We've all seen the standard movie heart attack scene: the victim (who is almost always a man), after an argument or physical exertion, clutches his chest and collapses. Does that happen in real life? A large international study of people around the world, published online Oct. 11, 2016, by Circulation, suggests that extreme physical exertion or emotional upset may indeed trigger a heart attack. Investigators asked more than 12,000 heart attack survivors (average age 58) what they'd been doing in the hour before the event. People who were either upset or engaged in heavy physical activity were at twice the risk of having a heart attack an hour later. Study participants who were upset while engaging in heavy physical activity were at three times the risk. The study does not prove that the triggers caused the heart attacks, but the findings are similar to those in smaller studies. What's the connection? Researchers say that being upset or engaging in heavy physical activity can raise blood pressure and heart rate, constrict blood vessels, and reduce blood supply to the heart. It's a good reminder to manage stress and to exercise on a regular basis to make your heart stronger and your blood vessels healthier.