The circadian variation in frequency of heart attack, sudden cardiac death, and heart pain is characterized by a morning peak.

Maximum heart attacks and sudden heart death occur between the hours of 6 am and noon compared to the rest of the day.

Cardiac events are triggered stimulation of sympathetic nervous system.

Fibrinolytic or the clot dissolving capacity is also low in the morning. Among patients with stable heart blockages plasminogen activator inhibitor-1 activity peaks in the early morning while tissue plasminogen activator activity is at its nadir.

Lessons

1.    If you are a heart patient do not smoke after getting up. It can increase the sympathetic activity

2.    If you are a heart patient do not take a cup of tea or coffee immediately after getting up. It can increase the sympathetic activity

3.    Heart patients should take their drugs in the night so that the drug is available in the blood in the morning hours

4.    Heart patients should not exercise early in the morning if they have not taken their morning drug or the previous night drugs

5.    Heart patients should not do kapal bhati or bhastrika pranayama without medical supervision

6.     Early morning anger can be harmful.

7.    Early morning is more harmful in winter and near full moon.

8.    Early morning is more harmful in diabetic patients

9.    Early morning is more harmful in uncontrolled blood pressure patients

10.  Beta blockers and aspirin can prevent early morning heart attack and sudden heart death

About the author: Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India, Dean Board of Medical Education Moolchand Medcity, Sr. Physician & Cardiologist, Chairman Ethics Committee Delhi Medical Council, Visiting professor Clinical Research DIPSAR, Past President Delhi Medical Association and Past Academic and Research Wing Heads IMA.