It goes down in the books as “sudden cardiac death” and it’s not at all uncommon – in fact, heart attacks are among the leading causes of death in the civilized world today. Most of their victims are men in their 40s and 50s; a third of these men are given no apparent warning. Their heart attacks strike as unexpectedly as lightning on a summer day.
Actually, of course, heart attacks hardly ever occur “out of the blue” – they’re merely the knockout punch delivered to cardiovascular system that’s already been beaten down by years of abuse. In a man whose heart is already vulnerable certain things – stress, temperature extremes, and alcohol can act as triggers that touch off a heart attack.
Researchers have identified at least six acute triggers of sudden cardiac death. They’ are the equivalent of righteous left hook to the head and knowing about them may help you learn when to duck.
1. Emotional Stress: A few years ago, researchers at Harvard and Birmingham and women’s hospital in Boston made headlines when they found that a substantial number of life threatening coronary events were triggered by acute emotional stress – in one case, a cliffhanger baseball game.
Getting all worked up emotionally can apparently touch off ventricular fibrillation, a heart arrhythmia one researcher describes as “a chaotic electrical storm” in the heart. Fibrillation turns the heart’s magnificently efficient contractions into erratic spasms, nearly destroying its ability to pump blood.
Of 117 survivors of life threatening arrhythmias questioned by the Boston investigators, 25 had some kind of acute psychological disturbance within the preceding 24 hours. In 15 cases, the disturbance preceded the arrhythmia by only an hour. In one case, a Yankees fan watching his team go down to the Red Sox on TV got so worked up that his heart went into fibrillation.
But what good is life if you can’t get all worked up about it? The point to remember is that emotional stress of 10 minutes duration is usually harmful only if it has been preceded by years of unrelenting, chronic emotional stress.
2. Temperature Extremes: Hospital emergency room personnel have long known that the incidence of heart attacks increases during snow storms. Some researches suspects it may simply be the cold.
When you are cold, the blood vessels to the skin constrict so you can conserve body heat. Blood vessels to the heart may also constrict, cutting off the blood supply to the heart.
People with angina pectoris (heart related chest pains) may suffer increases in the number and severity of attacks just by exposure to cold. This can happen in hot weather, too, or under any circumstances that cause the blood vessels to the heart to constrict.
People with angina pectoris usually have a fixed blockage. That does not change. But if you increase the work of heart by constricting the vessels in another place, that may be enough to precipitate a heart attack.
3. The Heavy Evening Meal: When researchers examined the coroner’s reports o 100 sudden deaths of British men listed as victims of coronary artery disease, they found that about a quarter had died about an hour after eating. Although this particular investigation didn’t turn up any significant link to the fat content of men’s last meals, there is other evidence that a fat-laden mean can have devastating consequences on the cardiovascular system.
Study of arteriosclerosis in Los Angeles, once suggested adding the “heavy evening meal” to the risk factors for heart attacks and strokes. The park of digestion probably occurs during deep sleep periods, when the body is unable to move blood fats through the arteries quickly. In arteries already damaged by arthrosclerosis, it’s likely that those fats will help block already narrowed arteries. The result is a bottleneck – “an ideal situation” for platelets to clot.
4. Booze: The same British researchers, examining the same 100 coroner’s reports, also found that slightly less than a quarter of the people had been drinking alcohol shortly before they died.
In fact, investigator 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 sudden heart attack.
5. Monday Morning: Canadian researchers at the University of Manitoba discovered a curious statistic: of all the sudden cardiac death they studied, 75 percent occur on Monday, the first day of the week, as people returned to their jobs.
The group they studied consisted of 3983 men, all of whom had been found fit for pilot training. The men who had obvious clinical signs of heart disease might be stricken at any time during the week, the research team found. But those who did not have obvious disease almost always died suddenly, on Monday, at work.
Could Monday mornings be all that blue? Well, may be so. The researchers speculated that a person’s return to work after a weekend break might cause enough psychological stress to touch off an arrhythmia, the presumed 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 847 heart attacks he studied, most had occurred between 6 a.m. and noon.
Dr Muller used information supplied by over 50 investigators nationwide to pinpoint the peak hours of cardiac arrest. His findings confirmed the work of researchers in Europe and the Soviet Union, who also found an early morning heart attack peak. It’s probably no coincidence that the 6 a.m. to noon period is when heart rate, arterial pressure and physical activity are also on the increase.