When New York Skies Turn Orange: What Wildfire Smoke Is Doing to Your Heart
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Most New Yorkers still remember June 2023. And here we go again, our skies are the color of a bad sunset at noon, the air smells like a campfire that won’t go out, and everyone from Central Park runners to office workers on the FDR start asking the same question: is this actually dangerous, or does it just look terrifying?
The answer, from a cardiology standpoint, is that yes, it is actually dangerous, particularly for people with heart disease, high blood pressure, diabetes, or a history of stroke. And with smoke from Canadian and Minnesota wildfires blowing across the Great Lakes and into the Northeast again, this is a good time to talk about what wildfire smoke does to your cardiovascular system and what you can do to protect it.
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What Is in the Smoke?
Wildfire smoke is a chemical soup. It contains carbon monoxide, volatile organic compounds, nitrogen oxides, and hundreds of other combustion byproducts. The component that gets the most attention, and deserves it, is called fine particulate matter, or PM2.5.
PM2.5 particles are 2.5 micrometers across or smaller. That is roughly 30 times narrower than a human hair. Because they are so small, they slip past the normal filters in your nose and throat, travel deep into the tiny air sacs of your lungs and can pass directly into your bloodstream. Once they are in circulation, they can reach your coronary arteries, your brain, and virtually every organ in your body.
This is why cardiologists care about wildfire smoke as much as pulmonologists do. Your lungs feel it first, but your heart is often the organ that pays the biggest price.
What Does Wildfire Smoke Do to Your Cardiovascular System?
The American Heart Association has now issued formal statements confirming that particulate air pollution, including PM2.5 from wildfires, has a causal relationship with cardiovascular illness and death. The biology is well characterized.
When PM2.5 lodges in your lungs and enters your bloodstream, it triggers a cascade of oxidative stress and inflammation. Your blood becomes stickier and more prone to clotting. The delicate layer of cells lining your blood vessels, called the endothelium, becomes irritated and less able to relax normally. Your autonomic nervous system tilts toward the sympathetic side, which raises heart rate and blood pressure. In someone with pre-existing coronary plaque, the combination of a stickier bloodstream, higher pressure, and inflamed vessel walls can be enough to tip a stable plaque into a heart attack.
This is not theoretical. A large study in California found a measurable increase in out-of-hospital cardiac arrests on days with high wildfire smoke, with the biggest jumps in people over 65 and those with chronic illness. Emergency department visits for heart attacks, strokes, arrhythmias, and heart failure all rise during and immediately after wildfire smoke events. Long-term exposure to elevated PM2.5, even at levels many cities consider routine, is linked with higher rates of coronary artery disease, heart failure, and cardiovascular death. The study is important because California continually experiences wildfires, which help accumulate volumes of real data.
Wildfire smoke is not simply an outdoor version of city smog. Because it burns hotter and includes chemicals from buildings, vehicles, and industrial materials, the mixture can be more toxic, gram-for-gram, than the ambient pollution urban patients breathe on a normal day.
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Who Should Be Most Careful?
Anyone with a heart or lung condition should treat a smoky day the way they would treat a dangerous winter storm. Stay in, plan around it, and take it seriously. The groups I worry about most in clinic are:
Patients with coronary artery disease, prior heart attack, or coronary stents.
Patients with heart failure, whose lungs and hearts are already working overtime.
Patients with atrial fibrillation or other arrhythmias, since PM2.5 can trigger episodes.
Anyone with high blood pressure, especially if it is not fully controlled.
People with diabetes, since PM2.5 worsens insulin resistance and vascular inflammation.
Older adults, pregnant women, infants, and anyone with asthma or COPD.
Even healthy adults can develop symptoms during heavy smoke events, and healthy children are especially sensitive because they breathe more air per pound of body weight than adults.
How Can You Check the Air in Real Time?
You do not have to guess. The Environmental Protection Agency runs a free tool at AirNow.gov and its wildfire-specific version at fire.airnow.gov. Type in your ZIP code and you will see a color-coded Air Quality Index, or AQI, for your neighborhood. This is the link for all of NYC, which allows you to zoom in/out and navigate the map.
The colors are simple: green and yellow are generally fine, orange means sensitive groups should limit outdoor exertion, red means everyone should limit it, and purple or maroon means stay inside.
I recommend that patients with heart disease check AirNow.gov often, and perhaps even download a free AQI app on their phone. Checking before a morning run or a walk takes about five seconds and can save a trip to the emergency room.
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What Can You Do to Protect Yourself?
When the AQI climbs, the goal is straightforward: put as many barriers as possible between the smoke and your bloodstream.
Stay indoors as much as you reasonably can. This is the single most effective step for most people.
Close your windows. In summer this is not fun, but it is essential during smoke events. Run air conditioning on the recirculate setting rather than pulling in outdoor air.
Upgrade your air filter. A HEPA air purifier in your bedroom or living room can meaningfully reduce indoor PM2.5. If you have central air, switch to a MERV 13 or higher filter during smoke season. Both are widely available.
Wear a real mask outdoors. Cloth masks and surgical masks do very little against PM2.5. A well-fitted N95 or KN95 respirator, the same style many of us got used to during COVID, is what filters these particles.
Skip the outdoor workout on smoky days. Exercise dramatically increases how much air you move through your lungs, which increases your dose of PM2.5. Move it indoors, take a rest day, or use the building gym.
Do not add to indoor air pollution. Avoid burning candles, using gas stoves without ventilation, or vacuuming without a HEPA filter, all of which raise indoor particulate levels.
Take your medications on schedule. During air quality events is not the time to skip a dose of your blood pressure or heart failure medication. If anything, this is when they are protecting you most.
When Should You Call Your Doctor?
Chest pain or pressure, new shortness of breath, palpitations, lightheadedness, or unusual fatigue during or after a heavy smoke event are not to be waited out. Call us and we can schedule an appointment. However, if symptoms are severe or feel like a heart attack, call 911 immediately. Wildfire smoke will not create a problem out of nothing, but it can absolutely accelerate one that was already brewing.
Wildfire smoke used to be a Western problem. It is now a New York problem, at least a few days a year, and it looks like it will keep visiting. If you have any cardiovascular risk factors, treat smoky days the way you would treat an ice storm: adjust your plans, protect your indoor air, wear a proper mask when you have to go out, and check in with your doctor if anything feels off. Your heart will thank you.
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Sources
Protecting Cardiovascular Health From Wildfire Smoke (Circulation, American Heart Association)
American Heart Association Scientific Statement: Air Pollution and Cardiovascular Disease
Wildfire Smoke and Your Health (Centers for Disease Control and Prevention)
Wildfires and Smoke: Tips for Protecting Your Health (Houston Methodist)
EPA Guide: Wildfire Smoke, A Guide for Public Health Officials
