After natural disasters, we all witness an increase in heart attacks and sudden deaths. We follow news about various types of natural disasters occurring in different parts of the world through written and visual media.

Why are heart attacks increasing, and by how much? What happens during and after an earthquake? What kind of changes in the human body trigger a heart attack?

Looking at the medical literature, we see that data related to earthquakes is mainly published from Japan. Japan is known as an earthquake-prone country where earthquakes of significant magnitude frequently occur. Japan is highly experienced in dealing with earthquakes, challenging them with robust buildings and precautions.

Our country is also earthquake-prone, experiencing earthquakes of various magnitudes in different regions. In 1999, we experienced the devastating Marmara earthquake, losing thousands of our people, and the destruction was immense. I was in Istanbul during that earthquake, having just graduated from medical school and preparing for the medical specialization exam. When the earthquake happened, sounds came from below the ground; I immediately jumped out of bed. The ground was shaking violently. I wanted to leave the room, but after taking a few steps, I held onto the wall and stayed there. Walking seemed impossible. At that moment, I realized that even getting out of the room during an earthquake was very difficult. We were staying in a student house, and our apartment was on the ground floor. The living room window opened directly to the garden. The three of us couldn’t manage to go outside during the earthquake because it was intense, the ground was shaking horribly, and walking was impossible. Luckily, our building didn’t sustain damage, and nothing happened to the residents. We spent the following few days outside, staying in the football field of the Burhan Felek Sports Complex. It was August when the earthquake occurred, and the weather was hot, so staying outside was comfortable. In the following days, we returned home, leaving the living room window open for the first few days and nights in case of aftershocks. Fortunately, there wasn’t a severe aftershock.

On February 6, 2023, we experienced two major earthquakes centered in Kahramanmaraş. These earthquakes, which saddened the entire country, caused extensive destruction. The impact of these earthquakes, affecting eleven provinces and more than 10 million people, was unfortunately greater than the Marmara earthquake.

Injuries and deaths during an earthquake mainly occur due to trauma. Crush syndrome and heart attacks are other significant causes of death. Heart attacks are important causes of death both during and within a year after an earthquake. The acute stress during an earthquake, sudden excitement, and fear cause an increase in stress hormones in the blood. The adrenaline level in the blood rises within seconds. Blood pressure increases, heart rate rises, and the heart contracts more forcefully. The oxygen demand of the heart increases because the heart is trying to respond to the increased stress. In individuals with atherosclerosis, where there is a buildup of cholesterol inside the blood vessels, these plaques can rupture. A blood clot forms on the ruptured plaque, completely blocking the blood flow in the vessel. Cutting off blood flow in this way leads to a heart attack, causing damage to the tissue in that area of the heart. In such a situation, the patient feels severe pain, similar to pressure covering the entire chest or sometimes in the form of burning. Cold sweating can accompany the pain. In such a situation, taking one aspirin and immediately going to the nearest hospital is vital. In the hospital, emergency angiography and balloon stent procedures are performed to minimize the damage to the heart.

We mentioned earlier that heart attacks increase during the earthquake process and within the following year.

In patients coming from the earthquake zone, we still see the lingering effects of the significant distress they experienced. People who lost their loved ones or whose homes and businesses collapsed cannot be expected to be in good shape. On the other hand, the major disaster has deeply affected the entire country. Patients coming to us express deep sorrow for the major earthquake, stating that their sleep patterns are disrupted, they cannot sleep at night, and they experience complaints such as fluctuation in blood pressure, disruption in blood sugar levels, chest pain, and palpitations.

What can be done to protect against post-earthquake heart diseases and reduce the risk of heart attacks? We can list these in bullet points as follows:

• Do not stop taking medications: Patients should continue taking their medications regularly. For example, those who use medications for hypertension, diabetes, high cholesterol, and heart failure should continue using these medications without interruption, as these medications can be obtained without a prescription.
• Keep hypertension under control: Patients with high blood pressure may experience fluctuations in blood pressure during this period due to stress. The stressful situation directly affects blood pressure. Therefore, patients should monitor their blood pressure during this period, and if their blood pressure is above 140/90 mmHg, they should seek medical attention. In such cases, the doses of the medications should be increased, or additional medications should be started.
• Blood sugar levels should not be elevated: Blood sugar levels of patients with diabetes should be measured, and if they are high, the medication treatments should be reviewed.
• Stay away from tobacco products: Smoking should be avoided as it is a major trigger for heart attacks. However, individuals who have previously started smoking and cannot quit should minimize the amount of smoking, at least during these sad and difficult days.
• Seek psychological support and treatment: Since major disasters deeply affect people, psychological support is crucial during this period.
• Ensure good health services: In this challenging period, a well-functioning referral chain and well-coordinated health services are vital. When a patient with chest pain applies, quickly taking an electrocardiogram and diagnosing a heart attack, followed by urgently referring the patient to a health center where angiography can be performed, is vital.
• Pay attention to hygiene and healthy nutrition: Ensuring adequate hygiene is crucial for earthquake survivors living in tent and container cities to protect against infectious diseases. All earthquake survivors, especially children and elderly patients, should pay attention to balanced and healthy nutrition for maintaining a strong immune system. Adequate fluid intake is essential. Approximately, daily fluid intake should be the body weight * 0.3 ml (For example, for a person weighing 70 kg, it should be around 2100 ml, or about 2 liters. This amount includes total fluid intake, including tea, coffee, other liquid beverages, and water).
• Avoid being sedentary: It is important for heart health to move as much as possible, considering the conditions.

I wish a speedy recovery to all our people. May God not make us experience such a disaster again. I wish everyone healthy days.