A-flat major (Opus 110) composed in 1821. We found that there may indeed be, in these works, a possible manifestation of an arrhythmia.\u201d<\/span><\/p>\n

For example, in Opus 130, there is a breathlessness characteristic of arrhythmias. And in Opus 81a, \u201cat both tempos, the rhythmic pattern seems to register a physical symptom of psychological distress, namely slow irregular heartbeats (in the Adagio), then racing irregular heartbeats (in the Allegro),\u201d the team reported. \u201cThis rhythmic profile has been ascribed to premature ventricular complexes (PVCs). Such extrasystoles can be felt as early beats, or as skipped beats. In addition, a premature beat (or an ectopic beat) is often followed by a compensatory pause. We hear several such prominent pauses in the introduction to Opus 81a, as well as in the opening movement, often apparent after `syncopal\u2019 phrasing.\u201d<\/span><\/p>\n

The trio reported numerous passages could outright be called \u201cmusical electrocardiograms.\u201d<\/span><\/p>\n

Organic musical electrocardiograms<\/span><\/p>\n

Ludertiz cautions that such abnormalities constitute an \u201corganic\u201d rather than an \u201cendogenous\u201d influence.<\/span><\/p>\n

\u201cWere Beethoven\u2019s arrhythmias coming from the endogenous rhythms inside all of us?\u00a0\u00a0 I do not think so!\u201d Luderitz told\u00a0Bioscience Technology<\/em>. \u201cThey are most probably due to organic heart disease. Beethoven was a heavy drinker. He consumed preferably punch with higher content of alcohol than wine or beer. It is very likely he suffered from alcoholic cardio-myopathy affecting the myocardium of the ventricles. The cardiac irregularities are eventually caused by ventricular premature beats.\u201d<\/span><\/p>\n

Ludertiz continued: \u00a0\u201cBeethoven\u2019s autopsy revealed liver cirrhosis; his heart was not investigated. Lead poisoning or other intoxications, perhaps acquired in the cemetery of Vienna, which also affect the heart muscle could have played a role. Beethoven was well aware of his rhythm disturbances, and consequently he put them into music. But the primary cause was his diseased heart. His arrhythmias seem organically caused, not endogenously.\u201d<\/span><\/p>\n

Another heartsick composer: Mahler<\/span><\/p>\n

Still, Ludertiz noted, plenty of music out there may have come from \u201cendogenous\u201d sources, just as much music may have emerged out of the maelstroms of illness\u2014 late-Romantic composer Gustav Mahler, for one.<\/span><\/p>\n

\u201cMahler likely suffered from rheumatic heart disease with mitral valve pathology. This diagnosis was discovered incidentally by the physician who was tending to his wife in 1907 after the death of their daughter,\u201d Goldberger told\u00a0Bioscience Technology<\/em>. That physician \u201cheard a murmur, later confirmed by the famed Viennese cardiologist Friedrich Kovacs.\u201d Still, while mitral stenosis, and consequent regurgitation, \u201cmay lead to atrial fibrillation, its relevance to Mahler\u2019s compositions requires more investigation. As other have asked, does the opening of his 9th<\/sup>\u00a0symphony actually have features reminiscent of rumbles and snaps?\u201d<\/span><\/p>\n

While potentially sending music lovers into a philosophical frenzy\u2014do we create music, or does it create us? Is music pleasure, or\u00a0pathology<\/em>?\u2014papers like Goldberger\u2019s may prove a practical boon for medicine.<\/span><\/p>\n

Music may turn out to be \u201ca useful tool for improving the physical exam, in terms of helping to make cardiologists aware of arrhythmias,\u201d said Goldberger. \u00a0\u201cI\u2019d like to think it enhances `auscultatory awareness,\u2019 if more so in composers whose symphonies sound like murmurs and rumbles with the percussion, such as Mahler\u2019s 9th.\u201d<\/span><\/div>\n
\u00a0<\/span><\/div>\n
Goldberger\u2019s co-authors are University of Michigan musicologist and Beethoven expert Steven Whiting, and University of Michigan internist and medical historian Joel Howell. Their paper was published in Perspectives in Biology and Medicine.<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

Does the music we play come from the music of our bodies\u2014at work? Recent research on Ludwig von Beethoven says: likely. Zachary Goldberger made newspaper headlines in the mid-1990s as a student, when he conjured music out of heartbeats with his Harvard Medical School electrophysiologist father Ary; made a CD of them; and built an […]<\/p>\n","protected":false},"author":6,"featured_media":2494,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38,14],"tags":[],"class_list":["post-2493","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-curiosity","category-innovation"],"featured_image_urls":{"full":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"thumbnail":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356-150x150.jpg",150,150,true],"medium":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356-235x300.jpg",235,300,true],"medium_large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"1536x1536":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"2048x2048":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"ultp_layout_landscape_large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"ultp_layout_landscape":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"ultp_layout_portrait":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"ultp_layout_square":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"newspaper-x-single-post":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",385,490,false],"newspaper-x-recent-post-big":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",283,360,false],"newspaper-x-recent-post-list-image":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",51,65,false],"web-stories-poster-portrait":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",393,500,false],"web-stories-publisher-logo":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",75,96,false],"web-stories-thumbnail":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/02\/shutterstock_239402356.jpg",150,191,false]},"author_info":{"info":["Amrita Tuladhar"]},"category_info":"Curiosity<\/a> Innovation<\/a>","tag_info":"Innovation","comment_count":"0","_links":{"self":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts\/2493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/comments?post=2493"}],"version-history":[{"count":0,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts\/2493\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/media\/2494"}],"wp:attachment":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/media?parent=2493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/categories?post=2493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/tags?post=2493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}