Did Beethoven Compose His Heart Problems Into His Music?

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A cardiologist, a musicologist, and a medical historian all publish a paper, and, turns out, Ludwig von Beethoven may have had a heart arrhythmia. If you're confused, but not laughing, that's good. This is no joke, but it is weird.

Researchers from the University of Michigan just published a paper claiming that Beethoven was influenced by his irregular heart beat, and while there isn't physical proof, the researchers believe there may be musical proof. Their  paper just published in Perspectives in Biology and Medicine states that there's evidence to suggest that Beethoven composed his own heart arrhythmia into his music.

The paper's authors admit that we don't actually know if Beethoven even had a heart arrhythmia, but here's what we do know:

1. Aside from his well-known deafness, Beethoven had a litany of other health problems and according to the paper, medical, historical and musical scholars believe that Beethoven was "at significant risk of experiencing cardiovascular disease."

2. Beethoven was deaf and thus possibly more aware of his pulse.

3. Beethoven drew inspiration from the outside world. His Sixth Symphony explicitly references flowing water and storms.

4. Beethoven's use of rhythm could be really idiosyncratic.

From there, the researchers started listening for examples.

"We listened to the rhythm of the music and we say 'does this sound like the rhythm of a heart that's arrhythmic," Joel Howell, the medical historian, who is both a physician and a musician, told me over the phone. They listened for pauses—that might very well be in the piece for dramatic effect—to see if they matched a heart beat that they recognized from medicine. "Now can we prove this? Absolutely not, but we argue at least consistent with that interpretation."

Other scholars have tried to tie the composer Gustav Mahler's music to his diagnosed heart condition, but there isn't a smoking gun—or dripping spit valve—linking music and health. And there's of course no record of Beethoven flat out admitting that he's composing a musical cardiogram. Unless, Howell said, there subtly is.

"In Beethoven's case we talk about a phrase in his music where he talks about being 'heavy of heart,'" Howell told me over the phone. The German word "beklemmt" appears next to a section of Beethoven's String Quartet in B-flat Major, Opus 130, where the melody is in syncopated triplets, which the researchers think may be referring to an arrhythmic pulse.

Playlist of songs referenced in the paper. Hear the heart arrhythmia for yourself, if it existed!

"What he means by 'heavy of heart' could be a couple of things. It could be a statement about his mood, but we suggest that it could also mean that he literally felt a weight on his chest. Turns out that people who have angina, a coronary artery disease, feel very heavy," Howell said. "When I'm practicing in the hospital, I'll ask people 'do you feel like there's an elephant on your chest,' and people with this problem with say 'yes, I feel like there's a huge heavy weight on me.' Is it possible that's what Beethoven was referencing? Is it possible he was referencing both."

It's tricky. Beethoven's rhythmic idiosyncrasies are consistent with the style of Romantic music that he was pioneering. The composer Hector Berlioz noted that Beethoven used dotted rhythms to fit "two beats…into the framework of bars in triple time," which, Berlioz says "imparts considerable vitality to the music." There's enough artistic justification for Beethoven's rhythms.

For example, the researchers claim that the rhythms in Beethoven's Piano Sonata in E-flat Major, Opus 81a sound like the composer is "skipping beats." The researchers note that the sonata was probably being composed at a very stressful time in Beethoven's life, and stress is a trigger for heart arrhythmia.

I listened to the piece several times, and I thought that while the conspicuously "skipped beats" added some pretty genius-level dramatics to the piece—I mean, it's true what they say about Beethoven—the sonata never felt arrhythmic. It's not Schoenberg, a 20th-century composer who, by this reading of rhythms, should've been constantly needed to be defibrillated. Beethoven was just writing with some flair.

Additionally, a 2012 study that looked ​at Beethoven's work as a whole, found that he actually uses rhythm far more predictably than Mozart or Haydn or Bach. Haydn, I hear, had some heart problems, but many of his co​ncertos eschew syncopation all together, and he wasn't big on the dotted notes that point to Beethoven's heart.

So put me in the skeptical camp here, but I love this intersection of medicine and the arts. Howell told me that the University of Michigan has a "medical arts" program, based on the idea that the arts will make medical students better physicians. He told me how some of Beethoven's and Strauss's last compositions were explicitly about their imminent deaths, a perspective that physicians who start practicing in their 20s should probably become familiar with, given who their profession puts them in contact with. "It's a way of music helping to teach people how to understand the transitions in life."

The program also helps medical students deal with ambiguity, Howell said. "We get people in medical school who are really good at getting the right answer on multiple choice tests in biology and chemistry. And they come here and we fill 'em full of knowledge so they know what to do, and they leave confident. But when you start working on real people you realize the world is full of 'I don't knows' and 'I'm not sures' and 'I guess I'll try this.' How do you grapple with it? You turn to the arts."

Howell continued, "the meaning of arts can be ambiguous. Is the end of Shostakovich's Fifth Symphony a great socialist victory march or a parody of one? I think the answer is 'yes,' it's both, and choosing one or the other side is missing the point. That's a way of realizing that there are not only times when it's okay to accept ambiguity but its incumbent upon you to for the sake of your patients. If you don't accept the ambiguities inherent in human existence, you're not going to do as good of a job."

That's not exactly what you'd want to hear a physician say—better words for a character in a Coen brothers movie—but I guess is where we have to come down on Beethoven's compositional cardiograms, at least for the moment. It's worth noting that it doesn't take away from Beethoven to attribute some of his brilliance to a heart arrhythmia. It does sound like a cautionary tale about who you sit around listening to music with, however. Now I can't help but wonder if a specialist could determine if sleep apnea inspired " Roll ​Over Beethoven."