chest pain

How to survive the deadliest time of year

The winter holidays are an occasion to reunite with loved ones and enjoy a few good meals. Alas, they’re also the days when you’re most likely to die.

The other major holidays don’t even come close to the carnage of Christmas and New Year’s Day. The risks of setting off fireworks, or of gorging on gravy-soaked mashed potatoes, are evidently no match for the pressures of holiday shopping, the stress of travel, and the psychological toll of visiting your extended family. And no one is safe, as the increased danger is seen across genders, races, and ages.

During the holidays, death is also more likely to occur on the way to the hospital or in the emergency room, indicating that people wait too long to get help. Perhaps they don’t want to ruin the fun. Perhaps they’re too busy or distracted to acknowledge their symptoms.

Regardless, if you’d like to make it to January 2nd, you’ll need to know when it’s safe to ignore a new symptom, and when you should put down the eggnog and hustle to the emergency room.  We’re going to share some wisdom about three of the most common but dangerous holiday-time symptoms – chest pain, palpitations, and shortness of breath – with tips on when to get medical attention.

Chest Pain

Heart attacks peak during the holiday season, in part because of high stress levels and increased alcohol intake. Chest pain is the most common symptom, and it’s typically described as a weight on the chest that can spread to the arms or neck. The pain typically worsens with physical exertion and isn’t affected by body position or deep breathing. Associated symptoms may include palpitations, nausea, and shortness of breath.

If you have risk factors for heart disease – like high blood pressure, high cholesterol, diabetes, or a history of smoking – you should be especially concerned about chest pain. A clean medical record lowers your risk, but not to zero, so prototypical chest pain as described above should always prompt an urgent medical evaluation.

Of note, heart attacks aren’t the only dangerous condition that causes chest pain. Surges in your blood pressure – for example, from the frustration of trying to gift-wrap a sixty-inch television – can cause a partial tear in the aorta, the major blood vessel that conveys blood from the heart. This condition, known as aortic dissection, produces intense, sharp, ripping chest pain that often spreads to the back. It is rapidly lethal and mandates an immediate trip to the emergency room.

Thankfully, many types of chest pain are nothing to worry about. For example, if your pain only occurs when you lift your arms or twist your torso, it’s likely just a pulled muscle. If the pain is associated with a bitter taste in your throat, and it gets better when you sit upright or drink a tall glass of water, it’s likely from acid reflux. Go easy on the feasting next time.

Palpitations

It’s normal to feel your pulse quicken as your uncle describes his views on immigration or climate change. In contrast, frequent or persistent palpitations can be a sign of a dangerous heart rhythm.

During the holidays, a few extra glasses of eggnog, champagne, or any other alcoholic drink can significantly increase your risk of an abnormal heart rhythm known as atrial fibrillation. Indeed, alcohol-induced atrial fibrillation is so common during Christmas and New Year’s that it’s actually called “holiday heart.” If you suffer from high blood pressure or heart disease, or one of your parents has atrial fibrillation, you’re at even higher risk.

Atrial fibrillation occurs when the atria, which collect blood upstream of the heart’s pumping chambers, generate chaotic electrical signals. Your heart rhythm goes haywire, producing an irregular and rapid pulse.

This condition can be dangerous for two reasons. First, your heart can beat so rapidly that the pumping chambers don’t have time to fill with blood. As a result, your blood pressure can drop (causing lightheadedness), and blood can back up into your lungs (causing shortness of breath). Second, blood can pool in the malfunctioning parts of the heart and coalesce into a clot. Alas the clot can get pumped straight into your brain, causing a stroke.

If your heart is racing for no reason, or you’re feeling frequent skipped beats, just stop and take your pulse. Turn one hand palm side up, then place two fingers from the other hand on your wrist just below the thumb. If your pulse is very irregular, you could have atrial fibrillation and need urgent medical attention. If, on the other hand, you just have an occasional extra or skipped beat, just recheck yourself the next day and schedule an appointment if the issue persists.

Shortness of Breath

During the holidays, the sheer amount of socializing, planning, and shopping can definitely leave you feeling run down. If you’re literally unable to catch your breath, however, you could have a serious problem.

First, traveling long distances increases your risk of developing dangerous blood clots. If you spend several hours seated in a plane, train, or automobile, blood can get stuck in your legs and turn solid. Recent surgery, cancer, and the use of hormonal contraceptives further increase the risk of clotting. A blood clot can cause pain and swelling in the legs, but the real danger occurs when a piece breaks off and travels to the lungs, where it causes shortness of breath and a rapid heartrate. If you feel really winded and have risk factors for blood clotting, as described above, you need an urgent evaluation for this condition, known as pulmonary embolism.

If, in contrast, you’re experiencing shortness of breath alongside fever, chills, and cough, you might be inclined to blame it on a bad cold. After all, everyone gets sick this time of year, and perhaps you shook the wrong hand at a holiday party. If you’re really panting, however, you may have developed a bacterial lung infection, known as pneumonia. Other tell-tale symptoms include recurrent high fevers and sharp chest pain that worsens with deep breathing. You may also be hacking up a lot of mucous whenever you cough. See a doctor as soon as possible, as you may need antibiotics.

Christopher Kelly, M.D., M.S.

Christopher Rehbeck Kelly, M.D., M.S., is a cardiology fellow at NewYork-Presbyterian Hospital / Columbia University Medical Center.

Marc Eisenberg, M.D., F.A.C.C.

Marc Sabin Eisenberg, M.D., F.A.C.C., is an associate professor of medicine at Columbia University Medical Center and an attending cardiologist at NewYork-Presbyterian Hospital.