Many of you have wanted to understand why heart attacks happen early in the morning, especially after the news of filmmaker Sanjay Gadhvi suffering one during his morning walk and collapsing to his death. So, most heart attacks indeed happen between 4 am and 10 am because of various triggers. And if you have an undiagnosed, underlying heart condition, then you could be vulnerable. Hence awareness is important.

Triggers for early morning heart attack

The first part of the day after sunrise is when the body prepares for a day of activity and quickly releases adrenaline and similar hormones to kickstart the day. Cortisol, the stress hormone, is also known to rise during this time and may reach its highest level soon after you wake up. These not only thicken the blood but also make the platelets stickier, compelling them to cluster up, as well as rupture unstable plaques in the brain or heart arteries. Now these unstable plaques on their own may not pose a problem and may have a low percentage deposit but when dislodged, can obstruct blood flow, initiating a heart attack.

With changing weather, the ambient temperature is least in the morning. That’s when arteries constrict to conserve body heat. As a result the heart has to pump harder, elevating blood pressure that in turn can trigger heart attacks.

Also during REM (rapid eye movement sleep), which usually is the last phase of your sleep cycle, the heart rate becomes irregular, the blood pressure increases and the breathing rate goes up, all of which can result in plaque rupture.

The body’s circadian system, or what we call the body clock, regulates wakefulness and tiredness throughout the day. It dips and rises throughout the day and results in increases and decreases in certain chemicals in your brain and cells in your blood. Around 6.30 am, the circadian system sends out an increased amount of PAI-1 protein cells which prevent blood clots from breaking down. The more PAI-1 cells in the blood, the higher the risk of a blood clot that leads to a heart attack.

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A study by the Queen Mary University of London found that cardiovascular disease patients have lower levels of an important family of protective molecules in their blood in the morning. This could increase their risk of clotting and heart attacks.

What preventive protocols should one look out for?

1) If you are hypertensive, then you must expect a BP spike in the early morning hours. That’s why doctors recommend taking a BP drug in the first half of the day.

2) People with heart problems should not venture out in the extreme cold and shift their physical activity to a more pleasant or sunny time of the day.

3) Drink two to three glasses of water before you move your limbs. Always warm up before any rigorous exercise session and space it out nicely. Take five minutes to do some walking, rotate your arms and legs and do simple stretches. Once the body is revved up so to speak, you can graduate to serious heavy exercises.

What should one do?

Always get a basic cardiac assessment and a co-morbidity profile done before you take up an exercise regimen. Identifying risk factors would help you navigate them better rather than being taken unaware.

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What are warning signs? What should you do when you experience them?

Most patients report a sudden chest pain. If you experience any kind of unaccustomed breathlessness or chest pain, seek help and call friends or family. Inform emergency services if alone. Don’t drive back home. Sit or lie down on a plain surface, take a breath and wait for help to arrive. Take a Disprin if you have one.

What are Monday heart attacks all about?

This one happens early Monday morning, when stress hormones for a whole week of activity perks up, elevating blood pressure markers. A study presented at the British Cardiovascular Society (BCS) conference in Manchester examined the records of 10,528 patients admitted to hospitals across the island of Ireland (including the Republic of Ireland and Northern Ireland). It found that the most severe type of heart attack, known as an ST-segment elevation myocardial infarction (STEMI), happens when a major coronary artery, which supplies blood to your heart, becomes completely blocked. Without emergency care, STEMIs can be fatal.

The researchers found there was a notable increase in the rate of STEMI heart attacks at the start of the working week, with rates highest on a Monday at13 per cent. So do not accumulate stress over the weekend and practise some self-love to keep your triggers in check.

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