so the cold can become an enemy

so the cold can become an enemy
so the cold can become an enemy

Heart in winter, the cold could become an enemy. In fact, with low temperatures, various ailments can occur. Especially in people with hypertension and with cardiac events behind them (coronary artery disease, ischemic heart disease, heart valve disease) who may be affected by a worsening of their condition. The cold, let us remember, requires an increase in the work of the muscle to respond to the demands of the organism. We will analyze the various conditions but the advice for everyone is to protect yourself and do not forget the heart.

ISCHEMIC HEART DISEASE

Ischemic heart disease, from angina pectoris to heart attack, is caused by a narrowing of the coronary arteries, those that carry blood to the heart. If you have to make an effort, and therefore require more oxygen, the constricted coronaries may not be able to carry enough. The same goes for those who have had brain problems such as a stroke or a TIA (transient cerebral ischemic attack). Better to avoid trips over 1,500 meters if you are returning from one ischemic heart or brain condition. The cold causes arterial vasoconstriction with a consequent rise in pressure which can lead to damage to both the heart and the brain. A study from the University of Manitoba in Winnipeg (Canada) coordinated by James Tam and published in the European Heart Journal has shown that a reduction in temperature of 10 degrees is associated with an increased risk ofheart attack of about 7%, with an evident correlation between lowering of temperature and increased risk of heart attack.

Antonio Giuseppe Rebuzzi

MONITORING

Therefore, careful monitoring of blood pressure and particular attention to the prescribed therapy is necessary. In case of very cold climatic conditions, most likely, there is a need to increase the dose of anti-hypertensive drugs. A study on about 23,000 subjects coordinated by Ling Yang for the China Kadoorie Biobank Collaborative Group and published in the European Heart Journal has shown that for a lowering of the external temperature of 10 degrees, there is an increase of the systolic pressure (maximum) of more than 6 mmHg with an increase in the risk of cardiovascular disease of approximately 21%.

VALVE DISEASES

Even those who have heart valve diseases, especially those of a stenotic nature such as aortic or mitral stenosis, must pay close attention to the severe cold. A disturbance of the correct blood flow caused by valve damage, in fact, increases the work of the heart. In this case, the increase in frequency and pressure caused by the cold adds to an already basic tiring situation, increasing the risk of heart failure, a situation in which the heart is unable to compensate for the body’s energy needs. Furthermore, coronary damage is often added to valve damage in aortic stenosis. Also in these cases, an assessment of the damage to the valves and functionality allows you to face the winter without risk.

AT THE TABLE

Another important factor to keep in mind is nutrition. It is worth mentioning that the Christmas and New Year’s Eve (but also abundant lunches and dinners independent of the holidays) are not a cure-all for hypertensive and heart patients. Considering that salt in food is one of the major determinants of hypertensive crises. Paying attention to what you eat becomes even more important in the cold. A useful tip would be to use a blood pressure device and perhaps a pulse oximeter (with the Covid many have learned to use it) to monitor the amount of oxygen in the blood. Also, supplement the medicine box with a fast-acting diuretic and perhaps a vasodilator. Obviously asking the doctor how and when to use them. Another important precaution to follow is to cover up well when you go out. Give preference to the less cold hours to get around. In fact, the cold, causing vasoconstriction, can trigger anginal attacks. Avoid going out after lunch, when the heart needs to send more blood to the stomach to aid digestion. In this case, adding an extra effort for the walk and at the same time to counter the cold is not healthy.

IN THE MOUNTAINS

If you want spend Christmas in the mountains, especially if you have heart disease, you have to be careful of the altitude and the cold. All factors that can damage our heart. High altitude air, in fact, especially above 2000 meters, contains less oxygen. And just to compensate for this lack, our organism increases cardiac and respiratory work and blood pressure. In addition, in Mountain, the ability to use oxygen itself is also reduced. There is, therefore, less oxygen available and also less ability to use it. It is important to evaluate the characteristics of our body. A study recently published by the Monzino Cardiology Center from Milano, coordinated by Professor Piergiuseppe Agostoni and published in the journal High Altitude Medicine and Biology has shown that a high body mass index, a sign of overweight, advanced age and male sex are factors associated with hypoxemia (reduction of oxygen in the blood) and difficulty breathing when climbing to high altitudes, particularly during the winter.

* Professor of Cardiology at the Catholic University of Rome

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