Bengaluru professional’s morning heart attack at 36 surprised me: What trigger was hidden in his daily routine?

He would dart for his cellphone on waking up as he feared he had missed important messages from higher-ups in office. Worse, since he worked late and slept fewer hours, he would almost immediately run to the gym for his workout to complete his fitness quota. What was problematic about his life?

No, it’s not just the winter when cold narrows blood vessels of the heart. The problem was a massive disruption in his circadian rhythm, or the body’s natural 24-hour internal clock that aligns with nature. It manages sleep/wake cycles, hormones, temperature and other functions. A disruption means that the body perceives everything out of the natural rhythm as an unnatural attack on itself and releases stress hormones. Excess hormones mean that the body is in an emergency mode and cannot unwind. Any added stress like attending to a flurry of work calls, working out in the gym or making a mad dash to the office through chores, only stresses you, and your heart, out further.

Why should you avoid morning stressors?

Upon waking, the body releases a surge of stress hormones, primarily cortisol and adrenaline, to set you up for the day ahead. These increase heart rate and blood pressure, raising the heart’s demand for oxygen. The gush happens because physiologically, human hormones still behave like we are still hunter-gatherers, preparing us for the physicality of finding food. So, when you plunge into activities headlong, the body feels confused, goes into panic mode and exaggerates the spike. Now if you have not slept well, the stress hormones have not really quietened and stay high. Any additional pressure means these hormones, which typically surge between 3 am and 6 am, have a multiplier effect and often constrict arteries, disrupting flow of oxygenated blood.

Waking up is, therefore, a delicate transition period for your brain and body. Immediately engaging with a phone’s stimulating or triggering content (work emails, messages, breaking news, social media comparison) can prematurely activate the body’s “fight or flight” response.

Blood pressure typically drops during sleep and then rises again in the morning, known as the “morning surge.” This rapid increase in pressure can stress the artery walls, potentially rupturing existing plaque buildup in a narrowed artery.

In the morning, blood platelets clump together faster as the body’s natural ability to break down clots is lower due to higher levels of a protein. This increases the risk of clot formation and blockage of a coronary artery. Besides, the body is dehydrated after several hours without fluids, which can make the blood thicker and slower-moving, further increasing the risk of clot formation. Besides, blood vessels can stiffen up in the morning, making it harder for them to dilate and accommodate the increased blood flow and pressure.

What you should do to minimise the risk of morning heart attacks

In short, pushing the body and mind immediately after waking up is bad news for underlying risk factors, which in my patient’s case was high cholesterol, excess weight and BP. They create what we call a “perfect storm” that makes a person vulnerable to heart attack in the early morning hours.

Drink a glass of water when you wake up to improve hydration and help lower blood viscosity. While on bed, stretch out your arms and legs. If you are into walking or exercise, warm up gradually before speeding up your routine. Meditate or empty your head of stimuli, so stay away from your cellphone for at least half-an-hour. Don’t look at the cellphone while walking or exercising.

For long-term improvement, sleep for at least seven to eight hours, have a balanced heart-healthy diet low in carbohydrates and saturated fat. Take out 30 minutes of moderate exercise most days of the week, such as brisk walking, cycling or swimming. Give up smoking and alcohol and monitor your parameters like blood sugar and lipids. As I say, wake up to a lullaby, not to noise, phone rings and distraction.

(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)