You Really Can Be Scared to Death

Oct. 25, 2012— -- Here's something to keep in mind this Halloween: A good scare can kill you -- even if you're perfectly healthy.

If a shock to the system is sufficient enough it can trigger a massive surge of adrenaline, stunning your heart so severely it ceases to beat.

Consider the case of a 60-year-old woman who was given terrible news about her husband's health. As she and her hubby left the doctor's office, a tightness suddenly gripped her chest and she was unable to breathe. Lucky for her, she was standing right outside the office of cardiologist Dr. Holly Anderson when it happened.

"After I had whisked her off to the emergency room and hooked her up to an EKG, I was surprised to see her whole heart had stopped moving, yet she had perfect blood supply to the heart," recalled Anderson, who is also the director of education and outreach at the Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "She was so emotionally overwhelmed about her husband's condition it literally stopped her heart."

Women, particularly older women, are far more susceptible to dying of fright, also known as the "broken heart syndrome." They account for about 90 percent of reported cases, according to Dr. Martin Samuels, chairman of the neurology department at Brigham and Women's Hospital in Boston.

He said postmenopausal women are at risk mainly because they no longer enjoy the known cardio-protective benefits of estrogen, he said.

Experts estimate that about 1 percent of men and 7 percent of women with suspected heart attacks have stress cardiomyopathy instead.

And it is more common than thought. Samuels said the average sudden death in any major city is about one per day. Studies show this number goes up slightly for about a week after a catastrophic event such as an earthquake or a terrorist attack and may increase on days that have a negative cultural significance, such as Friday the 13th.

"I don't believe there are any studies showing that Halloween falls into this category," Samuels said.

This type of abrupt cardiac event goes by several names. Technically it's referred to by medical experts as stress cardiomyopathy because it usually occurs immediately following an intense emotional event. When the syndrome was first identified by Japanese scientists in 1990, they dubbed it "takotsubo syndrome," after the strange balloon shape resembling a Japanese octopus trap the heart takes on when it occurs. Here in the U.S. it's usually known as "broken heart syndrome" because it often strikes after the victim has received gut wrenching news, such as the death of a loved one.

Samuels has studied and treated stress cardiomyopathy syndrome. He said that it's likely set into motion by an excessive, uncontrolled activation of the sympathetic nervous system, the part of the brain responsible for the control of the body's "flight or fight" response including increasing heart-rate, respiration, perspiration.

"Sympathetic storming, as it's referred to, produces a rush of stress hormones. This can work to our benefit much of the time, but in the case of stress cardiomyopathy, the exaggerated response can damage the heart," he said.

For many years, cardiologists didn't understand stress cardiomyopathy. They thought it was some kind of weird heart attack.

"Shortness of breath, trouble breathing, sweating -– the symptoms are exactly the same," said Dr. Ilan Wittstein, a cardiologist at Johns Hopkins Hospital in Baltimore. "Even when we take an EKG or measure the levels of heart proteins that spill into the bloodstream, there is no difference."

It's only when doctors take 3-D pictures of the heart that they can see the telltale balloon shape of the heart and the clear blood vessels that would normally show clots or blockage during a typical heart attack. The large coronary artery that supplies the heart often appears unperturbed but Wittstein said that he suspects the tiny blood vessels that supply blood to the heart -- and which aren't normally scanned in cardiac patients -- may be affected.

Dying of Fright or Broken Heart Syndrome

The massive rush of adrenaline may also temporarily stun the cardiac heart muscle into inaction, Wittstein said. This may explain why the heart of someone who's had an episode of stress cardiomyopathy will return to normal in just a few days or weeks whereas with the damage from a standard heart attack usually remains for the rest of a person's life.

The triggering event doesn't necessarily have to be bad news. Samuels said he has treated cases of stress cardiomyopathy preceded by shooting a hole in one on the golf course, bowling a perfect game and a not guilty verdict in court.

"Any highly emotional event whether positive or negative can set it off," he said.

Reoccurrence is low. Studies show only about a 5 percent of patients have more than one attack, though Wittstein said it seems some individuals are highly susceptible to the syndrome. He has one patient who has had five episodes.

Fortunately it seems to take a real bombshell to stun the average heart into cardiomyopathy. Halloween in and of itself probably isn't enough of a fright to get the job done unless a patient is a true believer in ghosts and goblins, Samuels speculated.

Still, why take chances? Better to go with the treats and skip the tricks.