Holiday heart syndrome blues


By Henrylito D. Tacio


Soon, it will be Christmas.

Despite grappling with the coronavirus disease 2019 (COVID-19) pandemic, no one can stop Filipinos from celebrating the most anticipated commemoration of the year.

“It will not be the same though,” says Rublita T. Madera, a housewife with two children, from Bansalan, Davao del Sur.  “We will still prepare food for our table but our celebration will not be as lavish as before.”

The birth of Jesus Christ brings joy and happiness.  It means cooking, gift-giving, bonus, and drinking.  It is also a season of heart attacks and strokes.

“The number of cardiac deaths is higher on December 25 than on any other day of the year, second highest on December 26, and third highest on January 1,” said a study published in Circulation.

In fact, several studies conducted in the United States showed an annual 5-percent rise in heart attacks and strokes – and deaths – during Christmas.  “We found the 30-day mortality of patients in December to be higher,” reported Duke University cardiologist James Jollis, who conducted a study of 127,959 patients hospitalized for heart attacks in 1994-1996.

The same phenomenon happened in the Philippines.  From 2004 to 2008, a survey was conducted in Metro Manila; it showed a tripling of emergencies and admissions during the holiday season.

“Patients were taken in for heart attack, stroke and diabetes – from overeating and a drink too many,” wrote Manila Doctors Hospital’s Dr. Anthony Leachon, an internist whose sub-specialty is cardiology.

“Usually, about 30-50 cases occur in January to November,” Dr. Leachon continued.  “But this rose to 153 in December 2004, 163 in 2005, 172 in 2006, 170 in 2007, and 170 in 2008.  Half of the holiday patients expired.”

In an article he wrote for Health and Lifestyle some years back, Dr. Leachon called this phenomenon as “holiday heart syndrome” (HHS)

“More people suffer from heart attack and stroke during Christmas time,” he pointed out.  “Worse, sufferers are more likely to die then than any other time of the year.”

It was Dr. Philip Ettinger and coinvestigators who coined the term “holiday heart syndrome” in 1978.  They defined it as “an acute cardiac rhythm and/or conduction disturbance associated with heavy ethanol consumption in a person without other clinical evidence of heart disease.”

According to Dr. Lawrence Rosenthal, in an article published by emedicine.medscape.com, “the initial recognition of the syndrome was a result of their study evaluating 32 separate dysrhythmic episodes in 24 patients who were admitted to the hospital for their condition.”

Dr. Leachon surmised HHS is due to the cold weather during the holiday season.  Compared with other months of the year, December is usually cooler.  “Doctors have long known that cold weather is hard on the heart,” he wrote.

“Blood vessels constrict, which raises blood pressure,” he explained.  “Blood also clots more readily.  Frigid temperature increases strain on the heart, and too much physical exertion can worsen the burden and trigger a heart attack.”

The phenomenon is more apparent in the United States as December is the time when winter sets in.  “During a 12-year period, there were consistently more deaths from ischemic heart disease during the winter than there were during the summer,” he wrote.

“Colder temperatures have been associated with an increase in vascular resistance, coronary vasospasm, blood pressure, and hemostatis,” Dr. Leachon went on. “This peak in cardiac deaths during the holidays might result from other factors, including the emotional stress of the holidays, overindulgence during the holiday season, or both.”

Some health experts believe, however, that holiday parties, powered by fatty, salty hors d’oeuvres with plenty of booze, trigger irregular heart rhythms known as atrial fibrillation.

Atrial fibrillation is an abnormal heart rhythm (arrhythmia) characterized by the rapid and irregular beating of the atrial chambers of the heart.  It often begins as short periods of abnormal beating, which become longer or continuous over time.

“While having existing heart disease makes one more vulnerable to holiday heart syndrome, the sudden onset of atrial fibrillation mostly strikes perfectly healthy people with no existing heart issues,” wrote Sandee LaMotte for CNN Health.

North Carolina cardiologist Dr. Kevin Campbell agrees.  “It is thought that atrial fibrillation in holiday heart syndrome is related to overindulgence of alcohol,” she said, adding that it can short circuit the heart’s electrical system, change electrolyte levels (or salts), in the blood and increase the release of stress hormones such as adrenaline and cortisol.

But it doesn’t mean you should stop drinking.  “Although the risk of atrial fibrillation appears to rise with the amount of alcohol consumed,” the Harvard Medical School reported, “attempts to pinpoint the level of alcohol consumption that triggers the arrhythmia have failed.”

“Researchers have determined that moderate alcohol use – two drinks a day for men or one drink a day for women – does not appear to increase the risk,” the Harvard Medical School stated.

This sits well with Dr. Peter Zimetbaum, an arrhythmia specialist at Harvard-affiliated Beth Israel Deaconess Medical Center.

“I advise moderation in all things,” Dr. Zimetbaum suggests.  “Do you need to cut out alcohol and live a Spartan existence if you have atrial fibrillation?  Absolutely not.  Just avoid excesses.”

In his article, Dr. Leachon cited six recommendations to prevent holiday heart attacks by Dr. Robert Kloner, who conducted a study on HHS in 1999.  These were:

Dress warmly.  Try to avoid exposure to very cold temperatures.

Take a load off.  Steer clear of heart stressors, including too much physical exertion, and emotional stress.

Make good choices.  Avoid excess salt and alcohol.  Too much drinking – from example, binge drinking – can lead to atrial fibrillation, which increases the risk of stroke, heart attack and heart failure.

Get a shot.  Consider getting a flu vaccination.  Infection and fever put extra stress on the heart. 

Breathe.  Go indoors during air pollution alerts but try to avoid breathing smoke in crowded places.  If you’re visiting another home during the holidays, sit as far away as you can from a burning fireplace.  Ultra-fine particles in the air can be bad for the heart.

Get help.  If you feel chest pain or other symptoms, call for help.  The stakes are high. So, give yourself and your family a gift this season.  Don’t postpone treatment because you don’t want to spoil the holiday merrymaking. – ###

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