Wednesday, June 13, 2012

Author Beware: Delusional Diagnosis (2/2)

Last post, I discussed the issue of heart palpitations and how, in isolation, they can be benign and not representative of heart disease.

The line in this particular published novel that did get my ire up is shortened as follows: "Any experience terrifying enough to cause a panic attack, in extreme circumstances, causes an arrhythmia. That's a heart attack."

Really? No. There's a lot medically wrong with this sentence.

First, in very general terms, a heart attack is caused from lack of oxygen to the heart muscle, generally from a clot in an artery that feeds blood to the heart-- your coronary arteries. When the heart muscle is not getting oxygen, it becomes irritable. One interesting thing about your heart is that each cell can generate an electrical current that will contract heart muscle. It generally does not do this due to the over-riding normal pacemaker. However, when oxygen is cut-off and the heart cells become irritable, they can begin to fire outside the normal conduction system.

When this happens, the medical team begins to see aberrant beats. But see, the heart attack itself generally causes the arrhythmia, not the other way around.

Let's stay on track with this character. A healthy, college age woman. The incidence of actual heart disease is going to be low. What causes chest pain during a panic attack? Generally, the heart rate may be faster than usual. However, the truly rapid heart beat of SVT (more on that later) I would say is rare and would point away from the mind and more to the conduction system in the heart.

The last thing to consider is that people who have true heart arrhythmias, may have structurally fine hearts. Meaning the muscle, valves, and coronary arteries are good. Just the conduction system is a little funky.

My advice for authors-- don't make blanket medical statements. Just like they taught you in school-- sentences that have all, every, etc... are likely the wrong answer.


  1. Excellent post! I'm loving this! In fact, I'm loving it sooooo much that my heart is racing! And I'm using so many exclamation points! That's a heart attack!


    1. Becky,

      That cracked me up. Remember,if you are having a heart attack, you need to call 911!!

  2. Sometimes it appears that an author is looking for the impact their writing will make on the reader rather than authenticity.

    1. Mattie,

      That's an interesting comment. What I have found is that when I do spend the time to consult an expert for my scene-- I am actually able to increase the conflict with their suggestions. This has always been the case. So, I think it is definitely worth the time to interview someone working in the field or ask a quick question. You'd be surprised how the story tension can change and the expert will bring up things you never even thought of.

  3. Thank you, Friend, for such a good article. Looking for more of these good reads/articles.

  4. I've had to sit back and think about the excerpt you posted from the novel in question, simply because you're right--there is so much medically wrong with it. I had to go to the Mayo Clinic site to doublecheck panic attacks, and it noted that panic attacks (normally/on average) do not occur directly after an experience of terror. They are more likely to be the result of long exposure to high stress and occur "out of the blue".

    As far as the choice of inflicting a heart attack on a healthy, college-aged woman . . . well. There were so many other choices that could have lent drama without stretching logic to a breaking point. The writer could have opted for a mitral valve prolapse (which can be accompanied by palpitations or sensations of suffocation when under stress) and, if there was a need for tragedy, make the valve leak.

    I had to LOL at the 'funky conduction system' term. While waiting in an ER a while back, I overheard a doctor explain to a cardiac patient about the two types of cardiologists: one's an electrician and the other is a plumber. Perhaps a bit blunt, but mostly accurate.

    Thanks for some very insightful posts!

    1. Thanks for your comment Shandiss and I love that explanation for the patient-- that's awesome!!

  5. So glad to find your blog. I have zero medical experience and so my writing is vulnerable to lay-person mistakes. So this is a good reminder to research properly.

    I was a lawyer and used to have a similar response when watching legal dramas / movies.

    The best story I heard about getting caught up over the details was from an old law lecturer. He was a huge movie buff and a big fan of Oliver Stone. Oliver Stone once did a pre-screening of one of his movies at Harvard when my lecturer was a student. At the end of the movie Stone took questions from the students. My lecturer put his hand up and identified a legal anomoly in the movie. Oliver Stone's response: It's just a movie! My lecturer was crushed...

    By the way congratulations on the new book!

  6. Raewyn,

    Thanks so much for your comment and sharing this experience of your law professor.

    It's interesting to me when authors/filmakers/TV producers are like-- it's just fiction. I can do whatever I want.

    Problem is-- readers like their fiction to be fairly well grounded in reality. It provides a better experience for them and shows the person has invested time in researching those details.

    I think it's a trust issue. Just my two cents...