Tis the Season for Heart Attacks

Year-end holidays are often about excess. Too much food. Too much alcohol. Too many savory salty or sweet tidbits.

Add to that, not enough exercise and sleep.

The result? The season between Christmas and New Year is prime time for heart attacks and other cardiac issues, including atrial fibrillation (abnormal heart rhythm), dangerously high blood pressure, and congestive heart failure.

“There are multiple explanations for why this happens,” says Mauricio Cohen, M.D., a cardiologist and chief of the cath lab at the University of Miami Health System. “We see many patients who end up coming in because of increased intake of salt, alcohol, and food in general, which exacerbates already existing conditions.”

The festive season also happens to rank among the deadliest.

Several studies document this. One, published in the journal Circulation in 1999, found that 33 percent more coronary artery deaths occurred in December and January than in June through September. Fatalities spiked specifically on Christmas and New Year’s Day.

In another 2018 study that looked at 16 years’ worth of myocardial infarction data, researchers found the risk of heart attack peaked during the Christmas and New Year holidays. Those with the highest heart attack risk were over 75 years old, and patients who are known to have diabetes and coronary artery disease.

Not all seasonal cardiac episodes lead to death, of course.

Blood pressure, for instance, may temporarily spike because of increased intake of sodium. Palpitations or heart flutters in a patient without chronic disease – known as “holiday heart” — may also signal something less lethal. But whatever the diagnosis, the treatment is the same: Cut down on alcohol and salt. (While an abnormal heartbeat may resolve itself once a person lays off the sauce, such events should always be checked by a medical professional.)

Stress also plays a considerable part in cardiac episodes, and there’s plenty to go around during the holiday season. Tense family interactions, difficult financial situations, and a packed schedule can trigger anxiety even in healthy people.

Stress-induced cardiomyopathy is the perfect example of this, says Mehrdad Ghahramani, M.D., a cardiologist at UHealth. Often referred to as broken heart syndrome, the symptoms mimic a heart attack.  But unlike a heart attack, there is no arterial blockage. Treatment is, therefore, trickier, though medication to regulate blood pressure may be prescribed. “We don’t fully understand why this happens, but it does affect the heart,” he says. “We know it doesn’t pump as effectively.”

The pandemic has only worsened what is a traditionally fraught time. “I see this in clinic all the time,” Dr. Ghahramani adds.  “People who had a healthier lifestyle pre-pandemic are not as active, are not exercising or eating as they should. Over time their bodies have deconditioned.”

In addition to stressors and overindulgence, doctors also have found that patients are more likely to skip their medication or postpone scheduled medical appointments during the holidays.

“I do know of patients who put it off,” says Dr. Cohen. “They don’t want to disturb family plans. They see it as an inconvenience.”

This reluctance to seek treatment has certainly worsened during the pandemic.

Cardiologists across the country have noticed a drop in emergency room visits for cardiac issues, mainly out of people’s fear of contracting COVID-19. An analysis in the August edition of JAMA Cardiology appeared to confirm that anecdotal evidence. People who had a severe heart attack were more than twice as likely to die during the pandemic than they would’ve been in 2018-19. Researchers speculated that the higher fatality rates were due to delaying medical care.

That’s why cardiologists urge people to seek immediate medical treatment by calling 9-1-1 as soon as they feel any telltale signs of a heart attack. These include chest pain, shortness of breath, pain in the neck, jaw, arm, back, or shoulders, nausea, sweats, or fatigue.

“Those symptoms present themselves differently in women and older people,” Dr. Cohen adds. “Their symptoms tend to be more atypical, but they still should look out for a general discomfort in the chest.” This might translate into a squeezing or fullness in the area. Also: unusual fatigue, lightheadedness or sudden dizziness, even vomiting.

While women tend to have less cardiovascular disease than men, the rate and aggressiveness of coronary and heart disease jump substantially in menopause.

When in doubt, it’s best to be safe.

“Time is of the essence,” Dr. Cohen explains. “The longer it takes to get treatment, the more damage to the heart muscle.”

Lastly, heart disease doesn’t suddenly pop up overnight. It develops over time, a result of genetics and bad habits. While you can’t change genetics, you can work on lifestyle factors.

“It’s important to practice good habits year round,” Dr. Ghahramani advises. “And that comes down to two main lifestyle factors: diet and exercise.”

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: cardiology in Miami, cardiovascular health, Dr. Mauricio Cohen, Dr. Mehrdad Ghahramani