A fight with your husband. A dreadful traffic jam. Shoveling six inches of snow. All are unpleasant situations.
But as ordinary as they sound, they're everyday events that for people at risk—those with high blood pressure, high cholesterol, diabetes or a family history of heart disease--could unmask the conditions that bring on a heart attack.
A heart attack happens when one or more of the arteries supplying your heart with oxygen-rich blood become blocked. But Alegent Creighton Clinic Cardiologist Eric Van De Graaff, M.D., said there are "triggers" that may make a heart attack that was going to happen later actually happen sooner.
# 1 Trigger: A lot of exertion
"We do see heart attacks after the first snowfall," Dr. Van De Graaff said. "There's a lot of research supporting this." For the average person who doesn't exercise, shoveling snow or playing in that neighborhood football game could be a trigger. Most at risk are those not used to exercise who also have risk factors such as high blood pressure or a family history of heart disease, among others.
Dr. Van De Graaff suggested if you're sedentary and, for example, need to shovel snow, make sure you've warmed up first and delay the work until later in the morning. Every year, 11,000 people end up in hospitals from shoveling—most are orthopedic injuries but seven percent are heart-related. Ideally, you can protect against this by getting moderate exercise year-round.
# 2 Trigger: Morningtime
Dr. Van De Graaff said when we wake up we experience an accompanying rise in cortisol to get us ready for the day. This can stress the heart. A disproportionate number of heart attacks happen between 5 and 8 a.m.as someone rises and his or her body releases hormones into the bloodstream.
He also said Monday mornings are problematic—we're getting up earlier than we did on the weekend, we may have participated in activities over the weekend that weren't healthy and we're just plain stressed about work.
#3 Trigger: Intense emotions
Stress and anger are triggers to watch out for. Stress hormones cause blood vessels to get narrow, slowing down blood making its way to the heart and causing a sudden spike in blood pressure.
That's why more heart attacks happen after disasters, Dr. Van Dr Graaf said. "For those who have coronary disease, research shows heart attacks rise after these events." For example, there was a 49 percent increase in patients admitted with heart attacks within a 50 miles radius of the World Trade Center in the 60 days after September 11, 2001, compared with the 60 days before. There were also large increases in the number of heart attacks after the 1989 earthquake in San Francisco and the 1994 earthquake in Los Angeles.
Even those without heart disease can experience symptoms of a heart attack—and damage to their hearts—in response to stress. Dr. Van De Graaf said researchers have identified stress-induced cardiomyopathy (also known as broken heart syndrome) as a condition that can lead to cardiac problems. It can be caused by a marital fight, a breakup, divorce or the death of a loved one.
Women are more likely to experience the sudden chest pain that comes with it. Stress-induced cardiomyopathy can happen to someone who's healthy and doesn't have blocked arteries. The false alarm, while not a heart attack, can cause problems. "There's a great outpouring of adrenaline, which can cause damage to the heart cells," Dr. Van De Graaf said.
#4 Trigger: Big meals
Super-sizing your meal or piling food on your plate also can unmask coronary disease. Dr. Van De Graaff gave an example of someone who's not active and has 90 percent blockage in an artery. After a big meal, his blood is being shunted to the stomach and intestines, making the heart work harder and faster. The result? Chest discomfort—or worse.
The 2013 death of 51-year-old actor James Gandolfini drew public attention to overeating as a trigger. The Sopranos actor reportedly had a large meal consisting of fried foods and several drinks before he suffered a fatal heart attack.
#5 Trigger: Dirty air and traffic snarls
Air pollution long has long been known as a risk factor for heart disease. But plop yourself into the middle of a long traffic jam, breathe in some dirty air and you're at higher risk for a heart attack. Dr. Van De Graaf said stress and undesirable particulates in the air can be trouble. One study found traffic exposure triggers about eight percent of heart attacks among those at risk.