Vol. 243 November 1, 2020 Are You Scared to Death??

 Is it because of Halloween or the election?
Can you be scared to death?
The short answer is yes, absolutely, BUT it is very rare.

Dr. Martin Samuels, Chief of Neurology, Brigham and Women’s Hospital summarized the mechanism as the familiar “fight-or-flight” response. The outpouring of adrenaline in our blood in response to stress can inundate the rhythm center of the heart, causing it to lose control, resulting in ventricle fibrillation and persistent contraction or “cramping” of the heart muscle. That stops the effective pumping of our heart, and we drop dead. The other effect of excess adrenaline is an overwhelming influx of calcium ions into heart muscle which causes strong, continuous heart muscle contractions resulting in no blood flow to the brain and unconsciousness.

The “flight-or-flight” response can be in reaction to any strong emotional event, pleasurable as well as not-so-pleasurable. Strong emotional stress may cause sudden death during a passionate religious experience or sexual intercourse.  I couldn’t find a study of sudden death following a “passionate religious experience” ( most references were about “mystical deaths”), but there is data on sudden death during  “passionate” sexual intercourse.

Sudden death during intercourse accounted for only 0.6% of sudden deaths in a 2011 JAMA report. That is about 1 death per 10,000 persons (not per coitus), almost entirely men. The good news is that is it very rare, and the even better news is that a study of 900 men followed for 20 years showed no increase in strokes during to intercourse. 

Stressful sporting events have been associated with sudden cardiac deaths as well as an increased number of post-event heart attacks. I have written previously about increased cardiac deaths in both Germany and Los Angles related to close soccer championship games and American  Super Bowl games,  again mostly in men. Interestingly the incidence of cardiac events was higher in those fans (men mostly)  rooting for the losing team. One UK study even revealed 1 sudden death in the stadium for every 5 to 10 soccer games!

During the week after 9/11 there was an uptick of cardiac deaths in New York city. Apparently, even getting a hole-in-one can kill you, though of the 152 deaths from lightening strikes over a 7 year span less than half were golfers.  The rate among boaters and fishermen was much higher.

It is this stress mechanism that explains the limited successes of voodoo curses, but unlike other forms of complimentary medicine like acupuncture and Reiki, you have to believe in voodoo to have it work.

 Can you be sued or charged with a crime if your action leads to a person’s death? Well, as is true of much of our justice/legal system, “it depend”. If you inadvertently harm a person you must likely will be held harmless. If you intentionally surprise or seek to scare a person and they die, you can be found guilty of “negligence”.  In 1979 a 20 yo.man who broke into the home of a 79 yo. woman and took her hostage was sentenced to life imprisonment in federal court after she died from a heart attack while in his custody.  The actual charges were “kidnapping” and “negligence”  (failure to seek treatment for her).

What about just a good old fashioned  “blood-curdling scream”? Well, that can cause you trouble too.  Dutch physicians studied 24 healthy volunteers and found that viewing a scary movie, like “Halloween 1, or 2, …#13”,  could cause the initiation of the “coagulation cascade” in their blood. This cascade involves multiple “factors” (proteins) that cause us to form a clot when we are cut, so that we don’t bleed to death from a simple cut. The cascade is started by Factor VIII which increased an average of 11 units after viewing a horror film. No increase was seen after watching an educational film. An increase of 10 units of Factor VIII increases your chance of forming a blood clot by 17%. Forming a blood clot inside a vein can lead to a pulmonary embolism, another cause of sudden death in apparently healthy people.

If you are reading this blog it means that you have survived the creepy clowns and other scares of Halloween 2020, but don’t be smug.
The Presidential election is just days away, so you are still at risk of being “scared to death” by a clown.


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