Were One-Third of Quake Victims Scared to Death? : Health: A high percentage of earthquake-related cardiac deaths does not surprise medical experts who have new respect for the power of human emotions.

When the Northridge quake struck, the woman was terrified. In less than a minute, the shaking stopped and her Granada Hills house remained intact. But the danger, for the 73-year-old, had not passed. Her chest began to ache. She gasped for air. She knew she was in trouble and dialed 911.

But 911 wasn’t there. The telephone lines were down.

Within minutes, the woman died in a manner similar to about 20 other Southern Californians following last week’s 6.6 earthquake.

Of the 51 earthquake-related fatalities, early reports indicate that one-third may be due to heart attacks, or what doctors call sudden cardiac deaths. The Los Angeles County Coroner’s official report is not expected for several weeks.

But the high percentage of cardiac deaths apparently related to the quake does not surprise medical experts who, in recent years, say they have developed an awesome respect for the power of emotions. In several of the cases, the victims were clearly reacting to immediate danger.

A 52-year-old Cypress woman died while racing through her creaking house to shepherd her children to safety.

A 62-year-old Northridge man was found dead in his car of an apparent heart attack. He managed to free himself from his buckling house and duck into his car. But he couldn’t escape his fright.

Seven other people got to a hospital before their hearts finally gave out.

Most of the heart-attack victims were 50 and older. But medical examiners have not ruled out heart attack as the cause of death for a 31-year-old Rancho Cucamonga woman who dashed to her baby’s crib during the quake, stumbled and died, and an 11-year-old Westside girl who had been ill prior to the quake.

Fear, panic and terror are among the most gripping of sensations--feelings strong enough that even young and healthy people often experience their hearts racing and breaths shortening in the midst of a traumatic event.

“I know I felt that way,” says Dr. Linda Demer, chief of cardiology at UCLA Medical Center. This response, she says, is the well-known evolutionary trait called “fight or flight.” It helps us react with some success when face-to-face with the saber-toothed tiger.

“This response involves massive releases of hormones (called catecholamines) which stimulate receptors in many places of the body, including the heart,” Demer says. “That is responsible for the increased heart rate that most people feel. The heart beats faster and pumps harder. That increases the work load on the heart. The blood pressure goes up as well.”

The response is designed to trigger an increase in strength in healthy individuals, Demer says. But, “if someone has compromised blood flow to the heart, they may not be able to meet the demands of the heart muscle.”

And, it could be that the Northridge quake was poorly timed in relation to how much strain hearts can withstand.

Consider this: Monday mornings are, statistically, the highest risk period for having heart attack. Early mornings are risky because of “normal biological variations, including the blood being more likely to clot in the morning hours,” says Dr. Howard N. Allen, an attending cardiologist at Cedars-Sinai Medical Center.

And Mondays are thought to be risky because the weekend has ended and people face the mental stress of beginning a new work week.

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Research has shown that severe anxiety can be the trigger for a heart attack.

Studies following moderate earthquakes in Thessaloniki, Greece (1978), and Newcastle, Australia (1989), provide “weak evidence that acute emotional and physical stress may trigger (heart attack) and coronary death,” according to the authors of one of the studies.

Another study to determine if fear caused heart attacks was begun at a large Israeli hospital during the days before the Gulf War in January, 1991.

In that analysis, a dramatic jump in the number of heart attacks was observed on Jan. 17, 1991, the day after the start of the war, but before the first missile strikes in the area. Heart-attack rates were higher throughout the war, although the not as high as on that very first day. This suggests that the stress related to fear had a greater impact than the actual missile attacks, the researchers said.

Scientists even think they understand the chain of events that links the sensation of fear to a malfunctioning heart. But what they do not understand is why this sensation kills some people with heart disease and not others. And how can fear kill a person with no detectable heart disease--for example, a seemingly robust, healthy person?

In people who already have some heart disease--such as narrowed, clogged arteries--catecholamines can cause an imbalance between the supply and demand of oxygen, causing a myocardial infarction, or heart attack, says Allen, a former president of the American Heart Assn.’s Greater Los Angeles Affiliate.

Catecholamines can also accelerate the blood-clotting process. And, if there is already plaque, or fatty deposits, in the arteries, the clot may close off the artery and cause a heart attack.

But another type of attack is simply called “sudden death.” And it is more mysterious in that--in rare cases--it can kill people who have no detectable heart disease.

In sudden death, the catecholamines flooding the body trigger an onslaught of electrical impulses that can shift the heart’s regular pace into a chaotic, rapid, irregular beat, called arrhythmia or tachycardia, says Allen. The heart is not really pumping anymore, but convulsing.

Even if an arrhythmia is triggered by anxiety or fear, “it’s likely you have an underlying (heart) problem that would predispose you,” says Dr. Barbara Natterson, a cardiology fellow at UCLA Medical Center who is also a psychiatrist. But that isn’t always the case.

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Much remains to be learned about how stress affects the heart, experts admit.

Some research in the past decade suggests that men with hostile, hard-driving personalities--the so-called “Type-A personalities”--are more likely to have heart disease and subsequent heart attacks.

Conversely, recent studies indicate that women who are poor at expressing their emotions are more likely to have heart attacks.

“People who have heart attacks tend to be those with the traditional risk factors, such as diabetes, high cholesterol, smoking, hypertension and family history,” Natterson says. “But the question remains: What ultimately causes that plaque to rupture?”

Along with putting their patients on a treadmill, doctors now commonly test people with possible heart disease to see how they respond to mental or emotional stress.

These tests include measuring the heart rate while the patient plays a challenging video game or completes a tough mental task.

But medical experts are far from being able to predict who might be more likely to have a heart attack while under stress.

A better question for Southern Californians--especially those with heart disease--might be: Do you get extremely frightened during an earthquake?

“The true meaning of stress is not only the stimulus--the earthquake--but how one has learned to respond,” Allen says. “We are aware, in California, that this is an area where earthquakes occur. We talk about preparedness and what to do, but when it occurs, some people handle it an organized way and some people panic.”

Psychologists often advise people to cope with an anxious situation by having a previously thought-out, well-rehearsed plan on what to do. Los Angeles psychologist Robert Butterworth, who has a long history of counseling trauma victims, says he wonders if some of those who died of heart attacks lacked a coping strategy.

“We can’t wake those people up and ask them ‘Did you have an alternative behavior?’ Did you rehearse something?’ ” he says. “But if you have an alternative plan, you might think, ‘If I do this, I’ll survive.’

“That is the therapy behind disaster-response drills--to learn to adapt, to get used to it. So when we are frightened, we are able to overcome it.”