El Rincon del Dr. KakaWate

In 2004, Phillips et al, published an article in Circulation (@circaha) that found an increased mortality around Christmas and New Year. We can even appreciate a a trend upwards since Thanksgiving. For cardiac and noncardiac diseases, a spike in daily mortality occurs during the Christmas/New Year’s holiday period. This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients

Holidays are a season in which we gather with family and friends. We enjoy good food, a couple of drinks. People with cardiovascular disease, or heart failure, crossing the thin red line of “balance” can be easily done.

Why does this happen? Some proposed but not tested possibilities

1) Respiratory Diseases: Did you get your flu shot? Respiratory disease increase in winter, and on individuals with underlying diseases, this can tip them over the age. Pneumonia, Upper Respiratory Tract infections, leading to decreased oxygenation, increased cathecolamine surge, leading to ischemia, etc.
– In summary! Get you flu shot if you have not done so
– Stay warm 😉

2) Emotional Stress
– Relax, and meditate. I can not prescribe you medication but I can recommend you some apps
– HeadSpace
– Mindfulness app 
– Buddhist Meditation Trainer
– Buddhify 2 

3) Changes in Diet and Alcohol consumption
– We might tend to indulge ourselves in these days. Remember that family members with history of heart failure, heart attacks, underlying hypertension, might not do so well with the task holiday foods. Increased Salt in foods in addition to quantity intake can predispose patients for increased water retention, causing a Heart Failure exacerbation and thus hospital admission
– They can eat everything, but with moderation
– Alcohol consumption as well as coffee and caffeinated drinks are important. We also see a trend in these parties for energy drinks mixed with alcohol. THIS IS HORRIBLE COMBO which can lead to the Happy Holiday Syndrome. In brief, arrhythmia.

Related to this:
Stress reduction with the Transcendental Meditation program was associated with 43% reduction in risk for all cause mortality, myocardial infarction and stroke in a high-risk sample of African Americans

Potential Mechanisms for the “Merry Christmas Coronary” and “Happy New Year Heart Attack” Phenomenon
1. Inappropriate delay in seeking medical attention
2. Reduced levels of healthcare staffing or fewer staff members who are familiar with individual patients during holiday on-call schedules
3. Increased emotional stress
4. Overindulgence (eg, increased intake of food, salt, fats, alcohol)      <—– WATCH OUT
5. Increased respiratory problems (eg, upper respiratory infection, influenza, particulate matter generated from wood-burning fireplaces)
6. Colder weather, leading to increased vascular resistance, coronary spasm, hemostasis and thrombus formation, O2 demand
7. Decreased hours of daylight
8. “Postponement of death” concept

Relevant Articles:
1) Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time The Holidays as a Risk Factor for Death
2) The “Merry Christmas Coronary” and “Happy New Year Heart Attack” Phenomenon