Beethoven’s musical electrocardiograms

There have been many suggestions as to the actual cause of Ludwig van Beethoven’s death. They include cirrhosis, syphilis, hepatitis, lead poisoning, sarcoidosis and Whipple’s disease while he has also been linked with inflammatory bowel disease, Paget’s disease and bipolar disorder. Beethoven’s health problems are said to have begun when he was in his 20s when he frequently suffered from diarrhoea and abdominal pain, problems that continued throughout his life. Indeed, Beethoven himself revealed that the 4th movement of his 2nd symphony is a musical description of the rumblings of his bowels. Many experts point to congenital syphilis, possibly passed down from his father, as the strongest candidate to explain his many health sufferings. Others suggest the analgesics supplied by his brother, who was an apothecary, could have caused analgesic nephropathy leading to the renal papillary necrosis. 

Since many of today’s diagnostic medical tests didn’t exist in the 18th century, it is probably impossible to prove or disprove which, if any, of these diseases he suffered from now. However, a team of researchers from the University of Michigan and University of Washington, which included a cardiologist, medical historian and musicologist, have speculated in an article in Perspectives in Biology and Medicine that Beethoven may have suffered with cardiac arrhythmia. 

The team studied the rhythmic patterns of several of Beethoven’s compositions and found that sudden, unexpected changes in pace and keys in his music appear to match the asymmetrical patterns that might be expected if he experienced arrhythmia. They also noted that from his late 20s his hearing began to deteriorate leaving him almost totally deaf by the last decade of his life. This deafness could have made him more than usually aware of the rhythm of his heartbeat.

The researchers identified arrhythmic patterns in the Piano Sonata in A-flat major, Opus 110 for example and in the opening of the “Les Adieux” Sonata (Sonata Opus 81a, in E-flat major). The latter, which has an irregular dotted rhythmic pattern, was composed at a time when Beethoven was known to be under considerable emotional stress, a possible trigger for arrhythmias.

Furthermore, during the final movement “Cavatina” in Beethoven’s String Quartet in B-flat Major, Opus 130, an emotionally charged piece that Beethoven said always made him weep, the key suddenly changes to C-flat major, involving an unbalanced rhythm that is said to evoke dark emotion, disorientation and what has even been described as a ‘shortness of breath’. The section is marked ‘beklemmt’, a German word that can be translated as ‘oppressed’,
in the composer’s directions to musicians. The researchers
 suggest that the expression could be used to describe the sensation of crushing pressure associated with cardiac disease.

The researchers say that while these musical arrhythmias may simply manifest Beethoven’s genius, there is a possibility that in certain pieces his beating heart could literally be at the heart of some of the greatest masterpieces of all time. Indeed, his music may have been both figuratively and physically heartfelt.

Last updated
The Pharmaceutical Journal, Beethoven’s musical electrocardiograms;Online:DOI:10.1211/PJ.2015.20067583

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