True laughter—not the strained, polite variant you find in offices, or the monotonous guffawing you hear on comedy podcasts, but real, involuntary, gasping laughter—is an escape from death, or at least the dread of it: you can think about death while laughing hysterically, can even, if you’re a sociopath, watch someone die while laughing hysterically, but it’s safe to say that, in that moment, your own death will not seem so frightening. And so of course the question is: can the act of laughing itself kill you, specifically with an aneurysm or a heart attack? For this week’s Giz Asks, we reached out to a number of doctors to find out.
Assistant Professor, Cardiology, Duke University School of Medicine
Overall, the answer is no. Laughing can increase your intrathoracic pressure, and if you have an aortic aneurysm, that pressure can be transmitted into your vascular system, and it would rupture. But in that case, you just happened to laugh: the laughing didn’t get you. Somebody can have a heart attack while they’re laughing, but they were going to have a heart attack no matter what.
But there are associations. A recent paper in the Journal of Epidemiology at how often 17,000 people laughed, and it showed that people who laughed less were more likely to die, and the risk of cardiovascular events was higher in those who laughed less.
Other than that I know of one case and one case only in the medical literature in which somebody died laughing. It is cardiovascular in nature. A 50 year old woman was on medication for schizophrenia, and sometimes these medications can lead to an irregular heart-beat. She was told she needed to stop the medications for this reason, because she was at risk for cardiac death. But she didn’t take the advice. Later, she was at home, and someone made a joke. She laughed for two or three minutes and then passed out and died. The laughter triggered an arrhythmia: she actually died laughing.
“Somebody can have a heart attack while they’re laughing, but they were going to have a heart attack no matter what.”
Associate Professor of Medicine, Cell Biology and Physiology at Washington University School of Medicine in St. Louis
If the laughing induced persistent laryngospasm [i.e., the sudden seizing up of the vocal chords, which can block the flow of air into the lungs], it is conceivable that the heart could be deprived of oxygen, resulting in a lethal arrhythmia (i.e., ventricular fibrillation, like what occurs when people have ‘sudden death’ during a heart attack). So unless someone started CPR right away and shocked the heart with a defibrillator, the person could ‘die from laughing.’
Another possibility along the same lines of laryngospasm would be if the person was laughing while eating and aspirated food into the trachea blocking the airway. Someone doing the Heimlich Maneuver could possibly relieve the obstruction, otherwise the result would be the same as above, because the heart would be deprived of oxygen and either stop beating or develop fibrillation.
“Another possibility along the same lines of laryngospasm would be if the person was laughing while eating and aspirated food into the trachea blocking the airway.”
Professor, Surgery, Stanford University
Not likely, especially if you are otherwise healthy. Certain individuals with inherited defects in collagen production or cross-linking, such as type IV Ehlers Danlos or Marfan Syndromes, could potentially develop an aneurysm if their blood pressure were to rise significantly while straining or holding their breath. This scenario could arise during “hard laughing.” I had a patient with Ehlers Danlos Syndrome develop life threatening internal bleeding from a ruptured artery while in a dentist’s office, possibly due to gagging or coughing during a dental procedure.
That said: could you laugh so hard that you “rupture” an existing aneurysm?
Yes, possibly. Especially if you have a large abdominal or thoracic aortic aneurysm, visceral artery aneurysm, or intracranial aneurysm. Hard laughing may increase blood pressure, which could precipitate rupture in an existing aneurysm if it was far enough advanced. Rupture of previously asymptomatic intracranial cerebral aneurysms—this occurs most tragically in young, otherwise healthy women. No one knows exactly what precipitates rupture in an existing aneurysm—it is a combination of increasing weakness in the arterial/aortic wall, combined with luminal pressure and hemodynamic forces inside the affected segment of artery. A patient of mine once ruptured his abdominal aortic aneurysm watching Monday Night Football with friends at home, so: possible.
Could you laugh so hard you “dissect” you aorta? Again yes, possible, especially if you have chronic high blood pressure or genetic predisposition for thoracic aortic aneurysms or dissections (TAAD). Dissections are acute aortic emergencies where blood gets in-between the layers of the aorta, causing the aortic wall to separate and tear along its length, creating two or more lumens for blood flow where only one existed before. The terms “dissection” and “aneurysm” are frequently confused—dissections can weaken the aorta, predisposing to late aneurysm formation. Aneurysms rupture but very rarely cause dissections. John Ritter died of complications of an aortic dissection. George C. Scott and Albert Einstein died of ruptured aortic aneurysms. Dissection is common in Asia (China/Japan) due to endemic high blood pressure. Dissections can have lethal consequences without causing rupture if the dissection obstructs blood flow to the brain or other critical organs, but dissections can cause acute rupture of a weakened aorta as well, even in the absence of an aneurysm.
Both ruptured aneurysms and acute dissections are extremely painful and frequently deadly. In that sense, neither are “laughing matters.”