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Am J Cardiol. 2010 Jan 1;105(1):136-8. doi: 10.1016/j.amjcard.2009.08.665. Epub 2009 Nov 14.

Homicide by fright: the intersection of cardiology and criminal law.

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  • 1Department of Legal Medicine, Armed Forces Institute of Pathology, Silver Spring, MD, USA.


The prevailing lay wisdom associates emotional stress with sudden death, and recent medical reports have linked massive catecholamine surges with demonstrable cardiac dysfunction that can be either reversible or fatal. This association does not strictly prove causality, and the question remains open for additional scientific investigation. From the legal viewpoint, however, the issue has been resolved, and case law clearly holds that sudden emotional stress can cause death. More significantly, case law also holds that if the sudden emotional stress is caused by criminal conduct, the resulting death of a victim of the criminal conduct can be prosecuted as homicide. Cardiologists are often called to testify in such circumstances. In the present study, we have reviewed 8 legal cases that are the basis of current opinions in these matters. These legal principles can be summarized as follows: emotional stress is sufficient, and physical abuse is not required for conviction; a time-lapse between the induction of emotional stress and death does not necessarily mitigate the charge of homicide; the criminal act must be the proximate cause of the victim's death; however, the accused does not always need to be physically present to commit the crime. In conclusion, although the pathophysiology of sudden death associated with massive emotional stress has not been fully elucidated from a scientific viewpoint, in the legal system, the association can be causative and can be the basis for a criminal prosecution. Cardiologists may be called on to provide expert opinions in the prosecution of these cases.

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