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Dr Rahul Kurup is a researcher at the Heart Research Institute as well as a specialist cardiologist in western Sydney, NSW. He answers some common questions about bushfire smoke and heart health.

Does bushfire smoke affect a person’s heart health?

Basically, bushfire smoke is like any other pollutant. The fine particles in smoke and ash, particularly when inhaled, can cause inflammation to the lungs, which may manifest as people experiencing issues with their breathing.

The lungs and heart are interconnected, with the lungs oxygenating the blood the heart pumps. Being exposed to that pollutant stimulus can affect the lungs and heart, leading to symptoms such as chest pains, difficulty breathing and the sensation of a racing heartbeat. Significant smoke exposure can also lead to flare-ups in people with pre-existing heart conditions such as heart failure and heart blood vessel problems.

Who is must vulnerable to the health effects of bushfire smoke?

At my cardiology clinic, more people are coming in with problems with their breathing and generally having a flare-up of their heart symptoms as well. We’ve seen it mainly in people with chronic conditions, and in people at either end of the age spectrum, so the elderly as well as really young kids. They tend to be a bit more sensitive to the smoke and similar things.

In particular, elderly, frail or patients dealing with a chronic condition don’t have the reserves to deal with an irritant like smoke. They just don’t have that back-up supply as their margins of operating are quite rigid and they tend to decompensate quite quickly.

How can you protect yourself from smoke in the air?

You can’t really stop the source of the pollution in the air, so it’s about trying to reduce exposure. Check the air quality index so that you know on particularly bad days to stay inside and not expose yourself to these things outside. Keep the windows and doors shut, and if you have air conditioning, turn it on and set it to ‘recycle’ or ‘recirculate’.

Reducing your activity can also help. For example, if you’re a runner, try to avoid going for runs on the days when air quality is bad.

You can use masks for protection, but they must fit well and have a really good seal – something like a P2 face mask. Often these things need to be fitted for you. This is particularly tricky in people who have facial hair, as it’s difficult to generate a good seal. They’re also not comfortable to wear for prolonged periods of time. A lot of masks you see people wearing filter the air, but don’t actually get rid of all the particles. Something is better than nothing, but these types of masks aren’t as effective as well-sealed ones.

I also see people wearing just surgical masks. While these aren’t filtering the air, they can help prevent infecting others if you have a cold or flu.

What can people with pre-existing conditions do to protect themselves?

For someone who has heart disease and gets chest pains and angina, you have to do something if you feel things getting worse. You can’t just think, “Oh, the smoke is making it play up.” You need to go for a check-up and be tested to make sure other factors aren’t playing into it, and that it’s not something potentially irreversible, like a heart attack or a bad flare-up.

The first port of call should be to see your GP, and if your GP thinks it’s urgent, then you can get an appointment to see a specialist. If it’s out of hours, and you experience symptoms beyond what you normally do, then actually go get urgent medical attention at a hospital or out-of-hours clinic.

If you have a chronic condition like asthma, COPD or emphysema, it’s very important that you have something like a management plan in place. This would cover things like what to do if your symptoms become worse. Someone with asthma may be taking their puffers a lot more regularly, so they should know that if things aren’t improving, they need to escalate and see someone.

What can someone expect from a check-up?

Depending on the symptoms being experienced, and the person’s medical history, we can do a physical examination and run tests like an electrocardiogram (ECG) to make sure the patient’s not experiencing anything else, because things like this can precipitate a cardiac event. For example, it’s possible for someone to have a heart attack after prolonged exposure to smoke because the whole body system is being irritated by the smoke and too much stress is placed on the heart.

If someone comes in and is just having more shortness of breath every time they’re outside, and when they’re indoors they’re completely fine, you know you might not need to investigate as extensively as in a case where someone has started off short of breath outside, but is now noticing that it continues when indoors. Those are the patients who need further assessment, like an ECG, chest x-ray or ultrasound.

If you are concerned about the effects of bushfire smoke on your health, please see your doctor or other healthcare professional as soon as possible.

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