Holiday heart advice: What to avoid, what to watch for and when to get help

Heart attacks and cases of heart failure shoot up during the winter holidays. In this Q&A, cardiologist Arasi Maran, M.D., with the MUSC Health Heart and Vascular Center, discusses what to watch for and how to strike the right balance between holiday fun and potentially harmful behavior.

Q: More people die from heart attacks during the last week of the year than any other time of year. Cases of heart failure rise, too. Why?

A: I think first, there is the stress of the holidays. Everybody is super excited, and everybody's super stressed. And there's always this expectation that the house has to be perfect, the food has to be perfect, and there's stress leading up to the day of Christmas and the day after Christmas. That's No. 1.

No. 2 is families are also seeing each other again after a long time. So your grandma or grandpa could have been sick the whole year, but you're seeing them now and then you're like, ‘Oh my God, you look really bad. I need to take you to the hospital.’ It's more than heart attacks. They may be in heart failure and need to be hospitalized. The day after Christmas is probably the busiest day in the hospital.

Q: What should people keep in mind?

A: I would start with where are you right now? How good or bad are your symptoms right now? Are you having chest pain when you move around? Are you having shortness of breath? Or are you so busy that you’re not even taking into account that you’re huffing and puffing after you carry a bunch of gifts up the stairs or something like that?

So identifying what is going on right now can be really, really helpful. And No. 2, keep in mind that it's just your family. It's your kith and kin, and things don't have to be perfect. Have some kindness and grace for yourself. Be a little bit more thoughtful and mindful and take it easy during the holidays.

Q: How can a person tell that it’s time to see a doctor (or call 911) for heart concerns?

A: Let's focus on two things. One is the heart attack, and other is heart failure. Both are common during the holiday season. So when you have a heart attack, the blood vessel is blocked or you have a clot in the blood vessel that completely shuts down the blood flow to that area of muscle.

If you are having symptoms that are exacerbated by physical activity and get better with rest, then more than likely you are having a blockage problem – which can lead to a heart attack. That is a plumbing problem and needs to be addressed ASAP. You can end up losing most of your heart function, then you end up becoming a heart failure patient.

Second: Heart failure – where the pump (a.k.a. heart muscle) is weak or stiff. You accumulate fluid steadily over time. This causes difficulty breathing and chest discomfort, swelling in your legs. You need to get fluid off your body with diuretics. If unrecognized, your breathing becomes increasingly hard.

Q: What symptoms should people look out for?

A: Let's start with the most dangerous, life-threatening kind and work our way down. Let's say you are doing some physical activity; you are just walking or something like that and you feel a terrible discomfort. I'm using the discomfort loosely because it can be chest tightness, it can be crushing, it can be a gnawing pain. It really comes on, and along with it, you are huffing and puffing. You're having difficulty breathing and you're beginning to sweat, or you're going to feel flushed. And you have a sense of impending doom. It is time to call 9 1 1.

If you’re around a family member or friend with heart trouble, and you notice they’re loosening their buttons and they're getting uncomfortable and they're getting flushed or they're holding onto their chest. That is a time to call 9 1 1 because that can be life-threatening.

The next situation is serious, but not immediately life-threatening. If you have symptoms that occur with physical activity and get better with rest, that is the time for you to pick up the phone and call your doctor. But if these symptoms are happening every day, like clockwork, you may have to go to the emergency room because you might be on the cusp, where if you push yourself, then you may end up with a heart attack.

Q: What about eating and drinking during the holidays and its effects on the heart?

A: Don’t go crazy with your food habits during the holiday season. If you have known heart disease or if you have known heart failure and you have to watch your sodium, you need to watch the amount of water you drink and the amount of alcohol you're drinking. Just because it's the holidays, it does not give you a free pass to do whatever you want and eat whatever you want. At the same time, don’t suffer in deprivation. Allow yourself a good time with a good meal. The holidays are more about family than the meals.

If you go to one holiday get-together after another, it just accumulates. If you go for 10 days eating and drinking whatever you want, you can end up at the hospital with 10 pounds or 15 pounds of fluid gain. Not necessarily weight gain, but fluid gain. In heart failure, that could lead to a heart attack.

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For more information about heart attack and heart failure warning signs, visit the American Heart Association’s website. And learn more about everything the MUSC Health Heart and Vascular Center has to offer, from locations and areas of care to clinical trials.