Think Twice Before Arranging a Surprise Party
20 Nov 2006
Are you considering a surprise party for a loved one or an old friend? It’s normally a generous thought and an enjoyable gathering. But a report in the New England Journal of Medicine shows that sudden surprises can have unexpected consequences.
There’s a scene that happens many times a day in this country. A patient arrives at the hospital emergency in acute distress. He’s complaining of constricting chest pain and shortness of breath. Suspected diagnosis is an acute coronary attack. But doctor’s jumping quickly to this conclusion can be wrong.
Johns Hopkins doctors faced a dilemma in 19 patients admitted to emergency. Outwardly the signs and symptoms were a textbook account of coronary attack. But the electrocardiogram was normal. Blood tests showed none of the changes associated with heart attack. Nor could they find any blockage of coronary vessels. The final diagnosis was labelled as a "fake" heart attack.
How could these doctors have initially been so wrong? After all, Hopkins doctors are not idiots. But when patients are diagnosed with a suspected coronary, doctors have no time to pour a cup of tea or chat about the weather. Rather than engaging in small talk, speed is essential in saving a life.
But later, doctors did have the time to ask patients what had transpired before their admission. Every case revealed that sometime during the 12 hours before symptoms occurred, all patients had encountered an acute stressful situation.
Some patients has suffered the death of a loved one, been involved in a car accident or had an exhausting and intensely angry argument. Others had been stressed about giving an important speech. And one occurred when a patient was given an unexpected surprise party!But not all patients are actors. Most are unable to fake a heart attack. So what triggers the symptoms that are so typical of this disorder?
Blood studies revealed that the 19 had high levels of stress hormones in their blood, 7 to 14 times the normal levels of adrenaline. In addition, the heart’s principal working chamber, the left ventricle, was not pumping sufficient blood. This, in some instances, can be life-threatening leading to an abnormal cardiac rhythm and heart failure.
Doctors are not certain of the sequence of events leading to a faked heart attack. But they believe that a sudden outpouring of adrenaline may cause a spasm of coronary vessels. Or that this outburst of adrenaline causes large amounts of calcium to enter cells temporarily putting them out of order.
There’s another unanswered puzzle. Why were most of the patients elderly women who were suffering from a faked heart attack?
Ilan Wittstein, cardiologist at Johns Hopkins, says "It may be that the female hormone estrogen serves to protect the heart cells from the effects of stress hormones like adrenaline. As women age and their estrogen levels decline, their hearts become more vulnerable to the effects of stress hormones in large amounts".
During a bone-fide heart attack a blood clot shuts off the supply of oxygenated blood to the heart’s muscle. This causes destruction of cardiac muscle unless clot-busting drugs are able to dissolve the clot.
But a sudden outburst of adrenaline appears to temporally stun heart cells that quickly recover their function. Magnetic resonance imaging (MRI) studies showed no lasting damage to cardiac muscle. So the majority of people with this condition are back to normal in a few days. And fortunately, like lightning, this problem does not appear to strike twice.
So you’ve planned a surprise party and have already sent out the invitations! If that’s the case, don’t despair. A faked heart attack is a rare problem.
Unfortunately none of us can escape the shock of losing a loved one or the news of a tragic accident. But suppose you’re considering taking an old friend surreptitiously out for a quiet dinner. And it’s your intention to have them open a door to encounter a room full of people. Think twice if it’s an elderly person who has a history of previous heart problem. A sudden flow of adrenaline is the last thing this person needs. In this case the best surprise is no surprise.
