Waking up on the wrong side of the bed is the least of your worries.

While major cardiovascular events can occur at any time of day and often at unexpected times, scientists are aware of some potential patterns, thanks to the body’s circadian rhythm or internal biological clock.

In the morning, the body prepares itself for the coming day’s activities. Per EMC Healthcare, a number of physiological changes occur to help wake up the body and get it moving — and also happen to put strain on the heart. 

When you wake up, your body experiences spikes in stress hormones — as well as a handful of things that affect bloodflow, like the activation of the sympathetic nervous system, slight dehydration from the night before and slow fibrinolytic activity, or the process that helps keep blood from clotting.

All of these things put you more at cardiovascular disease — the number one killer in the US —  especially if other risk factors are already at play.

These are the four health conditions that can be deadliest in the morning.

Heart attack

Smokers and people with hypertension, high cholesterol, family history of heart disease, chronic stress, poor sleep habits or a history of previous heart disease are especially vulnerable to a heart attack regardless of the time of day, but might experience extra cardiac distress in the morning.

Cardiovascular events are “more common in winter, at the beginning of each month, on Mondays (in working people) and during the early morning hours of each day,” Dr. William J. Elliott wrote in the American Journal of Hypertension.

Between 6 a.m. and noon, there’s a 40% higher risk of heart attack, and a 29% increased risk of dying from it.

Stroke

There’s an even higher risk of stroke in the hours after waking up: a staggering 49%, according to Dr. Elliott.

Many of the same reasons and risk factors that apply for morning heart attacks are true for stroke, too, which is the fifth leading cause of death in the US.

An analysis by the American Heart Association found that both ischemic and hemorrhagic stroke — stroke caused by a blocked artery or clot and stroke caused by a hemorrhaging or leaking artery, respectively — were significantly more likely to occur in the morning hours, contradicting previous studies that found strokes were more likely to occur during sleep.

Ruptured abdominal aortic aneurysm

A ruptured abdominal aortic aneurysm (RAAA) happens when the body’s main artery — which runs from the base of the diaphragm to the abdomen and supplies the lower body with blood — balloons out and weakens.

Studies show that RAAA also has a strong circadian connection, as it’s closely linked to systolic blood pressure and hypertension. 

Drugs that can help control heart rate and early morning blood pressure spikes may help manage RAAA.

Pulmonary embolism

A pulmonary embolism occurs when a blood clot blocks a major artery in the lungs, and can be fatal if not treated immediately.

Studies show fatal pulmonary embolisms also have a morning pattern for similar reasons as the other conditions listed above, but factors like sex and age might affect timing and severity.

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