WINTER | A Season for Heart Attacks in Kashmir

Winter has arrived, and we’ve experienced a new layer of snow on the beautiful mountains of Kashmir. The forecast suggests that colder days are in store. It is not only the coldest part of the year but also the wettest in snowy locales like ours. The word winter in fact in many Indo-European languages is related to wet and water.

Cold weather triggers many medical problems like influenza, asthma, sore throat, joint pains and heart diseases, in particular heart attacks. Heart attacks are the most concerning of these problems and especially for seniors. The reasons for this fact are multifactorial. People with underlying risk factors like diabetes, high blood pressure (BP), smokers, high bad cholesterol levels, overweight and obese people are more prone to get heart problems in this chilly season. In general heart related problems double during these times. Winter months typically are from December to February, with 21st December to 31 January being the coldest and called the “Chilai Kalan’’.

Cold temperatures lead to some adverse changes in the body. These include, shrinking of arteries in general including those of the heart. There are some circadian changes leading to higher cortisol levels which can result in higher blood pressure, increased pumping action of the heart to increase the circulation of blood necessary to keep the body warm.

The regions which are not intensely cold see an increase in pollution with worsening of the air quality indices. Pollution is an important cause of inflammation of the arteries which can lead to quiescent lesions to progress and block the arteries leading to heart attacks.

Of the 9 important risk factors which account for 90% of heart attacks as per the INTERHEART study from the Lancet 2012, many of them are adversely affected. These risk factors are: Smoking which invariably increases in colder months, high bad cholesterol levels generally deteriorate because of more sedentary habits and increased intake of cholesterol rich foods, BP levels increasing in general, diabetics getting sugar levels out of control, gain in weight and tendency for obesity, depression and anxiety because of gloomy overcast weather and often getting stuck indoors. Reduced exercise and less intake of fruits and vegetables. Those individuals who consume alcoholic drinks usually consume larger quantities which again is hazardous by increasing BP, triglycerides and also irregularities of heart beats. All this can lead to heart failure and sudden death especially in patients with previous heart disease.

Preventive Measures:

It is always desirable to get a general body examination done at the onset of winter. A blood pressure, blood sugar and blood cholesterol and triglycerides estimated. If abnormal, seeking a consultation with a physician is advised.

Exercise done regularly is one of the best ways to keep the heart healthy. For unaccustomed persons it should be started gradually and increased steadily. Taking tea and eatables in between is not recommended. Vigorous exercises should be avoided. There have been examples of people getting heart attacks during such spurts.

For persons with risk factors like diabetes, high BP and high cholesterol levels getting an exercise test with ECG monitoring is the best way to start. Keeping a count of the pulse rate is a scientific way of monitoring heart activity. A number of apps are available for this. In general, for an average person between 40 and 60 years a rate of 120/ minute is considered a good level. Patients with underlying heart problems should always consult their physician to guide them regarding the duration and speed etc.

Targets to Be Maintained:

Blood pressure at rest less than 140/90, Fasting blood sugar less than 120 mgs, Total cholesterol less than 150 mgs, weight under check and no use of tobacco and alcohol.
Vaccinations:

Mercifully COVID is now contained and most have taken all the 3 doses of COVID vaccination. Influenza vaccine once a year before the onset of winter and Pneumonia vaccine once after 65 years of age is advocated. If you are yet to get a Flu vaccine, get it done. Better late than never.

Take Home Message:

Winter season predisposes to heart related disorders. These problems can be avoided to a large extent by healthy heart checks and timely preventive measures. Regular exercise and intake of plenty of fruits and vegetables are very cost-effective solutions. Patients with high BP, diabetes and underlying heart diseases should maintain their targets. Tobacco use should be avoided at all costs.

Prof Upendra Kaul , Founder Director, Gauri Kaul foundation. Recipient of Padma shri and Dr B C Roy Award