I thought I should stop writing about the so-called holiday heart syndrome (HHS)—because people are already nauseated with such articles at this time of the year. But then I was called again recently to see a couple of patients at the emergency room of Manila Doctors Hospital presenting complications of HHS.

One was a long-standing diabetic, hypertensive and smoker in his early 60s. After gorging on lechon and scotch, he suddenly felt tightness in his chest and cold sweats. Initial workup showed an evolving heart attack.

The other one was an over-stressed businesswoman in her late 50s who came from several parties that night, and also had a few drinks too many. Her heart was pounding, with a heart rate of more than a hundred per minute. Her rhythm was irregular—atrial fibrillation (AF) on the electrocardiogram. Her blood pressure shot up to 200/110.

Fortunately, both cases survived and are recovering well. Now they know better what to avoid during the holidays.

Holiday heart

We have cases like these all year round, but they peak during the Christmas season, hence, the moniker “holiday heart.” Various scientific journals report a higher incidence of heart attacks, stroke and irregular heartbeat, especially AF, during the Christmas holiday due to excessive merrymaking.

Add to that the mounting stress of having to go from one Christmas party to another, and making sure one has gifts for everyone—and the elevated adrenaline in one’s system fuels up the engine of a cardiovascular catastrophe. It’s good if one survives a heart attack, stroke or life-threatening AF. Many are not fortunate and die before reaching the hospital.

So, if one is a known heart patient, or has some risk factors like being overweight, a heavy smoker, has hypertension, cholesterol problems and diabetes, one should take it easy during this season. HHS has a first peak as Christmas Day approaches, with a second peak on New Year’s Eve.

A 2004-2008 survey of Metro Manila hospitals showed a tripling of emergencies and admissions during Christmastime. That is a 200-percent increase.

Multiple factors

Doctors and other health care professionals should forewarn patients on the unseen danger of HHS, which a multiplicity of factors during the season could trigger. A third to a half of these cardiovascular attacks could end up in sudden cardiac death.

These hapless patients won’t even know what hit them. They can die on the spot, or succumb before reaching the hospital.

A sad illustration of this is what was reported in a remote Sicilian town several years ago, when three middle-aged brothers suffered heart attacks on the same day, with two dying suddenly. The third one was fortunate to be in a hospital during the heart attack. Prompt intervention at the emergency room stabilized his condition.

This may be an extreme situation, and one can also argue that the brothers were likely genetically predisposed to cardiovascular events. But it still goes to show that the “hyper-celebration” of the season and the overcharged atmosphere can trigger a heart attack or stroke, particularly in high-risk patients.

Mental preparedness

It could save some lives if these patients are identified and adequately forewarned about the incipient danger that comes with the holidays. Mentally, they could prepare themselves and have the discipline to say no when they have had enough partying, and the temperance not to overindulge in rich food and drinks.

Overindulgence has been blamed as a major culprit behind increased cardiovascular risk during the holiday season. With several parties on the same night, one easily loses track of the drinks, calories or fats one has taken. Add to that the fatigue and the raised adrenaline brought about by the excitement, and one can fall victim to an unhealthy mixture of triggering factors.

Robert Kloner, MD, PhD, a professor at the Keck School of Medicine at the University of Southern California, shares these precautions on how to prevent an unfortunate “event” during this season:

Dress warmly when it’s cold.

Avoid heart stressors, including too much physical exertion, anger and emotional stress (just stay cool and relaxed when caught in traffic jams).

Avoid excess salt, fats and alcohol. Binge drinking has been shown to trigger AF, which increases the risk of stroke and heart failure.

Get a flu shot. Infection and fever cause extra stress on the heart.

Avoid breathing smoke in crowded places. Courteously remind those who still smoke in public places or during parties that they should refrain from doing so, as they also affect other people’s health.

Avoid places where they make fires for warmth or to celebrate. In the United States, heart patients are advised to stay away from the fireplace. Here, one should avoid getting near bonfires, which may be part of celebrations outside the house. Ultrafine particles in the air from burnt materials can be bad for the heart.

If you feel chest pains, dizziness, palpitations, slurring of speech, weakness of a hand or leg, or other symptoms, call for help immediately. Time is gold during a heart or brain attack. Every minute counts and can spell the difference between surviving or succumbing to the attack. It’s better to err on the safe side if one is not sure whether the symptoms are due to a heart or brain attack, or otherwise.

We wish all our readers a joyful and healthful yuletide season.