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Should You Be Afraid of a Halloween Heart Attack?

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Halloween is the official holiday of fear, when haunted attractions and horror movie marathons offer plenty of scares. But here’s an important Halloween question for medical experts: Is it possible to be frightened to death?

The short answer is “yes”. The more useful answer is, “There’s little reason to fear being scared to death.”

When something frightening happens, we sometimes hear people say that it almost gave them a heart attack. So, it’s common to think of death by fear as some frightful stimulation that leads to a deadly cardiac event. However, the body’s reaction to fear is a more complicated process that rarely is dangerous.

The Science of Fear

When people experience an event that causes strong emotions, the brain responds by causing a surge of adrenaline, which is a stress hormone that makes the heart beat faster and quickly shifts the body into "fight-or-flight" mode. Adrenaline also triggers perspiration and rapidly sends blood to major muscle groups.

In rare cases, an extreme response to a highly dangerous or life-threatening situation can cause a cardiac event that ends in death. Such cases usually involve special circumstances, such as fleeing a tornado or other natural disaster, a violent assault, or discovering the loss of a loved one. Those events create more real-world fear and stress than horror movies and Halloween frights can induce.

The main factors for the rare possibility of being frightened to death are pre-existing cardiovascular conditions. If the heart is not healthy enough to manage the effects of large releases of stress hormones, the organ may begin to fail. Such failure leads to blocked blood flow (heart attack) or arrhythmia, which can cause the heart to beat too fast, too slow, or irregularly. If arrhythmia prevents the heart from pumping enough blood to the body, damage occurs to the heart muscle, brain, and other organs. Both a heart attack and an arrhythmia can cause the heart to stop beating (cardiac arrest).

Sudden Fear vs. Long-Term Stress

An adrenaline surge can be useful for making a person more alert and energized in a stressful environment. But constant stress and large amounts of stress hormones over time can have negative effects, such as high blood pressure or anxiety. William Maddox, MD, with the UAB Cardiovascular Institute, says ongoing stress is far more risky than any sudden jolt of fear.

“In terms of specific cardiovascular events or heart disease in general, the idea of being frightened to death — at Halloween or any other time — really isn’t on the radar for most patients,” Dr. Maddox says. “It’s technically a possibility in an extreme circumstance for someone who is already at risk for cardiac events. Heart arrhythmia in that case might induce cardiac arrest, and then the brain isn’t getting oxygen, which is a life-threatening situation. But if I were going to choose something to be afraid of, I would focus on the toll that prolonged stress and anxiety can take on the body.”

In short, Dr. Maddox emphasizes that long-term stress is much “scarier” than a sudden adrenaline rush, because the risks are multiple, more varied, and can increase over time.

“Stress is associated with increased cardiovascular events, because it may lead to high blood pressure, which is a risk for heart attack and stroke,” Dr. Maddox says. “Stress and anxiety over extended periods can also lead to risks such as smoking, weight gain from overeating, and reduced physical activity. There aren’t many people who have died from an adrenaline rush, but hundreds of thousands die each year from heart conditions created or made worse by years of stress and worry.”

Other Fears

There also is a direct link between severe emotional or physical stress and a potentially serious condition known as broken heart syndrome. Broken heart syndrome is a common name for stress-induced cardiomyopathy, or takotsubo cardiomyopathy, a condition that affects the heart’s muscle tissue. It causes severe swelling of the left ventricle (one of two lower chambers in the heart). Signs and symptoms are nearly identical to those of a heart attack and may include sudden chest pain, shortness of breath, and an irregular heartbeat.

Another condition related to a sudden scare, and in some cases heart disease, is panic attack. A panic attack causes a sense of being out of control, with rapidly increasing and overwhelming anxiety and fear. Physical symptoms may include increased heart rate, trembling, shortness of breath, weakness or dizziness, chest pain, perspiration, and nausea. Panic disorder is a disabling psychiatric condition, with serious consequences that can impair quality of life and could lead to depression and anxiety. Anxiety disorders are associated with the beginning and later stages of cardiac disease and in many cases are linked to poor cardiovascular outcomes.

For people with a heart condition or who already know they are at high risk for a heart attack, any stressful experience that gives the sensation of a cardiac event should be treated seriously. It is wise to be cautious and call for help or visit an ER when symptoms first appear.

However, cardiovascular specialists agree that it is wise to focus less on being scared to death in an instant and more on being worried to death over many years. In terms of heart health, a lifetime of stress and anxiety can be a scary thing.

Click here to learn more about risk factors for heart disease and steps to take for better heart health.