For generations, Ludwig van Beethoven's music has stirred the hearts of its listeners. From "Adelaide" to "Für Elise" to his "Moonlight Sonata," Beethoven's classic works are often thought to have come directly from the German composer's heart. And three researchers think this might be a literal review of how many of Beethoven's pieces were inspired.

According to a cardiologist, medical historian and musicologist who recently published their findings in the journal Perspectives in Biology and Medicine, Beethoven's music might have been heavily influenced by an underlying arrhythmia — an irregular heartbeat.

“His music may have been both figuratively and physically heartfelt,” said Joel Howell, a medical historian, professor of Internal Medicine at the University of Michigan Medical School, and a co-author of the study. “When your heart beats irregularly from heart disease, it does so in some predictable patterns. We think we hear some of those same patterns in his music.”

Beethoven portraitHowell, along with co-authors Steven Whiting, a musicologist and Beethoven expert also from the University of Michigan, and Zachary D. Goldberger, M.D., M.S., a cardiologist at Harborview Medical Center, University of Washington School of Medicine, found that some of the most striking rhythms found in Beethoven’s classic pieces may have been inspired by his own heartbeat.

The team looked at the patterns of rhythm of several of Beethoven’s compositions and found a match between the music and the asymmetrical heartbeat patterns common with cardiac arrhythmia, a condition that causes the heart to change pace suddenly — beating too quickly and then too slowly before settling into a more normal rhythm. 

The researchers cite the final movement “Cavatina” in Beethoven’s "String Quartet in B-flat Major, Opus 130," as an example of his arrhythmia-inspired music. The music is so emotionally charged that even the composer himself was quoted as saying that it always made him weep. In the middle of the piece, there is a quick an sudden key change to C-flat major, that many have described as simulating a “shortness of breath.” In his notes for that music, Beethoven wrote "beklemmt," a German word that means “heavy of heart.” He could have been describing the sad, emotional feeling of the music, but the authors note that he might also have been describing a literal sensation of heaviness or pressure in the heart that is associated with cardiac disease. “The arrhythmic quality of this section is unquestionable,” they wrote.

Other selections that the researchers highlighted as examples of Beethoven's possible arrhythmia are his "Piano Sonata in A-flat major, Opus 110" and the opening of the “Les Adieux” Sonata. 

Musical historians and researchers have speculated for years about possible ailments that might have plagued that famous German composer. From irritable bowel syndrome to liver disease to Paget's disease, Beethoven's health has been the source of much speculation over the years. But one health problem that the great musician did suffer from was deafness, a condition that the researchers of this study think would have made him only that much more aware of his heartbeat.

“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,” said Goldberger.

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Beethoven portrait by Joseph Karl Stieler: Public domain