William The Coroner’s Forensic Files

Thursday, 5, February, 2009

Murder By Heart Attack

Filed under: Forensics — williamthecoroner @ 17:47

White Coat asks the question “Can you be scared to death?”. It was triggered by this article. The problem that I noticed first was that the Scientific American people didn’t ask an expert in the field of sudden and unexpected death, they asked a neurologist.

But the short answer is yes, one can be frightened to death. The original research was done at the Cuyahoga County Coroner’s Office by Charles S. Hirsch, now the Medical Examiner for Manhattan. [1] Several other forensic pathologists have commented on this topic, including Drs. Dolinak, Davis, and Bernard.

But how could an emotional event be linked to a myocardial infarction, even if there are no physical injuries? The case White Coat described was that of an elderly woman who was surprised by an intruder hiding in her home? Well, these are the linkage criteria:

  • The criminal event should be sufficiently severe enough that would logically permit a charge of homicide if there was physical injury.  (In this case, breaking and entering is illegal enough, and supposes a criminal desperate enough to be a significant danger.)
  • The victim should have realized that they were threatened
  • The circumstances should be highly emotional
  • The collapse and death must occur within the time frame for physiological/emotional response
  • The victim should have heart disease that gives them a predisposition for sudden death

So, threatening someone with a weapon, or threatening one of their loved ones, or even just tying someone up when you ransack their house is a bad idea.

This is closely related to deaths that occur after an arrest, or a struggle with police. Usually, these folks are subdued, cuffed, and put into the back of a cruiser, and are found dead when they arrive at the station or shortly after arrival. The catecholamine (DA/NA/5HT) happens after the fight ends. Relatives of these decedents are usually unhappy and suspicious, not surprisingly.

1. Hum Pathol. 1980 Mar;11(2):123-32
2. Dolinak D. et. al. Forensic Pathology pp. 506-507



  1. Cool analysis. Learned something.
    Only issue I have is how one can say “beyond a reasonable doubt” that fright was the cause of death and not some other intervening factor.
    How do you differentiate between someone who dies in their sleep before a break-in and someone who dies from fear after a break-in occurs?
    Stakes are kind of high if you’re wrong – could mean a difference of decades in jail.

    Comment by WhiteCoat — Friday, 6, February, 2009 @ 19:34 | Reply

    • Well, WC, I don’t have to hold an opinion to “Beyond a reasonable doubt.” The standard is “To a reasonable degree of medical [or scientific] certainty.” Now, part of the scenario is the perpetrator must threaten the victim, by surprising them, tying them up, threatening them or a loved one, like that.

      So, if you’ve got an undisturbed scene, person dead in bed? I’d be more worried that the prosecutor would claim smothering, a COD that leaves absolutely NO marks on the body whatever, aka “the gentle homicide”. I think in your scenario, that would be plea-bargained down to avoid trial. But ask a lawyer.

      Comment by williamthecoroner — Friday, 6, February, 2009 @ 20:04

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