Health professionals have become increasingly concerned that hostages held captive by Hamas may suffer sudden cardiac arrest, as testimony from returned hostages revealed extreme conditions such as prolonged starvation, extreme malnutrition, lack of movement, and constant fear.
The heart is a muscle that requires a continuous energy supply to function. During prolonged starvation, the body enters a state of protein tissue breakdown for energy, causing heart muscle depletion and weakened function. When the calorie and protein supply remains low over time, starvation-dependent cardiomyopathy develops, leading to severe cardiac dysfunction and heart failure.
The heart relies on a delicate balance of minerals such as potassium, magnesium, calcium, and phosphorus to maintain normal electrical activity. When the body suffers from a deficiency in these essential electrolytes, it can even lead to ventricular fibrillation, a severe rhythm disorder causing immediate sudden cardiac arrest.
Potassium deficiency, for example, causes the heart rate to slow down and disrupt its electrical activity. Magnesium deficiency increases the risk of “Torsades de pointes” rhythm disturbances, which can lead to cardiac arrest. Severe phosphorus deficiency, typical in extreme starvation conditions, also causes heart failure. Calcium is essential for muscle contraction and cardiac electrical conduction, and its deficiency leads to heart failure.
Vitamin deficiencies also increase the risk of sudden cardiac arrest. For instance, a deficiency of vitamin B1 (thiamine), which is given to hostages immediately upon return, causes wet beriberi syndrome, characterized by heart failure, ventricular enlargement, and dangerous fluid accumulation.
Vitamin deficiencies in hostages
Vitamin B12 and folic acid deficiency cause anemia, which leads to blood oxygen deficiency and increases cardiac strain. Vitamin D deficiency caused by the dark conditions where hostages are held affects the body’s calcium balance, raising blood pressure and increasing the risk of heart failure.
In the absence of activity and during starvation, the body enters a catabolic state, breaking down tissues for energy use. In this way, the body begins breaking down skeletal muscles and, eventually, heart muscle cells. This condition leads to decreased heart muscle volume, reduced ventricular contractility, and progressive heart failure.
In addition to cardiac damage, prolonged starvation directly affects the brain, which is an energy-intensive organ. Extreme hypoglycemia (life-threateningly low sugar level) directly impacts autonomic nervous system function, which can cause cardiac arrest. In cases of phosphorus or sodium deficiency, severe imbalance in brain fluids occurs, leading to cerebral edema, intracranial pressure, and death.
DURING STARVATION, the body breaks down fats instead of carbohydrates, causing an accumulation of components called ketones and a condition called “acidosis” that affects brain function and increases the risk of lethal cardiac arrhythmias. The lack of activity and prolonged sitting in Hamas captivity also severely affects the heart muscle and blood pressure and increases the risk of fatal blood clots and death.
“The prolonged starvation and horrific conditions in Hamas captivity increase the risk of cardiac mortality for hostages who remain there,” said Prof. Amit Segev, Director of Cardiology at Sheba Medical Center, Tel Hashomer, and adviser to the hostages’ headquarters.
Terror, anxiety, despair, and trauma all affect the heart
“As we hear more and more stories about the terrible conditions in captivity, the abuse, the never-ending terror, it breaks our heart. This unbearable situation directly affects body function and heart activity in many ways. We know both from the terrible history of Holocaust survivors and from people who underwent extreme starvation or even anorexia about severe potential damage and increased risk of cardiac arrest through extensive mechanisms, some clear and some unknown, related to irreversible damage to heart cells, electrical activity, and muscle cell protein systems,” Segev said.
“The shocking psychological aspects in which the hostages find themselves – the terror, anxiety, despair, and trauma – all directly affect the heart itself, which could – without warning – stop working. Eyes tear up from thinking they’re still there, and we must do everything to bring them back immediately because every passing minute intensifies their immediate life danger.”
“The damage to hostages’ hearts is not theoretical or symbolic but a painful reality,” said Prof. Hagai Levine, a public health expert physician and head of health services at the hostages families’ headquarters.
“Some captivity survivors suffered significant cardiovascular system damage as a result of captivity conditions or lack of medical treatment, sometimes with life-threatening or irreversible damage,” he said. “We remember Hanna Katzir z”l and fear we’ll see more captivity survivors dying from medical complications related to captivity. Systematic and long-term medical follow-up is required for captivity survivors and their family members, who suffer from various damages we don’t yet fully know about,” Levine said.
“For the hostages, the danger is clear and immediate since they’re not receiving proper treatment and continue to be in hellish conditions that are life-threatening for all of them.”