We're used to seeing someone have a heart attack after getting angry in soap operas, but new research shows it can also happen in real life.
Getting angry can dramatically increase the risk of a heart attack, a study has found.
An episode of intense anger was found to raise the chances of an attack more than eight-fold in the two hours afterwards.
The research adds to previous evidence from studies and anecdotal reports that anger can act as a heart attack trigger. Those pre-disposed to outbursts of anger might be well-advised to keep a lid on their temper, the research suggests.
Study leader Dr Thomas Buckley, from the University of Sydney, Australia, said: "While the absolute risk of any one anger episode triggering a heart attack is low, our data demonstrates that the danger is real and still there."
The research focused on 313 heart attack patients admitted to the Royal North Shore Hospital in Sydney between 2006 and 2012 who were questioned about their emotional state in the 48 hours before they fell ill.
A seven-point scale was used to assess anger levels ranging from "calm" to "enraged, out of control, throwing objects, hurting yourself or others".
The threshold of acute anger was defined by a score of five - "very angry, body tense, maybe fists clenched, ready to burst".
Analysis showed that seven of the patients had reached at least this anger level within the two hour period preceding the onset of their symptoms.
One participant had reached anger level five within four hours of having a heart attack. Anger level four (moderately angry, so hassled it shows in your voice) was reported by two patients within two hours of their heart attack and by three within four hours.
Compared with patients' "usual" anger patterns, the relative risk of having a heart attack was 8.5 times higher in the two hours after an outburst rated as level five or above.
High anxiety levels were also associated with an increased risk of heart attack, raising the risk more than nine-fold.
Writing in the European Heart Journal: Acute Cardiovascular Care, the authors said the association shown in the study "adds to the small but growing body of evidence linking acute emotional triggers with onset of MI (myocardial infarction, or heart attack)."
Dr Buckley said the effect was mostly likely due to "increased heart rate and blood pressure, tightening of blood vessels and increased clotting".
He thought patients with heart disease should have their propensity to get angry or anxious assessed.
"Potential preventive approaches may be stress reduction training to limit the responses of anger and anxiety, or avoiding activities that usually prompt such intense reactions," Dr Buckley added.
"And for those at very high risk, one could potentially consider protective medication therapy at the time of or just prior to an episode, a strategy we have shown to be feasible in other studies. Minimising other risk factors, such as hypertension (high blood pressure) or smoking, would also lower risk".
Doireann Maddock, senior cardiac nurse at the British Heart Foundation, said: "Although these findings are interesting, the number of people affected was very small.
"More research is needed to explore their suggested link of intense anger as a trigger for a heart attack.
"The way you cope with stress can reduce angry outbursts and help you move on from high pressure scenarios. Doing regular physical activity can act as a stress buster. You could also learn relaxation techniques for managing stress.
"If you're worried about how you're coping with stress or are experiencing frequent anger outbursts have a chat with your GP."