For rabid fans of the New York Giants and New England Patriots, this Sunday's Super Bowl won't be just a game. It may be a health hazard.
Heart attacks and other cardiac emergencies doubled in Munich, Germany, when that nation's soccer team played in World Cup matches, a new study reports.
While history suggests European soccer fans can get a bit more worked up than the average American football fan, doctors think there are some valid warnings to be shared.
"I know a little bit about the Super Bowl," study author Dr. Gerhard Steinbeck of Ludwig Maximilians University in Munich said in a telephone interview. "It's reasonable to think that something quite similar might happen."
He and his colleagues present their results in Thursday's New England Journal of Medicine. They blamed emotional stress for the heart problems, but they note that lack of sleep, overeating, wolfing down junk food, boozing and smoking might have played a role too.
The suggestion is that high-stakes sports showdowns, like the Super Bowl this weekend, can cause the same stress as earthquakes and hurricanes.
"If it's coming down to the line and it's a field goal, all you see is sweat going down my face," Giants fan Eddie Lopez told CBS News correspondent Nancy Cordes. "It's like I'm the one kicking the field goal."
His wife agreed.
"Yes, yes, he gets all stressed out and yells and acts like an animal," she said.
The new work "confirms something people have been highly skeptical about ... that soccer (would) produce that kind of emotional investment that might trigger a heart attack," said psychologist Douglas Carroll of the University of Birmingham in England.
"People who are not interested in sport find it very difficult to comprehend this," said Carroll, who in 2002 reported a link between World Cup soccer and heart attacks in England.
The new paper included heart attacks, cardiac arrests, episodes of irregular heartbeat and activations of automatic implanted defibrillators. The researchers noted the number of cases reported in the greater Munich area during World Cup competition in Germany in the summer of 2006. They compared that to the totals for similar periods in 2003 and 2005, and for several weeks before and after the tournament.
In all, the study included 4,279 patients. Analysis showed that on the seven days when the German team played, the overall number of cardiac emergencies was more than double the norm. For men, it tripled.
Louis Tiechholz knows the symptoms well. He's a Giants fan - and a cardiologist, Cordes reports.
"If there's a sudden death overtime, I think in some individuals who are really at the borderline, that could tip 'em over in terms of stress," he said.
The effect was strongest in people with known heart disease. So on Super Bowl Sunday, such people and others with known risks for heart disease - like high blood pressure or diabetes - should take extra care of themselves, said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital.
She said that means:
People with known heart conditions should also keep their nitroglycerin and aspirin handy, she said.
And if heart symptoms appear, she said, call emergency services right away. "Don't just chew that aspirin and think it'll go away."
In fact, research by Dr. David Jerrard, an associate professor of emergency medicine at the University of Maryland, indicates that some men do put off seeking emergency treatment if they're watching a game.
On a typical Super Bowl Sunday, "the number of patients waiting to be seen dries up dramatically," Jerrard said. But delaying that visit to stick with a sportscast is a bad idea, especially for people with a history of heart trouble, he says.
"Much of the chest pain or upper abdominal pain that people might be experiencing is mostly likely related to the food they're eating, the alcohol they're ingesting," he said. "But of course, you never know."