The odds of dying from a heart attack are highest on Dec. 25, followed by Dec. 26 and Jan. 1; some are reluctant to seek care

By Rachel Fairbank
National Geographic

While the holidays can be the most wonderful time of the year, they can also be one of the most stressful—especially for the heart.

Along with traveling, family time, and festivities, the celebrations are also linked with an increase in heart attacks, strokes, and irregular heart rhythms. This year, the holiday season may be even deadlier than usual with Christmas falling on a Monday, according to a study presented at the British Cardiovascular Society earlier this year. The study authors found that the risk of a heart attack was higher on Mondays, compared to other days of the week.

This increase in heart-related issues is thought to be the result of multiple factors, including increased alcohol consumption, greater stress, and dietary changes such as eating more salt than usual.

“The heart does not get to take a holiday,” says Nick Ruthmann, a cardiologist at the Cleveland Clinic. “Neither does your health.”

This is what experts know about why the holidays are particularly stressful for the heart, and what people can do to reduce their risk of heart attacks, strokes, and arrythmias.

Effects of alcohol

Holiday heart syndrome refers to the increase in irregular heart rhythms, known as atrial fibrillation, that is linked to a sudden rise in alcohol consumption. As Ruthmann explains, alcohol is thought to disrupt cells of the heart, leading to irregular electrical impulses that cause the chambers of the heart to stop beating in synchrony. This in turn, forces the heart to beat faster, to compensate for its decreased effectiveness. The diminished efficiency of the heart can allow blood to stagnate in the chambers, forming clots that can then travel through the body leading to a stroke.The danger with atrial fibrillation is that if it goes on too long, it can cause permanent damage.“The longer you are in atrial fibrillation, the more opportunity there is to form a stroke, or to develop heart weakness or heart failure from having such a rapid heartbeat,” says Shaline Rao, a cardiologist at NYU Langone Hospital – Long Island, who specializes in treating heart failure. “These are things that, when caught early, we have a lot of opportunity to prevent and reverse.”

Signs of atrial fibrillation

For some people, going into atrial fibrillation leads to noticeable symptoms, such as a racing heart, forceful or skipped heartbeats, or dizziness. Others might not even notice that something is wrong. In these situations, it can be helpful to have a wearable device, such as Fitbit or Apple Watch, that can detect irregular heart rhythms. People who are at a higher risk for developing atrial fibrillation include adults who are over the age of 65 or who have a family history of the condition.

“No wearable is perfect yet,” Ruthmann says, adding that “more times than not, it can sometimes be the first and only evidence there is a problem.”

In addition to the link between atrial fibrillation and alcohol consumption, it’s thought that other factors can also contribute to this condition. Some holiday-related risk factors include increased stress, increased salt in the diet, major changes in physical activity, poor sleep, or missing doses of medication. Atrial fibrillation can also develop after a heart attack.

“All these can definitely increase the risk of atrial fibrillation in patients,” says Johanna Contreras, a cardiologist and volunteer for the American Heart Association.

Heart attacks are especially deadly during the holidays

In addition to the increase in atrial fibrillation—which is linked to a higher risk of strokes—the winter holidays are also associated with a 15 percent greater risk for heart attacks, which includes a 37 percent higher chance of developing a heart attack on Christmas Eve.“More people die of heart attacks between Christmas and New Year’s than any other time of the year,” Ruthmann says.

Some of the reasons for the higher risk of developing a heart attack during the holidays are linked to the higher risk of developing atrial fibrillation. A heart attack happens when a blockage causes a reduction in blood flow to the heart, which can damage or destroy parts of the heart muscle. This damage can also cause an irregular heart rhythm, such as atrial fibrillation. Meanwhile, the same risk factors associated with developing atrial fibrillation are also linked to the risk of developing a heart attack. “They are intertwined,” says Sadeer Al-Kindi, a cardiologist at Houston Methodist Hospital.

The odds of dying from a heart attack are highest on Dec. 25, which is followed by Dec. 26, and Jan. 1. In addition to the holiday-related risk factors, there is often a reluctance to seek medical care.

“During the holidays, people don’t want to go to the doctor,” Rao says. “They don’t want to think something is wrong.” However, waiting can have some serious consequences, leading to permanent damage, even death, if not treated promptly.

Warning signs

As the Heart Association notes, some of the major warning signs of a heart attack can include chest pains, pain or discomfort in the upper body, such as the arms, back, neck, jaw or stomach, or shortness of breath.

Other symptoms can include nausea, feelings of lightheadedness, or a cold sweat. It’s also important to recognize that heart attacks can look very different in women, with more women reporting symptoms such as shortness of breath, nausea, or back or jaw pain.

Symptoms of atrial fibrillation can include a racing heart, irregular heartbeats, fluttering or forceful heartbeats, sweating, dizziness or weakness, faintness, shortness of breath, becoming easily tired during exercise, or experiencing chest pains. Some patients may not experience symptoms. For both conditions, it’s critical to seek medical care immediately, either by calling 9-1-1 or by heading to the nearest emergency room.

How to have a heart-healthy holiday

To reduce the risk of developing holiday-related heart issues, it helps to prioritize healthy habits, such as eating and drinking in moderation, getting adequate amounts of sleep, and sticking to a sustainable exercise routine. For people who are traveling, it’s important to remember to pack your medications, including enough extra doses to accommodate for any potential emergencies or delays.

“Try as much as you can to pace yourself,” Rao says, “and to give yourself realistic boundaries.”

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