Many scientists have speculated that Beethoven had an arrhythmia (an abnormal heart rhythm), and some of his music is evidence of that. It seems that certain parts of the opening of the Piano Sonata in E-flat major (Opus 81a) were “transpositions” of irregular heart rhythms.

In fact, in the book A History of the Disorders of Cardiac Rhythms by German electrophysiologist Berndt Lüderitz, he mentions that Beethoven was thought to have an arrhythmia. I looked further and found that a few others had mentioned this as well.

But I wasn’t entirely clear on where the notion originally came from, even after corresponding with these individuals. I looked briefly at Beethoven’s letters written around the time of the sonata as well as the report of his autopsy, but neither provided any definite evidence of heart problems. And bear in mind that electrocardiograms — the heart tracings used to identify arrhythmias — were not introduced into practice until more than century after Beethoven’s death.

As a cardiologist and pianist I wanted to find out if Beethoven had an arrhythmia and if it influenced his work. And I wasn’t the only who wanted to know more. Joel Howell, a medical historian, and Steven Whiting, a scholar of Beethoven’s music, also wanted to explore the possibility that the composer suffered from heart rhythm problems.

Listening to heartsongs

We reexamined Opus 81a to see why others felt that it was a direct arrhythmic transposition. Then we studied other works where “arrhythmia” may be manifest: we examined the 5th movement (Cavatina) of the String Quartet in B-flat major (Opus 130) composed in 1825 (see video below), 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.

Take for example 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. In the middle of the quartet, the key suddenly changes to a C-flat major, involving an unbalanced rhythm that evokes dark emotion, disorientation and what has even been described as a “shortness of breath.”

Your heart has a song

The idea is that Beethoven’s heart arrhythmia made it into his music as a irregular rhythm. But we can also use heart beats to create melodies as well. The lub-dub we hear with a stethoscope is the sound that the heart valves make when the cardiac chambers contract. An arrhythmia may be fast or slow, and often the heart beats in an unpredictable, irregular fashion.

Many years ago, my colleagues at Harvard Medical School, Boston University and I, we were able to translate the cardiac interbeat interval fluctuations (those are the fluctuations of time between heart beats) in both healthy subjects and those with heart disease — into music. We used a device called a Holter monitor to record the heart rhythm for 24-48 hours. It looks like a Walkman, and it’s attached to leads connected to the chest wall and is used in medical practice to detect irregular heart rhythms. The intervals between heartbeats 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) — not the rhythm — reflects these interbeat intervals. Once the melody line was laid out, I added harmony and rhythm and played the pieces on the piano.

Zachary Goldberg , Author provided 1.74 MB (download) Music based on a health heartsong.

The variation in healthy hearts produced a very complex, variable melody line. Patients with severe cardiac disease yielded a melody line that was more monotonous in range and dynamics (the difference between the longest and shortest beat). A “heartsong” from a healthy subject, will therefore sound slightly different than one from a patient with heart failure. This correlates well with the surprising notion that highly regular patterns — or a loss of subtle irregularity — was actually not a healthy heart.

Zachary Goldberg , Author provided 2.43 MB (download) Music based on an unhealthy heartsong.

The musical stethoscope

Our paper is entirely speculative, but 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. Part of Beethoven’s genius, his sublimity, was to overcome adversity and transcend limitations with his art.

We invite listeners to approach these works with open minds and open ears, and formulate your 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 electrocardiogram.