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Times of India
29 April 2011
By Malathy Iyer
Mumbai, India

‘Heart Attacks During Morning Hours Most Risky’
It’s not just the patient’s age, weight and stress levels that decide the outcome of a heart attack. The timing may be a key factor too.

According to latest research from Europe, heart attacks are not only more common during mornings but are also most severe. The new study shows that heart attacks in the 6am to 12 noon period have the worst outcomes in comparison to cardiac episodes during other periods of the day.

“This means we may need to rethink our obsession with exercising in the mornings. Any time is just as good to exercise and maybe we should recommend evening walks,’’ said cardiologist A B Mehta from Jaslok Hospital. Preventive cardiology specialist Dr Aashish Contractor said it would be prudent to not write off morning queasiness as an acidity attack. “Don’t hesitate to wake up your relatives and rush to hospital at the earliest,’’ he said.

Matter of Heart
‘Heart Attacks During Morning Hours Most Risky’
Mumbai: The study by Spain’s National Centre for Cardiovascular Research, which has revealed that heart attacks during morning hours are more severe, is likely to have an effect on treatment and research in cardiac care. On Thursday, Heart journal published the research that reviewed data of over 800 heart attack patients treated between 2003 and 2009.

Heart attacks result in scarring or killing of heart tissues in the area around the attack. According to the Heart paper, morning episodes are likely to be associated with 20% more tissue death. For the first time, the Madrid doctors have connected the body’s Circadian rhythm–often called the body’s natural pacemaker that is governed by sleepwake or light–dark cycles–and heart attacks.

Cardiologist Ganesh Kumar from Hiranandani Hospital in Powai says, “Previous research has shown that certain blood hormones such as catecholamines and neurotransmitters too follow the Circadian rhythm and could be high during morning hours. Too much of it could possibly trigger heart attacks, and could be associated with adverse results.’’

The Heart study distributed patients into four groups based on the timing of their attack. “The morning group had much higher levels of an enzyme, which is a marker of dying heart tissue, in their blood than patients whose attack occurred in the evening (between 6 pm and midnight),’’ noted the study.

According to Jaslok Hospital’s Dr A B Mehta, most sudden cardiac deaths take place during early hours of the day. “We have heard of people going for walks or doing strenuous exercise in the morning suddenly getting a massive heart attack,’’ he said, adding that people could consider exercising in the evenings. But Contractor felt the take–home message was that one should seek help at the earliest. “Patients tend to wait until the entire household has woken up or until the hospital gets into work mode at 9 am,’’ he pointed out.

City doctors feel this study will result in changes in cardiac care. “While hospitals are 24x7 hubs, they work sub–optimally during early hours of the day. This contributes to morbidity associated with heart attacks. We have to change this,’’ said a doctor attached to a public hospital.

But cities like Mumbai and Delhi, Dr Kumar said, had round–the–clock heart care. “Most metros have been witnessing a 30–40% increase in cases of primary angioplasty–a minimally invasive procedure performed within six hours of an attack–in the last few years. This means patients are reaching hospitals faster and are getting treatment earlier,’’ he added.

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