The best way to manage heart health is through diet and exercise and, when necessary, the use of prescription medications. But there are certain heart attack triggers that might surprise you. In general, we think of the four "Es" as follows: exertion, exposure to cold, emotion and eating.

TOO MUCH EXERTION, TOO QUICKLY

We all know a regular exercise program is good for us, but it's important to work up to a level of fitness and not just "jump in." If you're not used to regular aerobic exercise, sudden and strenuous physical exertion can lead to a heart attack.

This can include everything from playing a competitive game of basketball with friends to going hunting and carrying an animal. Too much exertion could also come from sexual activity, running or shoveling snow.

"You should avoid being over strenuous in activities such as these if you're not used to exercising, have cardiac risk factors such as a family history of heart disease, diabetes, high cholesterol or high blood pressure, for starters.

Testing your ability to exercise, especially in weather extremes, can be a dangerous proposition," says Curtis Rimmerman, M.D., of Cardiovascular Medicine at Cleveland Clinic.

COLD TEMPERATURES

Cold temperatures add to an increased risk for heart attack because they cause the arteries to constrict, which can cause a sudden increase in blood pressure. Combine this with physical exertion and the effects could be dangerous.

Dr. Rimmerman says people need to remember that shoveling snow is hard work and puts extra strain on the heart. Each year, shoveling snow sends more than 11,000 people to the hospital. While most have orthopedic injuries, seven percent have cardiac problems, and many of these are heart attacks.

INTENSE EMOTIONS

It turns out that extreme emotions, both good and bad, can have an impact on the electrical impulses of the heart. Studies show that the stress spanning extreme happiness to acute grief has the ability to spur a heart attack. This is due to the body's involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.

Recent studies of grief have shown that the risk for heart attack is greatest within the first 24 hours of losing a close loved one and can remain high for a month after the person's death. And sharp anger is another emotion with real consequences for the heart. In a 36-year study at John's Hopkins University, it was discovered that men who are quick to anger are more likely to develop premature heart disease and five times more likely to have an early heart attack.

EATING A BIG MEAL

Studies have shown that a heavy meal can trigger a heart attack within a 26-hour period following the meal. The recent death of actor James Gandolfini from a heart attack brought this topic to the public domain. Researchers believe that this could be because eating raises levels of the hormone norepinephrine, which can increase blood pressure and heart rate.

Studies show other triggers for people with compromised heart function include excessive drug and alcohol use, too much caffeine and severe air pollution.

Knowing that these and other events can lead to heart attack just points out how important it is to keep your heart as healthy as possible with a carefully selected diet, regular exercise and medications.

(WhatDoctorsKnow is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at http://www.whatdoctorsknow.com.)

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