This week, I had to advise a couple of patients with longstanding heart problems to be confined for observation because of increasing frequency of chest pains. They were hesitant to go to the hospital, but I explained to them the simple options: remote risk of catching the virus, or imminent risk of a heart attack. They made the right choice, and are currently doing well. They should be discharged in a few days.

Physicians attending to heart patients have long been extra vigilant this time of the year because of the so-called “holiday heart” syndrome. There is a spike in heart attacks, strokes and even sudden cardiac death during the holiday season.

Several published studies note modest increases in these cardiovascular complications during the holiday season peaking on Christmas Day, 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.

Pandemic stress

We thought it wouldn’t be a major issue this year since there is much less partying and alcohol drinking, but the stress caused by the COVID-19 pandemic seems to be an additional triggering factor.

A colleague noted that we’re having more out-of-hospital heart-related deaths because many don’t want to go to the hospital for fear of getting infected with COVID-19. That is the big paradox we have with heart patients; they dread the virus more, not realizing that their heart condition could be up to 30 times deadlier. And once they develop a heart attack, the season of joy turns into a season of mourning for their family.

Heart patients should be forewarned of this real threat of potentially deadly cardiovascular complications, so they don’t increase their risk unwittingly with an unhealthy lifestyle, particularly in this COVID-aggravated season.

Half of these cardiovascular attacks could end up in sudden cardiac death. These hapless patients probably don’t even know what hit them. They can die on the spot, or they succumb even before reaching the hospital, when they finally decide to seek medical help.

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

This may be an extreme situation and is not likely to happen to the average family. One can argue also that the three brothers were likely genetically predisposed to develop cardiovascular events, but it still goes to show that the relatively cold weather, lifestyle recklessness, undue stress of the season and the simply overcharged atmosphere can trigger a heart attack, stroke and other cardiovascular events, particularly in high-risk patients.

It could save some lives if these patients are identified and adequately forewarned about the incipient danger that comes with the start of the usually hectic holiday celebration. Mentally, they could prepare themselves and have the discipline to say “no” to food and alcohol overindulgence.

Major culprit

Overindulgence has been blamed as a major culprit responsible for the increased cardiovascular risk during the holiday season. You add the lingering stress and paranoia over COVID-19, and the unhealthy mix of all these triggering factors could simmer into a catastrophic stew of a fatal heart attack.

Physicians can give cardiovascular patients, particularly those classified as high-risk, a most memorable Christmas gift by properly forewarning them of this real and perilous risk during the holidays.

Heeding the good old advice could go a long way in saving one’s life. Avoid excess salt, fats and alcohol. Binge drinking has been shown to trigger atrial fibrillation, an abnormal heart rhythm, which increases the risk of stroke, heart attack and heart failure.

Heart patients should also keep themselves warm. When their hands feel cold, that may indicate that the arteries are constricting and when this happens to diseased heart arteries, it might result in a lack of oxygen, called ischemia, which might lead to a heart attack if prolonged. So, heart patients, always dress warmly. Lack of sleep is a potential trigger, too, due to the stimulation of the sympathetic nervous system which raises our adrenaline level.

The year 2020 is already bad enough. Let’s not make it any worse by falling victim to the holiday heart syndrome.

We wish everyone a joyful and healthful Yuletide season.