PAP: The European Football Championship has begun, we are experiencing strong emotions again, and this is usually accompanied by a higher blood pressure and heart rate. Can this lead to a heart attack in some people? Or maybe a fan's heart attack is just one of many myths, a simple coincidence?

Professor Artur Mamcarz, head of the 3rd Department of Internal Diseases and Cardiology at the Medical University of Warsaw: It is not a myth, research has been conducted to prove it. It was published in 2008 in a serious journal, the New England Journal of Medicine. It revealed an increase in acute coronary syndromes among German fans during the 2006 World Cup. In general, the number of heart attacks was higher compared to the previous and following years. It can therefore be suspected that it was associated with strong emotions during these sporting events.

PAP: During national team matches, the vigilance of paramedics should be increased, and it is best to have an ambulance near the stadiums.

A.M.: European guidelines have even been developed on how to organize assistance and medical facilities for fans during major sporting events.

PAP: And for athletes, because during the match there were also heart attacks in trained and - seemingly - completely healthy players.

A.M.: Such a spectacular cardiac arrest in front of fans and spectators happened to Danish footballer Christian Eriksen during the previous European Championship.

PAP: To recap: in the 41st minute of the match, the player suddenly fell on the pitch, paramedics immediately started resuscitating the player, which ended with success. Eriksen said a year later in an interview with the BBC: 'I remember everything except those five minutes'. When he came to, he felt someone pressing his chest, but he didn't understand what was happening.

A.M.: Yes, those were dramatic events, a heart attack can always happen to a player, but it is also about protecting the fans. Sports cardiologist Professor Łukasz Małek writes about it in the book Kardiologia sportowa dla lekarzy rodzinnych ('Sports Cardiology for Family Doctors'), published a year ago. He emphasizes that paramedics are needed, as well as appropriate medical equipment, for example defibrillators necessary in the event of cardiac arrhythmia and heart attack.

PAP: If we look at it this way, it must be emphasized that such a situation can happen anywhere - at the stadium, in the fan zone, in a restaurant or at home.

A.M.: Absolutely, because all fans experience strong emotions during national team matches, no matter where they watch the match. Blood pressure increases and the activity of the sympathetic nervous system is higher, which is accompanied by increased secretion of adrenaline. The heart rhythm also accelerates, which may lead to the rupture of the atherosclerotic plaque in the coronary artery and a heart attack.

PAP: Who is most at risk of a heart attack during an exciting match?

A.M.: Mainly those who are at greater risk of heart attack, i.e. those with risk factors for cardiovascular disease. This applies especially to those who do not control risk factors, do not take appropriate medications and do not follow doctor's recommendations. Not everyone knows that they have hypertension, and even if they do, only some patients take prescribed medications regularly. The situation is similar with elevated cholesterol levels - many people do not take medications that lower them. But patients not taking their medications is a topic for a separate discussion.

PAP: Let us just add that in Poland, 11 million people have hypertension, 21 million have lipid disorders, 3 million suffer from diabetes, and three out of five adult Poles are overweight. And all these people are at risk of cardiovascular diseases and heart attacks.

A.M.: I would also add that more heart attacks, especially in this group of people, occur during both strong emotions and infections such as flu or Covid-19. A respiratory infection generates a greater risk of rupture of atherosclerotic plaque, because fever increases blood pressure, accelerates the heart rate and increases the demand for oxygen. In both cases - strong emotions and infections - the mechanism is similar. And the risk of these complications is higher when comorbidities occur and are not controlled.

PAP: Alcohol is an additional risk factor during football matches and other sports competitions. It is often drunk in large quantities, in the stands, in the fan zone and at home.

A.M.: Yes, that is true. Alcohol also activates the sympathetic nervous system and is harmful to the heart. From an epidemiological point of view, it causes only harm. Any amount of alcohol is unhealthy. And when you abuse it, for example during a match, the damage is even greater. The match is a good excuse to drink more.

PAP: It does not matter whether the match was won or - unfortunately - our team lost. There are a lot of matches during the championship, and some fans drink alcohol almost every time.

A.M.: I remember that during the European Championship taking place in Poland and Ukraine, an Irishman with a record dose of alcohol in his blood was brought from the stadium to the Solec Hospital in Warsaw, where I worked at the time...

PAP: Let me guess - over 5 per mille.

A.M.: Even more - 8.9 per mille. This is a lethal dose, at least for some people. We saved this patient, he left the hospital the next day. When he left, the Polish fans he had befriended were standing outside the hospital with bags full of beer.

PAP: We are hospitable…

A.M.: Let me remind you that during those championships, both national teams, ours and the Irish, had similar successes, that is, they did not even make it out of the qualifying group.

PAP: All the more reason to improve your mood.

A.M.: I still warn against alcohol abuse. Of course, I admit that in people who are relatively healthy and do not have atherosclerosis and atherosclerotic plaque, the probability of a heart attack is low. However, when hypertension, hypercholesterolemia and diabetes occur, the risk is much greater. It is highest in patients who have had a heart attack or a cardiovascular event.

PAP: There is also a higher risk of stroke, which is less talked about in this context.

A.M.: In the case of a stroke, some of the risk factors are the same, mainly hypertension and atherosclerosis. There is a direct relationship between increased blood pressure and hemorrhagic stroke, which occurs as a result of a rupture of a cerebral artery. But this accounts for 10 percent of all strokes. The most common are ischaemic strokes, caused by blockage of an artery supplying blood to the brain. Such a stroke may result in the so-called atrial fibrillation - especially when it coexists with other risk factors. This type of heart arrhythmia increases the risk of stroke by as much as five times and affects 1-2% of the population. And all this is facilitated by alcohol.

PAP: We cannot avoid strong emotions, but we can at least limit alcohol consumption if we are unable to give it up.

A.M.: People who abuse alcohol or are addicted to it are more likely to have persistent or paroxysmal atrial fibrillation, as well as damage to myocardial cells. Stress, strong emotions and alcohol are a very unfavourable triad.

PAP: What is your advice for football fans during the European Championship?

A.M.: Maybe it would be a good opportunity for a check-up, for example, measure your blood pressure and blood cholesterol, and then consult a doctor. I especially recommend it to people who notice a change or a new ailment during this competition. Do not ignore it. Let this championship motivate us to take greater care of our health. (PAP)

Zbigniew Wojtasiński

zbw/ bar/ kap/

tr. RL