Hurricane Irma and Heart Disease: A Killer Match

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Physicians should encourage patients with heart disease to prepare for what happens after the storm.
Physicians should encourage patients with heart disease to prepare for what happens after the storm.

Just 4 days before making landfall in southern Florida, Hurricane Irma reached her peak intensity, with maximum sustained winds at 185 miles per hour and gusts that exceeded 200 miles per hour. And she held that intensity for 37 hours. The storm was 425 miles wide, with hurricane-force winds extending more than 60 miles from the center and tropical-force winds another 152 miles from the center

I have lived in southern Florida all my life, but I have never seen such an incredibly large storm pack such brute force. For a state that's only 160 miles wide, there was no escape. Those who tried to evacuate north only found bumper-to-bumper traffic, gas shortages, and an unpredictable trajectory that landed many directly in the path of the eye.

For patients with cardiovascular disease, such storms can pose serious dangers aside from the wind and storm surge. Increased stress about evacuation plans and how best to prepare for the storm may increase sympathetic drive and increase circulating catecholamine levels. This stress is then further exacerbated by the stress of the storm itself: loud thunder and wind, heavy rain, and the uncertainty that each minute brings as the storm passes overhead. "Will my windows hold up?" "Will my roof stay on?" "Will I be able to keep my family safe?" These are some of the most concerning questions that might pass through one's mind during the storm.

My father is 72 years old, lives in the Florida Keys, and has significant heart disease. He's one of those patients who you might say is at the highest risk for adverse cardiovascular outcomes during and after a storm. As we considered where to weather the storm, one thing was for certain: he could not stay in the Keys. The Florida Keys are a chain of islands linked by 1 road and a series of bridges. Evacuation is often the only option, even when at-risk patients have hurricane-resistant homes, because the lack of emergency services after the storm places them at increased risk for poor outcomes if they experience an injury during the storm. However, patients with heart disease are also at increased risk of having an adverse cardiovascular event, such as a myocardial infarction or sudden cardiac death.1 Any delays in the emergency response for these patients can lead to severe morbidity or mortality. Needless to say, I had my father evacuate to my home in Miami.

Yet, Hurricane Irma's trajectory made evacuation practically impossible for South Floridians. Most hurricanes in the past have crossed the state from east to west or vice versa, allowing most people to avoid the eye of the storm by driving a short distance north or south of the trajectory. We rarely see a storm attack from south to north. Given the size of this storm, the path of the eye threatened the entire state with hurricane-force winds.

My father was hesitant to leave his house in the Florida Keys because he had never evacuated for a storm before. He reminded me that the house was entirely poured concrete, had hurricane shutters, and was on stilts 13 feet off the ground. Although these specs had always reassured me in the past, we also had never been faced with hurricane-force winds of more than 180 miles per hour and storm surges exceeding 10 to 15 feet. After the storm, fallen trees and powerlines could have restricted travel to and from his house, not to mention flooding from the massive storm surge. Loss of communication further complicates the possible scenarios. Thus, the decision to evacuate was a crucial. I encouraged him to join me on the mainland so we could buckle down for the hurricane together.

For my father, it was a choice plagued by significant stress. He worried about leaving his home with the uncertainty of what he would come back to. Moreover, he wasn't really escaping the storm, since it was still predicted to hit Miami. This made it harder for him to justify why he was leaving his beloved home and further exposed him to the stressors of experiencing the storm. Like many people, he was simply relocating to a larger metropolitan area that was slightly further from the coast with markedly better access to emergency services.

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