People have to learn sometimes not only how much the heart, but how much the head, can bear

Maria Mitchell

Holiday Heart Syndrome

’Tis the season for cardiac deaths

Keith B. Churchwell, MD
Vanderbilt University School of Medicine

November 15, 2008

Special from Bottom Line/Personal


The holidays bring more than gifts and good cheer. They also bring an increase in deaths from heart disease, with spikes both on Christmas Day and New Year’s Day. The trend is so predictable that cardiologists now refer to the “Merry Christmas Coronary” and the “Happy New Year Heart Attack.”

A research team led by Robert A. Kloner, MD, looked at death records of more than 220,000 people who had died over a 12-year period. The study, published in Circulation, found that about one-third more deaths were recorded in December and January than from June through September.

The holidays also bring a rise in hospital admissions for nonfatal cardiac events, including angina (chest pain).

IS COLD WEATHER TO BLAME?

It was once thought that cold weather was the primary reason for holiday-related heart attacks. However, the Circulation study looked only at patients in Los Angeles County, where temperatures generally are mild all year.

Cold weather can play a small role in the incidence of cardiovascular events, especially for people with existing heart disease. It can increase the body’s response to stressful conditions, which can put people at heightened risk, particularly when they engage in more vigorous activities (such as shoveling snow) than they’re accustomed to.

The holidays themselves, however, present other risks...

INCREASED ALCOHOL

People socialize more -- and drink more -- during the holidays. Excessive alcohol can be toxic to the cardiovascular system, particularly in people with heart disease. Alcohol both depresses heart function and irritates the top heart chambers (the atria). The irritation can lead to atrial fibrillation, a dangerous change in the heart’s normal rhythm.

One of my patients, a young woman who usually didn’t drink, had shared a bottle of champagne with a friend. That’s not a lot of alcohol, but within 24 hours, she went into atrial fibrillation. Fortunately, her heart rate was back to normal after 24 hours.

What to do: Don’t use the holidays as an excuse to drink more than usual. Stick to the guidelines recommended by the American Heart Association -- no more than one drink daily for women ... two drinks daily for men.

LARGE MEALS

People eat more often during the holidays, and they tend to eat more, on average, at each meal. After a large meal, blood is directed to the intestines to aid in digestion. In patients with atherosclerosis -- blockages in the coronary arteries that can restrict blood flow to the heart -- the reduction in cardiovascular circulation can result in angina, chest pain caused by decreased blood.

Also, people tend to eat richer foods during the holidays. High-fat meals make the coronary endothelium -- the inner lining of blood vessels -- more reactive. This can cause an increase in coronary spasms, constrictions that further impede coronary circulation.

What to do...

Eat normal serving sizes, particularly if you’ve been diagnosed with atherosclerosis, angina or other heart condition. Don’t “save” calories so that you can eat more at a special meal.

Don’t add salt. Excessive sodium can cause fluid retention, resulting in spikes in blood pressure in some people. In patients with existing high blood pressure or impaired heart function, an increase in salt can lead to increased risk for heart failure or pulmonary edema, a buildup of fluid in lung tissue.

INCREASED STRESS

The holidays are one of the most stressful times of year. People are interacting more with relatives (with whom they may or may not be on good terms)... fighting crowds at the malls... traveling... attending parties... and/or worrying about finances. There’s a direct correlation between stress and cardiovascular events. During stressful situations, people with cardiovascular disease are more likely to experience coronary spasms -- and sometimes chest pain that can indicate angina or a heart attack.

There’s also a condition called stress-induced cardiomyopathy, which can cause heart attack–like symptoms in response to intense stress. It is seen predominantly in women and is thought to occur when a stress-related surge of adrenaline stuns the heart. Most people recover without long-term harm, but in rare cases, it can be fatal.

What to do: Take steps to minimize holiday stress -- by not overbooking your social calendar... walking away from (instead of confronting) unpleasant social situations... and keeping up with regular exercise and relaxing activities.

WINTER INFLUENZA

The flu season peaks between the months of December and March. Flu is potentially dangerous for everyone, but heart patients are especially vulnerable. There’s evidence that the inflammation that accompanies flu may destabilize arterial plaque and increase the risk for clots, the cause of most heart attacks.

What to do: An annual flu vaccination is the best protection. The Centers for Disease Control and Prevention recommends the vaccine for adults age 50 and older... any adult with a heart, lung, kidney or metabolic disease (such as diabetes)... and those with compromised immune systems.

Get vaccinated in October or November. This gives your body time to create the necessary antibodies prior to the peak influenza season.

MEDICAL DELAYS

People who are caught up in holiday excitement -- or who don’t want to spoil the holiday fun of others -- may delay seeking medical care even if they’re having chest pain or other heart symptoms. They also are more likely to forget to take medications, such as anticoagulants and blood pressure drugs.

What to do: Stay on top of your health throughout the holiday season. Put medications in a place where you’ll see them -- and if you have worrisome symptoms, don’t wait until the end of the holidays or even the end of the day to get medical attention. Don’t delay -- immediately call 911.

COMMON HEART ATTACK SYMPTOMS

The most common heart attack symptom for men and women is some type of pain, pressure or discomfort in the chest. But it may not be severe, especially in women, who are more likely than men to have symptoms unrelated to chest pain. Symptoms for men and women include…

Chest pressure or pain

Pain extending beyond the chest to the shoulder, arm, back, jaw

Abdominal pain

Shortness of breath

Sweating

Sense of doom

Light-headedness or dizziness

Nausea and vomiting

Unexplained fatigue

Bottom Line/Personal interviewed Keith B. Churchwell, MD, assistant professor of medicine and radiology at Vanderbilt University School of Medicine in Nashville. He is associate medical director at The Vanderbilt Heart and Vascular Institute.

Bottom Line Holiday Heart