Is arrhythmia at the heart of Beethoven’s music?

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Whether or not music stirs inside, each of us bears a living metronome at our core. It may tick at 40 or 100 beats per minute, in three-quarter time or in six-eight, erratically or like a Swiss clock. The human heart quietly marks the rhythm of our lives.

A new study focusing on the music of Ludwig van Beethoven treats shifting musical rhythms as a sort of musical electrocardiogram. In Beethoven’s dotted rhythms, tempo shifts, sudden pauses and composition notes, a trio of researchers suggest that they have gleaned the distant echo of the German composer’s heart.


An earlier version of this post said the study focused in part on Beethoven’s Piano Sonata No. 12 in A flat major. The study focused on, among other pieces, Piano Sonata No. 31 in A flat major (Opus 110).



Where most hear greatness, they hear cardiac arrhythmia.

Although definitive diagnoses died with him, historians have speculated that Beethoven, who died, deaf, at 56, suffered from medical conditions including alcohol-induced cirrhosis, lead poisoning and syphilis.
Beethoven’s heart was found structurally sound upon autopsy in 1827. But in an article published recently in the journal Perspectives in Biology and Medicine, the authors — a cardiologist, an internal medicine specialist and a musicologist — cite the rhythmic turnabouts in three of the master’s compositions to diagnose an irregular heartbeat.

What is clear from his personal letters and notes is that Beethoven began to lose his hearing around 1800, at the age of 30. He composed the bulk of his music even as the sounds of the world around him dimmed — and that, say the authors of the new study, may have made him exquisitely attuned to his own heartbeat. Some of his most haunting and ambitious works — the late string quartets, the Mass in D minor (Missa solemnis), the Ninth Symphony in D minor — were composed after he became completely deaf in 1819.
“This is entirely speculative,” said Dr. Zachary D. Goldberger of the University of Washington, the cardiologist on the team. “At least it gives us a new dimension by which to listen to his music.”

Goldberger said he and his coauthors focused on the rhythmic shifts and punctuations of three Beethoven compositions: the Piano Sonata in E flat major (Opus 81a, called “Les Adieux”), the String Quartet No. 13 in B flat major (Opus 130) and the Piano Sonata No. 31 in A flat major (Opus 110). These works have been characterized by musicologists as particularly abrupt, dramatic or unusual in music of Beethoven’s time.
The authors note the “distinctive ‘galloping’ rhythm” of the Sonata in E flat major’s adagio section and hear slow, irregular heartbeats, followed by “racing irregular heartbeats,” in the allegro section that follows.

In the String Quartet No. 13, the authors hear, in a seven-measure section in the middle of the fifth movement (the “Cavatina”), “a short paroxysm of an atrial tachyarrhythmia.” They cite Beethoven’s notation: that the passage should be played “beklemmt,” or “heavy of heart.” And they note the 2011 observation by pianist Jonathan Biss that the section always evoked a sensation of shortness of breath.
In the third movement of the Piano Sonata No. 31 in A flat major, the authors point to an “arioso dolente“ (or lamenting song) preceding one of two fugues. The left hand plays a repetitive run of notes that “bears some resemblance to rapid tachyarrhythmia,” they write. The right hand, simultaneously, plays an irregularly punctuated melody that “bears some resemblance to dyspnea,” or shortness of breath, “which would not be an unusual sensation for someone experiencing a tachyarrhythmia.”

“When your heart beats irregularly from heart disease, it does so in some predictable patterns,” said Dr. Joel D. Howell of the University of Michigan, the team’s internist (who also has a PhD in the history and sociology of science). “We think we hear some of those same patterns in his music.”

Beethoven’s litany of physical woes clearly predisposed him to atrial fibrillation, atrial flutter or even multifocal atrial tachycardia, Goldberger, Howell and University of Michigan musicologist Steven M. Whiting wrote in the paper. But they acknowledged that their observations are far from proof of those conditions: “Similar rhythmic intricacies” are found in other works by many composers, and cardiac arrhythmia can hardly be ascribed to all who use irregular syncopation.


“However, in highly charged passages of certain pieces, the possibility of cardiac arrhythmia can lend a quite physical aspect to one’s interpretation of the music in question,” they wrote. “These passages can seem, in an unexpectedly literal sense, to be heartfelt.”

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