38 Nabal's 'heart failed him and he became like a stone. His pre-morbid state gives some clues. However, the NIV rendering 'his heart failed him' is more suggestive of a cardiac aetiology. We might therefore surmise that Nabal suffered a myocardial infarction upon hearing the anxiety provoking news of his escape from David's wrath.
Strong emotion is a well known precipitant of unstable angina or heart attack.
He then went into cardiogenic shock and became peripherally shut down, cold and clammy, 'like a stone'. Dr Luke therefore suggests that the cause of death was an acute myocardial infarction complicated by ventricular aneurysm that subsequently ruptured leading to cardiac tamponade and death. Translated and edited by F Rosner New York.