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Health takes a holiday; Season of eating, drinking and stress leads to spike in heart attacks.

Byline: Elizabeth Cooney

Now here's something else to add to your holiday to-do list:

Don't overdo it.

And if you do eat, drink, shovel, travel or stress too much, don't ignore how bad you feel. Especially if where you feel bad is in your chest, arm, shoulders, neck, back or jaw. Or if you're short of breath, fainting, nauseous, seating or lightheaded.

You could be having what cardiologists and emergency physicians call a "Christmas coronary" or a "Happy New Year Heart Attack."

Those cheery terms were coined several years ago by researchers puzzled by the spikes in deaths from heart disease on Dec. 25 and Jan. 1. The peaks stood out in an already elevated terrain from just before Thanksgiving to just after New Year's.

A doctor at the University of Southern California in Los Angeles wondered in 1999 if it was just the winter weather causing the uptick. Cold is known to affect blood vessels and blood pressure, even in mild Southern California, so a connection seemed plausible. But even when the temperatures stayed flat, heart attacks still jumped.

Other researchers, from the University of San Diego and Tufts University School of Medicine, reported in 2004 that the phenomenon was widespread, with the same holiday highs across the country no matter how warm or cold the weather was.

It makes sense when you add up all the factors, doctors said about the earlier round of studies and more recently after Vanderbilt University investigators analyzed data from 1973 through 2001.

"The holiday period is one of very exaggerated emotional response, both highs and lows, and also stress," said Dr. Robert A. Phillips, medical director of the heart and vascular center at UMass Memorial Medical Center in Worcester. "When you couple that with the effects that cold weather and respiratory infections have on the heart, and that people tend to have bursts of exertion - shoveling snow being a major one - it's really not that much of a surprise. You can predict this is going to happen."

Blood pressure is generally higher in cold weather when blood vessels are constricted. Colds cause inflammation in the blood vessels, too, setting the scene for clotting that can block blood and the oxygen it carries from reaching the heart. A heart attack occurs when the heart is starved of blood.

Dr. Frederick A. Spencer of McMaster University in Hamilton, Ontario, led a study published in 1998 while he was at University of Massachusetts Medical School that showed a marked rise in heart attacks during the winter. He and his colleagues didn't find a holiday spike, but he said last week there's at least an equal risk of heart attack around the holidays. Rates of depression go up this time of year too. Along with stress, those potential triggers can mean trouble.

"You can have a heart attack anytime," he said. "People tend not to take as good care of themselves around the holidays."

Dr. Phillips said people on heart medications should be sure to take them, despite any disruption travel or visitors might cause. If they do come down with a cold, taking aspirin to keep fever down will have the added benefit of protecting them against a heart attack. If they feel depressed, they should seek help from a clergy member or physician or someone else they can talk to.

He also recommends caution when it comes to exertion, especially for people who are not physically fit.

"If you're not exercising and you have a burst of exertion, you have a 50 times greater chance of having a heart attack compared to someone who exercises regularly," he warned. "People have to shovel snow, but go back into the house, don't do it all at once, and get warmed up" before you do.

Dr. Phillips said it's understandable, if regrettable, that people ignore symptoms especially at this time of year.

"If someone has chest discomfort or shortness of breath that is unusual for them, they should treat it as serious," he said.

Dr. Spencer also said it's human nature to put off seeking help when family and friends are gathered.

"You tend not to go as quickly to the hospital," he said. "We get patients who won't come into the hospital until the next day, when the damage (to the heart) is already done."

Not a good idea. Better to call 911 than be sorry you didn't.

"A heart attack doesn't care whether it's a holiday or not," Dr. Spencer said.

Common heart attack symptoms

Uncomfortable pressure, fullness, squeezing sensation or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.

Pain that spreads to the shoulders, neck, jaw, arms or back.

Chest discomfort accompanied by lightheadedness, fainting, sweating, nausea or shortness of breath.

Not so common warning signs of a heart attack

Shortness of breath and difficulty breathing.

Abnormal chest pain (angina), stomach, or abdominal pain that may feel like indigestion or heartburn.

Nausea or dizziness.

Unexplained anxiety, weakness or fatigue.

Palpitations, cold sweat or paleness.

Source: The American College of Emergency Physicians
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Title Annotation:LIVING
Publication:Telegram & Gazette (Worcester, MA)
Date:Dec 17, 2007
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