Human stress cardiomyopathy. Myocardial lesions in victims of homicidal assaults without internal injuries.

In order to clarify the relationship between stress and sudden death, we reviewed homicidal assaults that occurred in Cuyahoga County, Ohio (metropolitan Cleveland), over the preceding 30 years. Specifically, attention was focused on the autopsy and investigative findings relating to victims who died as a direct result of physical assault without sustaining internal injuries. Fifteen such victims were identified, and 11 of them showed cardiac changes (myofibrillar degeneration) consistent with "stress cardiomyopathy," comparable to lesions described in stressed animal experiments. Age matched and cardiac disease matched control subjects showed little or no evidence of such changes. Two victims survived for a time in the hospital, suffered arrhythmias throughout the hospital course, and had the described cardiac lesions at autopsy. We interpret our data as being strongly supportive of the theory of catecholamine mediation of these myocardial changes in man and of the lethal potential of stress through its effect on the heart.