Death by Angry Outburst

Extreme Physical Activity Can Also Trigger Fatal Attacks

From the WebMD Archives

Sept. 9, 2002 -- If you have heart disease, an angry outburst can cause a fatal heart attack. A new study shows that when the heart is fragile, anger can trigger a life-threatening change in heartbeat.

"People get angry in trivial or transient situations -- when the elevator takes too long or traffic is bad, when they don't have any control over the situation," says study researcher Diwakar Jain, MD, professor of medicine at Drexel University in Philadelphia.

"They need to be aware of the effect their emotions can have on the heart, that when you get angry, you're exposing yourself to risk of death," he tells WebMD.

His study appears in the Oct. 1 issue of Circulation: Journal of the American Heart Association.

While people have been known to die "in a fit of anger," researchers have been unsure exactly what triggered the heart attacks.

"Studies are very difficult to do because these patients die suddenly and we don't know what happened to them, what triggered the death," Jain explains.

People who have already had a heart attack -- and are at highest risk for sudden cardiac death -- are primary candidates for a relatively new device called an implantable cardioverter-defibrillator (ICD).

They are the perfect patients to help unlock the mystery of sudden cardiac death, says Jain. "They survive to tell the story, what happened right before the attack."

The device is implanted in the chest. When the heart develops a potentially deadly abnormal heart rhythm, the ICD produces an electrical shock that restores normal rhythm. Without that shock to "jump-start" the heart, the person can die of sudden cardiac death.

"Patients with ICDs have episodes out of the blue, dangerous [abnormal rhythms], but the device kicks in, so the patient is all right," says Jain.

In a study published two years ago, Jain and colleagues found that mental stress -- like asking people to do a difficult arithmetic exercise -- could trigger a life-threatening abnormal rhythm if they were at high risk of heart disease.

In this current study, 240 patients who had received ICDs kept a diary for more than two years, keeping track of their moods and physical exertion levels. If they had an ICD shock, they recorded the emotions they were feeling shortly before the shock; they also tracked their emotions at the same time a week later -- therefore serving as their own comparison, Jain tells WebMD.

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The patients noted the level of each emotion -- whether it was anger, anxiety, worry, sadness, happiness, challenge, feeling in control, or interest -- on a scale of 1 to 5.

In 15% of the cases, anger (level 3 or higher) was the person's emotion, occurring most often while they were driving, arguing, gambling, or receiving bad news.

"In healthy people, the heart can withstand a lot of abuse," Jain says. "But when the heart is fragile, anger stands out as the primary cause of sudden death."

Also, in 53% of cases, the person had been involved in extreme physical activity. Though a sudden burst of physical activity may put a fragile heart at risk, "we're not saying people should refrain from exercise," he says. "They should engage in low levels of exercise under supervision, like in a cardiac rehabilitation center, where somebody can watch them. But they should not engage in high-level physical activity."

To deal with the anger, "medications are not the answer," he says. Instead, people need to change their response to things they cannot control. "Be aware this is what certain emotional things can do to heart -- that when you get angry, you're exposing yourself to risk."

With the help of a therapist, people can learn to contain anger or redirect their angry emotions, he says.

"There's no easy solution because it's almost impossible to avoid stressful situations and anger in all circumstances," says Jeremy Ruskin, MD, director of the cardiac arrhythmia service at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School.

"It is important to think about ways to blunt those responses," he tells WebMD. "That can be done with drugs like beta blockers, with relaxation techniques such as meditation. It can also be done through insight -- becoming aware that these emotions can be dangerous and short-circuiting the reaction. That would be useful for all people, but for the cardiac patient it could be lifesaving."

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