September 23, 2021 by John Fernandez and Bethany Rundell
Why You Shouldn’t Delay Care: Heart Attacks, Strokes and Holiday Uptick in Emergencies
The holiday season is here, and so is the annual uptick in the number of cardiovascular emergencies.
“The increased incidents for both stroke and heart attack around the holidays has been studied for quite a while,” said Leo Huynh, D.O., chief of emergency medicine at Baptist Hospital. “A lot of it is preventable, as far as overindulgence of food, alcohol, as well as salt intake, which will put a big stress on the cardiovascular system.”
Felipe De Los Rios, M.D., medical director of the stroke program at Miami Neuroscience Institute, warns that travel and other disruptions to one’s routine can also contribute to higher stroke risk this time of year.
“There’s that situation where people don’t generally exercise, and now they have time and they start doing a lot of exercise all of a sudden,” explains Dr. De Los Rios. “That puts an extra strain on your body. Or the opposite, where normally you are relatively active, then all of a sudden you’re sitting on the couch or watching TV for prolonged periods of time. That lack of movement can also predispose to clot formation.”
Dr. De Los Rios and Dr. Huynh explored the factors behind this “holiday phenomenon” and how to prevent it in a recent episode of Baptist Health’s Resource Live program hosted by Jonathan Fialkow, M.D., chief of cardiology at Miami Cardiac & Vascular Institute and chief population health officer for Baptist Health. Highlights of their discussion are in the Q&A below.
Dr. Fialkow: “Felipe, let’s start with a level set. First, can you speak a little bit about what is a stroke?”
Dr. De Los Rios: “Stroke is a very common condition. Actually, one out of six people will have it in thier lifetime. It’s the fifth leading cause of death. And what happens is the brain receives, needed oxygen and nutrients that come through the blood to survive. And when you have a stroke, there’s an interruption of blood flow to an area of the brain. So that area essentially gets deprived of oxygen nutrients, and doesn’t survive very long. The brain doesn’t store energy like some other organs do. So as soon as blood supply is cut, then that organ starts to malfunction and you can get permanent brain injury by that lack of blood flow.”
Dr. Fialkow: “Why do we think this might increase in frequency during the holidays?”
Dr. De Los Rios: “There are many reasons. People travel, they might forget their medications so there are interruptions of things that they need to take, be that medications for blood pressure or diabetes or aspirin, things like that. That puts you at increased risk if they’re stopped suddenly. Prolonged travel as well. It has been shown that if you have longer flights, sitting for eight hours or more, you have higher risk of getting complications than smaller or shorter flight durations. But that applies to any prolonged car ride, it would be the same. Changes in exercise habit can also put extra strain on your body.”
Dr. Fialkow: “Leo, we see similar statistics and experiences with heart attacks around the holiday season, right?”
Dr. Huynh: “Yeah, we do. I think the most important thing regarding strokes as well as heart attacks is timely care. Certainly with COVID everyone’s a little more tentative in their daily life, but it’s really important to distinguish a medical event and they have to get immediate attention. So regarding stroke and heart attacks, time plays a very critical role. It’s very important for everyone and also people around them. Pay attention to the people around you around the holidays. And if you see something, then certainly act upon it.”
Dr. Fialkow: “Felipe, can you explain why getting medical attention at the first sign of a stroke, for example, is so critical?”
Dr. De Los Rios: “It has been shown that brain cells don’t survive too long, mostly in the range of hours, for the most part, when there is a complete lack of blood flow. So, the longer that time goes by, the more injury those brain cells endure, and there’s a point where it’s, you can’t recover. Those brain cells will die, even if blood flow is restored, but if it’s restored too late. So then that’s irreversible injury and you don’t recover. Brain cells don’t regenerate like hair or skin though. So whatever injury there is, it’s permanent. But people do improve because other brain cells train and get better at doing things that they weren’t doing before. But you don’t really regenerate brain cells like that. So being able to restore blood flow before they have irreversible injury is key.”
Dr. Fialkow: “And the same is true for heart attacks as well. The quicker one gets taken care of and able to restore blood flow, the less damage and the better they’ll do.
“Felipe, what are the warning signs of a stroke, or what are the symptoms that should make someone say to themselves or to a family member get to the emergency room or call 911 right away?”
Dr. De Los Rios: “What we focus on is lack of function. So people are able to do something, and then suddenly they can’t do something. They can’t speak, they can’t understand, they can’t move, feel.
“The acronym FAST, F-A-S-T captures about 70 to 85 percent of all stroke symptoms. And what it stands for is F is for face. So you can have facial weakness, one side of the face looks more droopy than the other. A is for arm. So there’s arm weakness, arm or leg weakness. Usually one side. The S is for speech changes, any speech change, meaning it’s a little slurred or the person doesn’t understand language or can’t speak normally. And then the T is for time. So because time is so important.
“Not all hospitals can treat stroke, so it’s important that you go to the right hospital at the beginning, otherwise you will incur delays of treatment. 911 lets us know before the person arrives. So the whole team is much more ready to really streamline the process. So, 911 is the way to go.”
Dr. Fialkow: “So, let’s bring this conversation a little bit to the COVID scenario. Early on where COVID was hitting hard, we saw decreased ER visits for strokes and heart attacks. Are you still seeing that?”
Dr. De Los Rios: “We have not been seeing that as of late. In April when we had the first wave, we did see that there was a significant decrease in ER visits. People were very scared to come to the hospital and they were not coming with life-threatening emergency conditions, which is a very bad decision because these conditions have a higher risk of death and disability by far than COVID does — more than two, three times of what COVID could do to you. These heart attacks and strokes will damage permanently someone’s life.”
Dr. Fialkow: “We’ve also spent great effort, time and thought in protecting people from COVID in the emergency room.”
Dr. Huynh: “Yes, this has been a very large hospital collaborative right from the beginning. And it’s really separating the COVID patients versus the non-COVID patients right from the point where they enter the door. So we have a screener and then we have separate processes for those patients to ensure that the COVID patients or the person under investigation are treated appropriately, as well as a non-COVID patient.
“It’s a separate process, separate waiting room. And we really worked hard to protect all the patients and all of our staff. The proper use of PPE is critical and thankfully at Baptist we’ve never had any shortage. And we’re always really on top of our supply of PPE. So, we take a lot of pride, because it took a lot of work.”
Dr. Fialkow: “Felipe, what kind of recommendations would you make regarding this holiday season and COVID for keeping people healthy?
Dr. De Los Rios: “Alcohol and binge drinking really increases the risk of stroke and heart attack as well as accidents and all other sorts of things. So just drink in moderation. Don’t get over anxious with traveling and plan ahead, make sure you have enough medication supplies to last the whole trip. Be aware of the protections that you need during these COVID times, because it’s not just COVID. I mean, stroke risk goes up with all sorts of infections.”
Dr. Fialkow: “Leo, anything to add?”
Dr. Huynh: “Listen to your body, pay attention to those around you, I think that will keep everyone a little safer. In this day and age there’s a lot of access to medical care. So, certainly do not be afraid to seek medical care because it could save your or your family member’s life.”