Yes, we can frighten ourselves to death

By Deborah Kotz, Globe Staff

Going to haunted houses and scream parks is part of the Halloween fun, but can that fright factor be bad for your health? “I always get these calls this time of year,” said Dr. Martin Samuels, chair of the neurology department at Brigham and Women’s Hospital.

A Wall Street Journal reporter spoke with him earlier this week about healthy people, with no signs of heart disease, who go into full cardiac arrest when panicked and are literally scared to death. Thankfully, this is extremely rare.

Samuels has pored over hundreds of cases of people whose heart gave out, called stress cardiomyopathy, after experiencing a shocking fright like an emergency ejection from an airplane, an earthquake, or a mugging at gun-point -- all before any physical injury.

At a rental cabin in Hyannis Port one summer, he saw the horrifying act up close. “We walked into the place, and our cat had cornered a mouse,” Samuels told me. “After a few minutes, the mouse dropped over dead. The cat had never touched it.”

Sometimes even a shocking surprise like winning the lottery or seeing a presumed dead loved one return from war can cause the heart to stop.

Harvard medical school physiologist Walter Cannon called it “voodoo death” in a 1942 paper since through the centuries, people who suddenly dropped dead from shock or fright were assumed to be killed by the powers of a wizard or medicine man. But Cannon, the man who first described the fight-or-flight response, had a more probable explanation, Samuels wrote in this paper.

Just as with the fight or flight response -- where the brain releases a flood of chemicals like adrenaline that move us to action when we’re in a dangerous situation -- sudden deaths from fright, Cannon theorized, were due to a ramped up and lasting action of this response.

“It’s such a powerful example of how the brain controls visceral organs,” said Samuels, like the heart or the stomach.

Who hasn’t had a gut-wrenching reaction on a roller coaster?

As rare as scared-to-deaths are, researchers haven’t been able to determine who’s most at risk for them. They have, though, figured out why the heart can stop beating in response to extreme fear. A storming cascade of stress hormones called catecholamines triggers the release of calcium into heart cells causing them to contract, Samuels explained. The heart’s electrical system begins to malfunction, causing abnormal heart rhythms and then cardiac arrest.

In an autopsy report that Samuels examined, a man who committed suicide by jumping off the roof of Brigham and Women’s Hospital in 1980 most likely died from fear before he hit the ground since his heart exhibited signs of this catecholamine reaction. “It was probably occurring even as he was contemplating jumping,” Samuels said.

But the effect isn’t always so immediate. Researchers have documented a three- to five-fold increase in cardiac arrests -- not associated with physical injuries -- in communities hit by earthquakes within a few days of the event. They saw the same trend in lower Manhattan after 9/11.

“Most people who have a catecholamine attack recover and walk away without any harm,” said Samuels. If those attacks occurred hundreds or thousands of times over the years -- which happens with a rare genetic disorder -- the heart could sustain some lasting damage raising the risk of heart failure.

There’s probably, though, not much reason to worry about getting scared every year on Halloween. “It isn’t really frightening,” said Samuels. “It’s not the holiday it once was.”