By Sheikh Mustafa
As the frost settles, the temperature plummets and scarves become our constant companions, a hidden danger lurks beneath the winter’s charm – a surge in heart attack risk, turning the season of cozy fireplaces into a potential danger zone for some.
A complex interplay of biological and behavioural factors turns the dial on our cardiovascular health when the mercury dips as the cold triggers our blood vessels to tighten, leading to slightly higher blood pressure. This, combined with seasonal changes in cholesterol levels and potentially reduced physical activity, creates a perfect catalyst for increased heart stress.
To delve into the science behind the season’s cardiovascular risks, to unveil the hidden culprits, and to get the practical tips to keep one’s heart safe as the temperatures plummet, Cardiologist and Additional Professor Dr Imran Hafeez SKIMS Soura explained the causes, symptoms, precautions and treatment facilities. He also spoke at length about how to navigate winter in order to keep the heart warm, beating strong and steady.
Psychological Changes
Dr Imran Hafeez says, “Winter’s arrival often brings changes in our routines, social interactions, and even moods. These shifts, subtle as they may seem, can trigger a cascade of psychological effects that can ultimately impact our cardiovascular health. Especially during winters, the exposure to our body constricts the vessels – they become narrow to prevent heat loss due to which the blood pressure goes up, causing excessive workload on the heart. This means one’s heart will have to make more effort to pump oxygen and blood due to which the heart rate tends to become unstable and manifests in abrupt heart attacks. This process is called as vascoconstriction.”
While the drop in temperature itself plays a role, the true story lies deeper, in the realm of our psychology. Winter triggers certain physiological changes in our body, often setting an unwelcome stage for heart problems.
Dr Hafeez paints a grim picture. He explains, “You will also be shocked to know that even those who don’t know about pre-existing heart conditions may also be prone to heart diseases.”
He says, “Although we don’t have adequate data but still we are acutely observing the troubling trend of heart attacks going 3 to 4 times higher in our hospital at SKIMS during winters. We are trying to study this.”
According to the Indian Heart Association, India is known as the “heart disease and diabetes capital of the world”. “India has about 60% of the world’s heart disease burden, despite having less than 20% of the world’s population.”
Risk among Smokers
Dr Hafeez said, “This coupled with the chronic damage that is inflicted by smoking clogged arteries, weakened heart muscle, and increased blood clotting creates a perfect storm for a potentially fatal event. The nicotine from a single cigarette can cause blood vessel constriction for up to an hour, and winter’s icy grip can magnify this effect, making even a light smoker vulnerable.”
He further elaborates, “During winters, there is an increase in pollutants and their dispersion. This can trigger inflammation, thus aggravating breathing difficulty in asthmatics and smokers.”
“Add in the seasonal influenza or the stress of holidays, and the risk escalates further. So, while others bundle up and enjoy cocoa by the fire, smokers face a stark reality – a puff could be all it takes to trigger the heart attack’s icy grip. This winter, the message is clear quit smoking to breathe easier, both literally and figuratively, and face the cold with a warm, beating heart,” he added.
As the seasonal shift occurs and the temperature plummets, a hidden and heightened risk of heart attack lurks for smokers. The cold doesn’t just bite at bare skin, it triggers a cascade of physiological changes that put an already-stressed cardiovascular system on overdrive. Blood vessels constrict, pushing up blood pressure and demanding more work from the heart.
According to National Library of Medicine (USA), “Smoking Increases mortality from all causes and has a crucial role in atherosclerotic cardiovascular disease (ASCVD). Active smoking and secondhand smoke exposure determine more than 30% of coronary heart disease (CHD) mortality.”
Risk among Existing Heart Patients
With the winter air turning brisk and snowflakes swirling, a hidden danger also lurks for those already battling heart disease a heightened risk of heart attacks.
Dr Hafeez says that “The patients with the underlying heart disease are at the high risk.” Cold weather acts as a silent accomplice, amplifying the risk of cardiac emergencies for those with vulnerable hearts. He explains, “winter is a challenging season for many people, especially those who have heart problems. According to experts, cold weather can increase the risk of heart attacks by affecting the blood vessels, blood pressure, and blood clotting. And some possible reasons why the risk of heart attack is high among people who already have heart problems are that cold weather also makes the blood thicker and more likely to clot, which can block the arteries and cause a heart attack. These waves increase the risk of respiratory infections, which can also affect the heart and cause inflammation and damage to the heart muscles. People who have heart problems may not be able to cope with the increased demand for oxygen and energy that cold weather imposes on the body. People who have heart problems may also engage in activities that can increase the risk of heart attack, such as shoveling snow, walking through heavy snow, or exercising without proper warm-up.”
Family History
Dr Hafeez says that a family history of heart disease can increase the risk of developing heart disease. In some cases, having family members with heart disease at a young age can be a sign of familial hypercholesterolemia, a genetic disorder that causes high cholesterol.
“It is also known as a disorder that causes an excess of low-density lipoprotein (LDL) in the blood” Another cause is Cardiomyopathies (heart muscle diseases) and Channelopathies (heredity, life-threatening heart rhythms). Besides that, family history of coronary artery disease (CAD) is one the strong factor increase your chances of developing the condition. For men, this means a close relative being diagnosed before age 55, and for women, before age 65. CAD limits blood flow in your coronary arteries, coronary arteries, which deliver blood to your heart muscle,” he adds.
Dr Hafeez emphasizes, , “Genetics, lurking in the shadows of family history is very crucial individuals with a family history of heart attacks, particularly early-onset ones affecting parents or siblings were significantly more likely to suffer a heart attack themselves, even if they maintained a seemingly healthy lifestyle. This suggests that a hidden hand in our genetic makeup may be pulling the strings, silently predisposing some to cardiovascular trouble.”
According to Centers for Disease Control and Prevention (USA), “If you have a family health history of heart disease, you are more likely to develop heart disease yourself. Different types of heart disease and related conditions, like high blood pressure and high blood cholesterol, can run in families.”
Social Stress
Dr Hafeez says, “Chronic social stress, like isolation or conflict, even depression can accelerate atherosclerosis, or hardening of the arteries. Anxiety can also be especially damaging for people with existing heart disease. These things raise blood pressure and inflammation casting a long shadow of on your health and boosting the risk of heart failure.”
The cardiologist explains, “High levels of cortisol from long-term stress can increase blood cholesterol, triglycerides, blood sugar, and blood pressure. These are common risk factors for heart disease. This stress can also cause changes that promote the buildup of plaque deposits in the arteries.”
According to the American Heart Association, “Stress can lead to high blood pressure, which can increase the risk of heart attack and stroke.”
Symptoms
Dr Hafeez says, “Recognizing the subtle cries of your heart is crucial, because sometimes, a heart attack doesn’t scream, it whispers. While the classic crushing chest pain and radiating arm numbness are often present, many experience less dramatic symptoms that can easily be mistaken for indigestion or fatigue. Pay attention to an unusual heaviness or tightness in your chest, squeezing or burning sensations that spread to your neck, jaw, or back. Unexplained shortness of breath, especially after minimal exertion, cold sweats, and sudden lightheadedness or dizziness could also be warning signs.”
“Besides that, whenever you feel a pain from umbilical upwards to the neck, immediately report to doctor. Diabetic, blood pressure patients and smokers are prone to heart attacks. Even women might experience more atypical symptoms like nausea, vomiting, and extreme upper back pain. If any of these strikes, don’t hesitate to call for help immediately. Remember, early intervention saves lives, and the sooner you act, the quicker you can mend your heart,” he adds.
Precautions
The noted cardiologist explains that “winter can increase the risk of heart attacks for existing heart patients. To stay safe, they should limit their time in extreme cold and avoid picking heavy snow. Wearing warm clothes in layers, especially when going outside, is crucial. Focus on a healthy diet and quit smoking, as these lifestyle choices can significantly reduce the risk of heart complications. Consuming warm, nutritious foods can help maintain your body temperature and overall well-being during winter.”
He further elaborates, “Besides that diet modification – avoid high sugar or fatty things or street foods and increase consumption of fruits, vegetables, and whole grains – is important. It is also important manage stress effectively, whether it’s through deep breathing, meditation, or spending time with loved ones. Listen to your body, recognize the warning signs of a heart attack, and seek immediate medical help if needed. Remember, winter may test our hearts, but with a proactive approach, we can ensure they bounce back stronger and merrier than ever. So, bundle up, eat right, stay active, and de-stress for the sake of our hearts.”
That’s his advice for navigating the winter season for a healthy heart.
Treatment Facilities
Dr. Hafeez warns that “many heart attacks originate in outlying peripheral areas” where prompt recognition of symptoms and swift medical intervention are critical. Unfortunately, most patients arrive with a concerning delay, limiting our ability to effectively intervene. Therefore, recognizing and acting upon early warning signs is paramount in saving lives. Mostly we have two-pronged, very effective and lifesaving approach to treat. On an immediate basis we give drugs, or we immediately do angioplasty.
“Angioplasty is a procedure that opens blocked coronary arteries. It restores blood flow to the heart muscle without open-heart surgery.” Besides that, we do thrombolysis. “Thrombolysis is a procedure that breaks up blood clots that restrict blood flow in arteries and veins”. It is often used as an emergency treatment to dissolve blood clots in the arteries that feed the heart and brain. Or sometimes we have put stent to the patients. “A heart stent is a tiny, expandable metal mesh tube that helps keep arteries open. Stents are often used to treat narrowing in the coronary arteries, which provide the heart with oxygen-rich blood.”
Awareness Programmes
Dr Hafeez also spoke about a path breaking initiative its success stories. “Save Heart Kashmir” is a virtual cardiac emergency hospital that provides timely expert advice to doctors in the state of Jammu and Kashmir, he reveals.
“The initiative was started in 2016 by me and my two friends in Kashmir to manage cardiac emergencies. The primary objective of the initiative is to reduce treatment delays and improve survival rates for patients with myocardial infarction (MI),” he says and adds that the initiative uses a WhatsApp group to connect doctors across Kashmir. The group provides timely and affordable management for acute cardiac events. “Besides this, there are awareness programs seminars and symposium initiatives by health department,” he adds.
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