How to avoid a trip to the ER on Super Bowl Sunday
From heart attacks to broken bones, doctors weigh in on how to avoid common health emergencies linked to the big game.
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The NFL logo and a FOX TV camera are seen before the NFL Super Bowl 57 football game Sunday, Feb. 12, 2023, in Glendale, Ariz. (AP Photo/Adam Hunger)
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This week, millions of football fans are gearing up to cheer on the Philadelphia Eagles as they face off against the Kansas City Chiefs at this year’s Super Bowl. For those hosting watch parties, that means loading up on salty snacks, stockpiling beer, and if you’re the city of Philadelphia, greasing the poles along Broad Street.
But, according to local physicians, there’s one more step Eagles fans should be taking in the run-up to Sunday’s game: making a plan to avoid and, if necessary, deal with medical emergencies before they happen.
Heart attacks
It may sound like an urban legend, but it’s true — heart attacks go up during the Super Bowl.
“It’s not football-specific, as much as it is, I’ll use the word ‘adrenaline-specific,'” said Daniel Edmundowicz, a veteran cardiologist who chairs the Department of Medicine at Temple University’s Lewis Katz School of Medicine. “Emotionally taxing events, things that really raise our blood pressure, our heart rate, and give us that surge, can lead to cardiac events, particularly in those who are most vulnerable.”
So who’s most vulnerable? Edmundowicz cited a few major risk factors: those who’ve experienced heart attacks in the past; people with heart disease or a family history of heart disease; and those who are obese, use tobacco or have risk factors like diabetes, high blood pressure and high cholesterol or triglycerides.
“Folks who have a history of high blood pressure with a lot of adrenaline on top of that can raise their blood pressure even higher, and that can cause problems in the blood vessels,” Edmundowicz said, adding that it’s extremely unusual for heart attacks to occur in young, healthy people, even under high levels of stress. “Usually it’s the person who has unrecognized risk factors or risk factors they know they have, but unfortunately just haven’t been paying attention to — particularly in a stressful time where their team is not winning.”
In fact, research indicates that there’s an emotional component to the most dangerous kinds of stress. Studies have shown that high-stakes games are more likely to induce cardiac events, with at least one study showing they can double spectators’ risk, and that death rates are highest among fans of the losing team.
Worse, an analysis published in 2020 found that, when it comes to fan injuries and deaths that occur during the Super Bowl, the Eagles are the fifth “most dangerous team” in the NFL. The Tennessee Titans topped the list, followed by the Atlanta Falcons, the Denver Broncos and the Los Angeles Rams; the Kansas City Chiefs didn’t make the cut.
Alcohol-related injuries
Heart attacks aren’t the only risk Eagles fans might face.
“When there are big Eagles games and a Super Bowl, you are going to see alcohol-related injury, and that’s across the board,” said Chidinma Nwakanma, an emergency room physician with Penn Medicine and associate professor of clinical emergency medicine at the University of Pennsylvania’s medical school. “The Super Bowl is highly, highly stressful and it brings a lot of people together. So with alcohol comes a lot of violence and injury.”
Take, for example, the raucous celebrations that erupted on Broad Street after the Eagles won the National Football Conference championship.
“We did see a lot of injuries just because people were out,” said Nwakanma, who was working in the ER that night. “And when you have that many people in close proximity, you are going to have fights, you are going to have injuries because people are heavily intoxicated, highly spirited, and then they’re doing things that are very risky, including climbing poles and climbing onto cars and driving recklessly while being intoxicated.”
The pole-climbing tradition has already claimed one victim this season — an 18-year-old Temple student who fell from a pole on the night of the NFC championship celebration, and later died from his injuries.
After a big win, Nwakanma says, they tend to see more broken bones, sprains and other injuries resulting from fights. After a loss, they’re more likely to see injuries resulting from falls — although both are common, regardless of the game’s outcome.
Other common alcohol-related injuries Nwakanma sees on game days include drunk driving accidents, alcohol poisoning, and a condition called “holiday heart syndrome,” the symptoms of which can mimic those of a heart attack, including weakness, shortness of breath, chest pain, dizziness and a racing or irregular heartbeat.
“What happens is you have this overconsumption of alcohol and that causes electrolyte disturbances, and also kind of triggers your autonomic nervous system,” Nwakanma said. “And the two together can increase the likelihood of someone having an arrhythmia or a really fast heart rhythm, namely atrial fibrillation.”
Stress and overeating, especially of high-sodium and high-fat foods, can also contribute — hence the syndrome’s name, which refers to the holiday excesses that typically lead to its emergence.
While people with existing heart problems or risk factors for heart problems are more vulnerable to holiday heart syndrome, it can also happen in relatively young and healthy patients. In fact, on the night of the Eagles’ NFC championship win, Nwakanma saw a 27-year-old patient with atrial fibrillation who was ultimately diagnosed with holiday heart.
“This is a young, healthy guy with no underlying heart issues,” Nwakanma said. “So it’s really binge drinking. Try to avoid binge drinking.”
Making a game-day game plan
So how do you avoid a trip to the ER on game day?
When it comes to alcohol-related injuries, the advice is simple — moderate your drinking and don’t drive drunk.
If you suspect someone has alcohol poisoning, Nwakanma suggests attempting to rouse the person — if they wake up and are able to tell you where they are and that they’re OK, they’ll likely be able to sleep it off.
Signs that someone’s in trouble include:
- Inability to wake up
- Altered mental status
- Vomiting, especially excessively
- A head injury
- Depressed mental status
As for cardiac events, Edmundowicz says there’s plenty you can do by way of prevention — not all of it fun.
First, if you’re prescribed medications to treat heart problems, high cholesterol or high blood pressure, make sure you take them faithfully in the days leading up to the Super Bowl.
Second, do your best not to overeat — especially when it comes to fatty, sugary and high-sodium foods.
“Pretty much if it tastes good, spit it out,” Edmundowicz said with a laugh. “We do know that in a short period of time, like within hours, a really, really high-fat meal has an effect on blood vessels, their ability to contract and relax. And so, not just the feeling pretty full and not very healthy afterwards, but there are acute effects that if you’re on the verge and you have a plaque, God forbid, that’s for whatever reason ready to rupture, you don’t want to push it over the edge by doing that kind of thing.”
Third, avoid smoking, which, like fatty foods, can hobble our blood vessels’ ability to react, dilate and constrict.
Fourth, moderate your intake of alcohol, which raises blood pressure.
“And it [alcohol] can particularly make worse some parts of the cholesterol profile, like triglycerides and things like that,” Edmundowicz said. “So it doesn’t mean you have to just stand there and watch a game without enjoying yourself. But again, it comes to moderation and some particular attention for those in our high-risk group that now’s not the time to kind of go out on the deep end, so to speak.”
Fifth, make sure to stay hydrated, especially if you’re drinking alcohol. In addition to pacing yourself, Edmundowicz suggests alternating between water and alcohol.
And finally, as hard as it may be to do, try and manage your stress throughout the game — even if it means taking a break from the action at a crucial moment.
“Don’t be afraid to walk out of the room, maybe go outside if it’s not snowing and 5 degrees, just to remove yourself from the situation and try and relieve that stressful feeling that you might be having,” Edmundowicz said.
It can also be helpful to be aware of the warning signs of a heart attack, which include discomfort or pain in the chest or other parts of the body, including the jaw, neck, back, shoulder, back or arms; lightheadedness or dizziness; shortness of breath; fatigue; sweating; and a rapid or irregular heart beat. Women are more likely to experience symptoms like indigestion or gas-like pain, fatigue and nausea or vomiting.
If you suspect someone else is having a heart attack, immediately call 911, keep them calm, encourage them to take slow, deep breaths and, if you have it on hand, give them some aspirin to chew on, as it can help thin their blood and reduce the risk of clots.
But what if you aren’t sure if you or someone else is actually having a heart attack?
“While it’s not easy to put parameters around it, I always say if it’s something that is completely foreign to you, you haven’t felt this situation and it’s actually stopping you from doing something — you can’t get up out of the chair because of this, or you can’t find a comfortable position — I would err on the side of caution,” Edmundowicz said, “particularly if I had one of those risk factors.”

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