Be merry, but take care
Just when we thought we’ll have a leisurely week before Christmas, we get urgent calls from the hospital emergency room, more than what we bargained for.
A 50-something diabetic patient was brought in for palpitations and was found to have a fast irregular heartbeat called atrial fibrillation. He just came from a Christmas party, had a little too much drink, and was already at home preparing to sleep when he felt the bothersome palpitations.
A long-time patient of mine with clogged arteries fixed by bypass surgery around five years ago, woke up in the middle of the night with chest tightness similar to the one he had during his first heart attack. He has been under stress the past several weeks, organizing their high school class reunion.
Another patient with previously controlled hypertension insisted to be seen ahead of the other patients in the clinic because his blood pressure was 210/100 mmHg. He admitted throwing caution to the wind with his diet the past several weeks.
Warning
With the holiday merrymaking, doctors really need to spend some time warning their patients of the increased incidence of cardiovascular complications, especially heart attack and stroke during this period.
There are at least three studies done abroad showing modest increase in incidences of heart attack, stroke and deaths during the holiday season. The foreign authors all sounded the alarm, saying everyone, especially those with increased cardiovascular risk, should be especially careful with their lifestyle during the holidays, and taking the risk of developing a serious cardiovascular complication.
This increased preponderance to develop a cardiovascular event is not only true abroad, but right here in our country as well. There is a 2004-2008 survey of Metro Manila hospitals which showed a tripling of emergencies and admissions during Christmastime. Many of these were cardiovascular in nature. This represents a 200-percent increase in the risk, which, by any standard, is indeed alarming.
It is therefore important for doctors and other healthcare professionals to forewarn patients on the unseen but lurking danger. We don’t know exactly what causes it, but it’s likely due to a multiplicity of factors during the season, like the added stress of having to juggle from one party to another, binging on alcohol and unhealthy foods, and perhaps the cold weather, which can make the heart arteries prone to more vasospasm. And a big number of these cardiovascular events could end up in sudden cardiac death. These hapless patients probably won’t even know what hit them. They succumb even before reaching the hospital.
In the midst of the holiday merrymaking last year, this increased cardiovascular risk was dramatized—quite unfortunately for the involved family—in a remote Sicilian town. Three middle-age brothers all had heart attack on the same day, with two of them dying suddenly. Fortunately the third one was in a hospital when his heart attack, complicated by a ventricular fibrillation, happened. He was promptly treated, preventing more serious complications; and he survived his heart attack. His other two brothers were not as lucky.
Genetically predisposed
This is of course an extreme situation which will likely not happen to the average family. Most likely the three brothers were genetically predisposed to develop severe, progressive atherosclerotic cardiovascular disease. Nonetheless, it still highlights the fact that the so-called “hypercelebration” of the season and the simply overcharged atmosphere can trigger heart attack, stroke and other cardiovascular events, particularly in high-risk patients.
It may sound like an old refrain, but it is essential that patients at risk 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” when they have had enough partying, and not to overindulge in the rich foods and intoxicating drinks that come with the holiday celebrations.
Being merry during the season is great, but overindulgence has to be avoided. One should keep track of the number of drinks, calories or fats he/she has already taken in. By engaging in everything the season offers in moderation, and knowing exactly when to stop and say “No,” many cardiovascular events could be prevented.
It would indeed be unfortunate if the season of joy turns into a season of mourning for the family of a victim of a cardiovascular event.
So, let’s all heed and take good care, and have a Merry Christmas!
