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Everyone has experienced heartbreak and emotional shock, from mind-numbing news a loved one has died suddenly through to the breathtaking "Surprise!" bellowed by friends marking a special birthday.

In some instances, these events can break your heart literally, not just figuratively -- and suddenly stop the heart from beating.

Until now, scientists believed being "scared to death" was a form of heart attack. But, according to research published in today's edition of the New England Journal of Medicine, it's something else entirely -- stress cardiomyopathy.

Dr. Ilan Wittstein, a cardiologist and assistant professor at Johns Hopkins University School of Medicine in Baltimore, Md., said while symptoms are the same as a classic heart attack -- crushing chest pain, shortness of breath, fluid in the lungs, nausea and heart failure --- the condition is not caused by an arterial blockage, which cuts blood flow to the heart muscle.

Rather, stress cardiomyopathy is triggered by a sudden surge in stress hormones that stun the heart, and stop it beating.

The good news, Dr. Wittstein said, is that once a "broken heart" is restarted -- which can be done with a shock of electricity from a defibrillator -- a person suffers no lasting effects.

The heart muscle does not die, and the patient does not require the usual post-heart-attack treatments, angioplasty or bypass surgery.

The research was conducted on 19 patients who were diagnosed with left ventricular dysfunction after a sudden emotional stress. Eighteen were middle-aged women, but researchers are not sure why the condition appears more common in this group.

The subjects suffered broken hearts for a variety of causes, including the death of a loved one, a fierce argument, a motor-vehicle collision, a surprise party, fear of a medical procedure and fear of public speaking.

Dr. Don Beanlands, deputy director-general of the Ottawa Heart Institute, recalled a woman who was scared to death of dental work, and whose heart stopped in the dentist's chair. "It looked like a classic heart attack. Her cardiogram was abnormal. Her lungs were filled with water. But test after test showed nothing amiss."

Dr. Beanlands said the woman was critically ill and spent two days in the intensive-care unit, but recovered fully.

According to the new research, some people respond to sudden, overwhelming emotional stress by releasing large amounts of stress hormones called catecholamines (the best know of which is adrenalin) into the bloodstream. The chemicals, along with other proteins produced by an overexcited nervous system, can be temporarily toxic to the heart.

Dr. Wittstein said the most important aspect of the research is that it can help clinicians distinguish between a heart attack and stress cardiomyopathy.

He said this type of patient can often befuddle their physicians. "These cases were, initially, difficult to explain because most of the patients were previously healthy and had few risk factors for heart disease," Dr. Wittstein said.

The patients in the study underwent a battery of tests. Angiograms revealed no blockages in the arteries supplying the heart. Blood tests did not show typical signs of a heart attack, such as highly elevated levels of cardiac enzymes that are released into the bloodstream from damaged heart muscle. And magnetic resonance imaging (MRI) scans confirmed that none of the stressed patients had suffered irreversible muscle damage.

But the most pleasant surprise for researchers was the swift recovery after stress cardiomyopathy. The ability of the patients' hearts to pump improved within a few days. Complete recovery occurred within two weeks. In contrast, partial recovery after a heart attack can take weeks or months and, frequently, the heart-muscle damage is permanent.

Cardiovascular disease is the leading cause of death in Canada, according to Statistics Canada. About 74,600 people died of heart disease in 2002, the most recent year for which data are available.

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