Recently, on the day Nigeria met the South African team for the semi-final at the Africa Cup of Nations (AFCON 2024), not less than four Nigerians were reported dead following the gripping match, particularly when penalty was awarded against the Nigerian Super Eagle.
Heart-pounding events, from various continental and global football matches are now known to be a risk factor for cardiovascular events. The risk is higher for at-risk people in cities or regions where the teams playing are from. “It is a known phenomenon and known risk factor,” said Muhammad Choudhry, a Dignity Health cardiologist.
In fact, 1 in 5 heart attacks occur with no recognizable signs or warning. Moreover, having conditions such as diabetes or high blood pressure can increase your chance of a heart attack by up to 2x!
A 70-year-old restaurateur, Josephine “Ann” Harris, died of cardiac arrest hours after President Obama stopped at her diner for breakfast last week. Harris, who didn’t know that Obama would visit until shortly before he arrived, was described by friends and family as a big fan of the president. Can people die from being too excited?
Yes. Excitement can trigger heart attacks, cardiac arrest, strokes, and other potentially fatal medical emergencies. Your body reacts to excitement in much the same way it reacts to feelings of fear or stress—by releasing the hormones adrenaline and noradrenaline. These stress hormones trigger what’s known as the fight-or-flight response, which primes people (and animals) to face dangerous situations. However, too much adrenaline and noradrenaline can be dangerous to the heart, brain, and other organs. An enormous shock, whether positive or negative, can cause your heart to speed up, beat irregularly, or stop. In patients with pre-existing heart disease, the fight-or-flight response can also dislodge arterial plaques, sending blood clots to the heart, causing a heart attack, or to the brain, causing a stroke.
Excitement and death
All kinds of excitement have been shown to kill people. A Taiwanese man died of a stroke after watching Avatar. One study showed that soccer fans in Munich experienced higher than normal rates of cardiac emergencies during Germany’s games in the 2006 World Cup. Orgasm can trigger fatal heart attacks, as can unexpected personal triumphs: One man died after sinking a hole-in-one in golf; another passed away after bowling a perfect game. (Doonesbury cartoon character Dick Davenport died after seeing a vanishingly rare Bachman’s warbler.) Newspapers sometimes report on tragic deaths of young people apparently triggered by excitement, like the boy who experienced an asthma attack and then heart attack while opening birthday presents, or the British teenager who had a burst aneurysm while traveling in Thailand. However, death from excitement is exceedingly rare, especially among otherwise healthy people. (Harris was known to have had heart disease.) More common are medical emergencies triggered by negative emotions like stress, fear, or sadness, such as “voodoo death,” a term used to describe death caused by fear of supernatural punishment, and “broken-heart syndrome,” a cardiac abnormality triggered by sadness or emotional trauma.
With the Big Game upon us, fans and nonfans may be surprised to learn that the risk of a heart attack can more than double when the home team is playing. Heart disease is the No. 1 cause of death in the U.S. due in part to the often-invisible risk factors. In fact, 1 in 5 heart attacks occur with no recognizable signs or warning. Moreover, having conditions such as diabetes or high blood pressure can increase your chance of a heart attack by up to 2x!
Cardiac arrest is not the same thing as a heart attack – cardiac arrest occurs due to an electrical problem in the heart vs. obstructed arteries. However, certain diseases/conditions that make the heart weaker, along with physical overexertion and trauma can increase the chances for cardiac arrest. Even athletes who appear extremely fit and well, with no obvious warning signs can suffer from cardiovascular events – some while on the field during games. Fortunately, they were all treated and survived.
Taking a “time out” to find out if someone is at risk for cardiovascular disease, including heart attack can be lifesaving. The more people know about managing stress, blood pressure, cholesterol, and other controllable heart attack risk factors, the more they can live the heart-healthy way.
Miguel Maturana, MD, was introduced to the sports world when his father took him to a soccer game at an early age. Witnessing the emotions of his father and other spectators in the stadium sparked his curiosity of the emotional impact of athletics.
Dr. Maturana earned his medical degree from the University of Valparaíso, Chile, and completed his residency in Internal Medicine at the University of Tennessee Health Science Center. Now, Dr. Maturana, is a chief cardiology fellow in the Department of Internal Medicine in the UTHSC College of Medicine.
Dr. Maturana is the lead author, in collaboration with researchers in the UTHSC College of Medicine and Christian Brothers High School, of the research article, “Are Die-Hard Football or Other Sports Fans at Risk of Cardiovascular Events?” published in Current Problems in Cardiology. His research and knowledge in cardiovascular health was featured recently in the American Heart Association News, U.S. News & World Report, Health Day, and other media outlets.
“Relating one of the things I am very passionate about, which is soccer, with cardiology was very interesting. In Chile, there’s a very strong community of passionate fans of different sports, including soccer, which is very common,” he said.
Their study found that spectators of sports including soccer, rugby, baseball, and football, who experience strong emotional and psychological stress responses are associated with a risk of cardiac events, especially in individuals with a history of coronary artery disease. The strong emotional and psychological responses can lead to various outcomes including heart attacks, arrhythmias, and cardiac death. And they conclude, based on clinical evidence they analyzed, that it is better for an individual’s cardiovascular health to participate in sporting activities as an athlete than as a fan.
“When fans undergo strong emotional experiences at the stadium or while watching television, the strong emotion itself can create a sympathetic stimulation with releases of epinephrine, norepinephrine, and catecholamines, and leads to a sudden increase in blood pressure and heart rate.”Miguel Maturana, MD
“Also, this transient inflammatory response, that is mediated by cortisol, leads to inflammation, and if patients have a prior history of coronary artery disease, having inflammation in the coronary vessels increases the risk of cardiac events,” Dr. Maturana said.
Coronary artery disease is the most common type of heart disease and is caused by a buildup of plaque in the walls of the arteries that supply blood to the heart, according to the Centers for Disease Control and Prevention. In addition, current lifestyle behaviors including consuming alcohol, eating fatty meals, and tobacco use, is connected to an increased risk of cardiovascular events.
“During sporting events people tend to drink more alcohol, which raises blood pressure, and eat fatty food, which increases the risk of inflammation and increases LDL,” Dr. Maturana said. “People tend to smoke more, and drink more, and those environmental factors related to the event are contributing to the emotional response.”
With their review, the team also noticed a relation in emotional responses towards the end of the athletic event or during a specific time in the sport when the competition is more intense. Additionally, environmental factors such as atmospheric pressure are considered to have some correlation, said Dr. Maturana.
Watching your favorite team lose can increase your risk of a cardiovascular event, according to years of research into the relationship between fandom and heart health. Reports on passionate supporters in Los Angeles, Germany, Japan and Spain have demonstrated that watching stressful games releases higher levels of hormones like cortisol and testosterone into the bloodstream, which puts the body under a tremendous amount of stress.
According to analysis from previous World Cup tournaments, fans’ risk of suffering an acute cardiovascular event can increase by threefold on match day. The most dangerous period is the initial two hours after the game begins.
The answer isn’t to quit spectating sports, as feeling part of a fanbase has powerful mental health benefits, especially for aging supporters, who otherwise don’t have many communities to their name.
But striking some sort of balance in one’s viewing habits is crucial. Know your heart risks (your current health, your history) and however silly it may sound at the outset, or to your friends, recognize that cheering for your beloved club or country carries its risks. And remember, while losing sucks, there’s always next year. The same can’t be said for losing one’s life.
The negative impact of emotions when your heart is already vulnerable
There are two kinds of stress that impact your brain. Helpful stress (also known as eustress) can assist you with getting things done by helping you focus your attention. Unhelpful stress (distress), on the other hand, can be so severe that it can lead to fatigue and heart disease.
If you have coronary artery disease (CAD), your heart may be deprived of oxygen. This deprivation, called myocardial ischemia, can occur in as many as 30% to 50% of all patients with CAD. It can be further exacerbated by emotional stress. In fact, if you have any type of heart disease, any strong emotion such as anger may also cause severe and fatal irregular heart rhythms. Expressions like “died from fright” and “worried to death” are not just hyperbole — they are physiologic possibilities. Furthermore, when patients with newly diagnosed heart disease become depressed, that depression increases the risk that a harmful heart-related event will occur within that year.
Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovascular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.
The negative impact of emotions when you have no heart disease
Of course, stress can have a big effect on your heart even if you don’t have heart disease. Here’s just one example: In 1997, cardiologist Lauri Toivonen and colleagues conducted a study of EKG changes in healthy physicians before and during the first 30 seconds of an emergency call. They saw changes that indicated oxygen deprivation and abnormal heart rhythms.
More recent studies have also observed these changes in the setting of with stress, anxiety, and depression — all of which are, of course, brain-based conditions. Even in people with no prior heart disease, major depression doubles the risk of dying from heart-related causes.
Cardiac psychology: Tending to your emotions for your heart’s sake
It is important to control your worry and stress, not just because you will worry less and feel better, but because less worry means less stress for your heart. This applies to the entire range of stressors, from a small episode of acute panic to a larger context such as living through a natural disaster. For all the reasons outlined above, a new emotion-based approach to heart health, called cardiac psychology, is receiving increasing interest.
You really can change your brain and get a healthier heart in the process. Here are some ways to get started:
- Seek professional help. Don’t ignore stress, anxiety, depression, excessive worry, or bouts of anger that overwhelm your life. Seek professional help. If you meet criteria for a diagnosis, treatment can help reduce symptoms, thereby protecting your brain and your heart.
- Available treatments in cardiac psychology.Aside from more traditional psychiatric treatment and exercise, psycho-educational programs, educational training, stress management, biofeedback, counseling sessions, and relaxation techniques should all be considered before or after a heart-related event. Newer treatments such as acceptance and commitment therapy and expressive writing can also be helpful.
- Exercise.Physical exercise can help you have a healthier heart and brain — in the right doses. For example, many recent studies have demonstrated that aerobic exercise can help you be more mentally nimble by helping you think faster and more flexibly. Even frail older adults have improved their thinking and overall psychological well-being from exercising for one hour, three times a week. And people in rehabilitation after being diagnosed with heart failure report clearer thinking when their fitness levels improve.As clinical research scientist Michelle Ploughman commented, “exercise is brain food.” Various types of aerobic exercise, including jogging, swimming, cycling, walking, gardening, and dancing, have all been proven to reduce anxiety and depression and to improve self-esteem. This is thought to be due to an increase in blood circulation in the brain, and the fact that exercise can improve the brain’s ability to react to stress.
A starting point for better brain — and heart — health
If you struggle with stress, anger, anxiety, worry, depression, or problems with self-esteem, talk to your primary care physician — or a cardiologist, if you have one. A consultation with a psychiatrist may be very helpful. Together, you can explore which of these potential therapies might best protect your psychological state, your brain, and your heart.
Credits