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Heart, alcohol cases surge in ED during holidays

Saturday December 24, 2011
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Health emergencies spike during the holiday season, according to the medical director of the ED at the University of California, San Francisco Medical Center.

"People tend to delay care around the holidays," Steven Pelovi, MD, said in a news release. "They may have symptoms of cardiovascular disease such as abdominal or chest discomfort which they interpret as indigestion or overeating, but in fact it could be cardiac ischemia."

Heart-related deaths increase by 5% during the holiday season, and fatal cases of myocardial infarction peak on Christmas, the day after Christmas and New Year's Day, according to a study published in the journal Circulation in 2004.

"The longer the time that there's a lack of coronary blood flow, which is the cause of the vast majority of heart attacks, the more damage there is to the heart," Polevoi said. "Often patients come in with discomfort and by a series of tests, we find out they're having a heart attack and they've already suffered a significant amount of damage to the heart muscle and that's what leads to the problems."

Cardiac ischemia can cause more heart damage if not treated quickly, with insufficient blood flow to the heart muscle possibly leading to heart failure, end-stage heart disease and even death. Overeating and stress typically associated with the holiday season can exacerbate existing conditions.

"The holidays are a time when we really increase the amount of salt and fat we eat," Ameya Kulkarni, MD, a cardiology fellow with the UCSF Division of Cardiology, said in the news release. "Most people don't notice the difference. However, there are certain people — for example, those with heart failure — for whom the slight increase in salt intake could result in big problems."

Alcohol intoxication

The UCSF ED on New Year's Eve 2010 experienced a 50% jump in the number of visits from the year before. Of that increase, 70% of cases were for alcohol intoxication. Many such patients are so intoxicated that they cannot walk or talk. Some lapse into unconsciousness, have trouble breathing and even die.

"There's a lot of morbidity associated with binge drinking, and the holidays are an excuse for people to drink too much," Polevoi said.

The influx of intoxicated patients can stretch resources at a typical ED because there is no antidote. Doctors and nurses must monitor these patients while treating other non-preventable emergencies.

"We must wait until their blood alcohol level decreases, and that's a slow process," Polveoi said. "Basically we are left with lots of patients in semi-conscious states. They often spend six or eight hours with us until they're sufficiently sober to go home."

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