Heartfelt fear: findings link stress and cardiac symptoms.

Terrible sadness, a sudden fright, or other emotional stress can bring on heart attack symptoms in people not actually experiencing a heart attack, according to two new reports.

The researchers examined people who showed up at hospitals with chest pain and an impaired capacity to pump blood but no heart-tissue damage or clogged coronary arteries. Rather, the patients turned out to be experiencing physical effects after stressful events, such as the death of a loved one.

Cardiologist Hunter C. Champion of Johns Hopkins Medical Institutions in Baltimore and his colleagues treated 18 women and 1 man with severe symptoms. After initial tests had ruled out a heart attack, bedside talks revealed that all the patients had recently had a stressful experience. These included the death of spouse, a car accident, an armed robbery, a family dispute, a court appearance, and a surprise party.

The patients had blood concentrations of catecholamine hormones that were more than seven times normal and two to three times as great as those in five patients having heart attacks triggered by coronary artery blockages. Catecholamines, which include adrenaline and dopamine, are powerful hormones that regulate heart rate, blood pressure, and other body processes. The researchers report their findings in the Feb. 10 New England Journal of Medicine.

In the other study, cardiologist Scott W. Sharkey of the Minneapolis Heart Institute and his colleagues identified 22 women who were brought to a hospital shortly after a stressful incident. "These patients came in with what looked like massive heart attacks," Sharkey says. But tests of their hearts showed no blockage and no tissue damage.

However, magnetic resonance images revealed an unusual abnormality in the movement of the wall of the heart's strongest pumping chamber, Sharkey and his colleagues report in the Feb. 1 Circulation. This condition prevents the heart from circulating enough blood.

All patients in both studies recovered, but some of them received assistance from a machine in pumping blood for a few days.

Sharkey points out that heart tissue is rich in nerve endings that can stimulate the release of catecholamines. The flood of these chemicals brought on by stress might cause spasms in small arteries that nourish the heart, he says.

The new findings also suggest that excess catecholamines have a toxic effect on heart tissue, says Yoshihiro J. Akashi of St. Marianna University School of Medicine in Kawasaki, Japan.

Sharkey adds, "This process is an example of the strong physical connection between the brain and the heart, in women especially."

Emergency room physicians should ask patients about stressful events when apparent heart attack patients have no sign of a coronary artery blockage, Champion says. Then, after stabilizing the patient, it's a matter of waiting it out.

"Time really does mend a broken heart," Champion says.