It appears in the books as “sudden cardiac death” and is not uncommon; in fact, heart attacks are among the leading causes of death in today’s civilized world. Most of its victims are men between the ages of 40 and 50; a third of these men receive no apparent warning. His heart attacks strike as unexpectedly as lightning on a summer day.
In reality, of course, heart attacks almost never happen “out of nowhere”: they are simply the knockout blow delivered to the cardiovascular system that has already been defeated by years of abuse. In a man whose heart is already vulnerable, certain things: stress, extreme temperatures, and alcohol can act as triggers that set off a heart attack.
Researchers have identified at least six acute triggers for sudden cardiac death. They are the equivalent of a good left hook to the head and knowing them can help you learn when to duck.
1. Emotional stress: A few years ago, researchers from Harvard and Birmingham and the Boston Women’s Hospital made headlines when they discovered that a substantial number of life-threatening coronary events were triggered by acute emotional stress – in one case, a suspenseful baseball game.
Apparently, getting emotionally nervous can trigger ventricular fibrillation, a cardiac arrhythmia that one researcher describes as “a chaotic electrical storm” in the heart. Fibrillation turns the heart’s superbly efficient contractions into erratic spasms, nearly destroying its ability to pump blood.
Of 117 life-threatening arrhythmia survivors questioned by the Boston researchers, 25 suffered some form of acute psychological disorder in the previous 24 hours. In 15 cases, the disturbance preceded the arrhythmia by just one hour. In one case, a Yankees fan who watched his team go to the Red Sox on television became so nervous that his heart skipped a beat.
But what good is life if you can’t get nervous about it? The point to remember is that 10-minute long emotional stress is generally harmful only if it has been preceded by years of chronic and relentless emotional stress.
2. Extreme temperatures: Hospital emergency room personnel have long known that the incidence of heart attacks increases during snowstorms. Some research suspects that it may just be the cold.
When you are cold, the blood vessels in your skin contract so that you can conserve body heat. Blood vessels to the heart can also constrict, cutting off the blood supply to the heart.
People with angina pectoris (heart-related chest pains) may experience an increase in the number and severity of attacks simply from exposure to cold. This can also happen in hot weather or under any circumstance that causes the heart’s blood vessels to constrict.
People with angina usually have a fixed blockage. That does not change. But if you increase the work of the heart by contracting the vessels elsewhere, that may be enough to precipitate a heart attack.
3. The heavy dinner: When investigators examined coroner’s reports of 100 sudden deaths of British men on the Coronary Artery Disease Victims List, they found that about a quarter had died about an hour after eating. Although this particular research found no significant link to the fat content of men’s past meals, there is other evidence that a fat-laden sock can have devastating consequences on the cardiovascular system.
The Los Angeles Arteriosclerosis Study once suggested adding “heavy dinner” to risk factors for heart attacks and strokes. Digestion park probably occurs during periods of deep sleep, when the body cannot quickly move blood fats through the arteries. In arteries that are already damaged by osteoarthritis, those fats are likely to help block the already narrowed arteries. The result is a bottleneck – “an ideal situation” for platelets to clot.
4. Drink: The same British researchers, when examining the same 100 forensic reports, also found that just under a quarter of people had been drinking alcohol shortly before they died.
In fact, a researcher in Scotland, looking for acute triggers of sudden cardiac death, found that Saturday night and alcohol were the fatal combination. Other studies in this country have implicated binge drinking in a sudden heart attack.
5. Monday morning: Canadian researchers at the University of Manitoba discovered a curious statistic: Of all the sudden cardiac deaths they studied, 75 percent occur on Monday, the first day of the week, when people return to work.
The group they studied consisted of 3,983 men, all of whom had been deemed fit for pilot training. Men who had obvious clinical signs of heart disease could suffer at any time of the week, the research team found. But those with no obvious illness almost always died suddenly, on Monday, at work.
Could Monday mornings be so blue? Well, it can be so. The researchers speculated that a person’s return to work after a weekend break could cause enough psychological stress to trigger an arrhythmia, the suspected cause of these sudden deaths.
6. Morning – Any morning: Harvard cardiologist James E. Muller reports that heart attacks seem to have their own internal sense of timing. Of the 847 heart attacks he studied, most occurred between 6 a.m. and noon.
Dr. Muller used information provided by more than 50 researchers across the country to identify peak hours for cardiac arrest. Their findings confirmed the work of researchers in Europe and the Soviet Union, who also found a heart attack spike early in the morning. It’s probably no coincidence that the 6 a.m. to noon period is when your heart rate, blood pressure, and physical activity are also increasing.