Hektoen International

A Journal of Medical Humanities

Mahler’s endocarditis and broken heart

Michael Yafi
Houston, Texas, United States

Gustav Mahler (1860–1911), Austrian composer, and his wife Alma (1879–1964) near Toblach. Unknown photographer. 1909. ÖNB, Bildarchiv Austria, Austrian National Library.

Gustave Mahler (1860–1911) suffered from personal setbacks throughout his life. Despite receiving more acclaim in early 1900, the death of his daughter Maria from scarlet fever and diphtheria affected him deeply.1 During the same year, Mahler received a vague diagnosis of a “defective heart,” which was later confirmed by the Viennese cardiologist Friedrich Kovacs2 who suggested that Mahler should avoid fatigue. This increased the psychological burden on Mahler, who was already in distress. Worried about dying from the curse of the ninth symphony (many well-known composers died after the completion of their ninth symphony), he refused to number his symphonic work written between 1908 and 1909, calling it instead “The song of the Earth.” Mahler may have also heard and felt his own irregular heartbeat caused by the rheumatic heart disease affecting his heart valves. He represented this musically and rhythmically in his compositions from that era.3,4

In 1909 Mahler discovered that his beloved wife Alma was having an affair with another man.1 Mahler’s marriage had not been stable. Both families had initially rejected the union: his family saw Alma as an opportunistic woman and Alma’s family sadly rejected Mahler because he was Jewish. These circumstances led Mahler to meet Sigmund Freud, who was leading the field of psychiatry at that time. This meeting between the great composer and the father of modern psychiatry has captured the imagination of intellectuals, such as in the 2010 German film Mahler on the Couch.

Mahler contracted bacterial endocarditis and died in 1911.


  1. Carr, J, Mahler: A Biography. Woodstock, NY: The Overlook Press. ISBN0-87951-802-2., 1988
  2. Tofield, A. Gustav Mahler’s ‘Maladie Célèbre’: The life of a brilliant composer cut short by endocarditis from recurrent tonsillitis. European Heart Journal, Volume 40, Issue 38, 7 , Pages 3134–3135. 2019
  3.  https://blogs.jwatch.org/cardioexchange/2015/01/19/music-cardiac-arrythmia-draft/
  4. https://hekint.org/2017/01/30/surgery-note-by-note-marin-marais-tableau-de-loperation-de-la-taille/?highlight=mahl

MICHAEL YAFI, MD, is an Associate Professor and Director for The Division of Pediatric Endocrinology at UTHealth, (The University of Texas Health Science Center at Houston).

Highlighted Vignette Volume 12, Issue 4 – Fall 2020

Winter 2020



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