We sing about how Christmas brings “tidings of comfort and joy,” but the holiday also brings something not so “merry and bright.”

In fact, heart attacks and strokes surge during the last two weeks of December, according to the American Heart Association, with Dec. 25 being the day of the year with the highest number of cardiac events.

One side of the crisis comes from the weather, because “cold temperatures cause blood vessels to constrict, which raises blood pressure and makes the heart work harder to pump blood,” according to Dr. Patricia Vassallo, associate professor of cardiology at Northwestern University.

The typical stressors we all experience during this season also play a role.

“For some, the season is joyous, but for others, it can be upsetting or stressful, grieving lost loved ones, managing big holiday gatherings or dealing with in-laws,” Vassallo said in a news release. “Stress around the holidays and disrupted routines, like less sleep, more alcohol and skipped medications, add to the strain.”

However, there are precautions you can take to help your heart make it through this chaotic season intact.

Come inside often

During the colder months, it can be tempting to brave the weather longer than your body can take it. However, spending long periods in the cold can have detrimental effects on your heart health.

Instead, Vassallo recommends giving yourself frequent breaks to warm up.

Dress for the weather

There are so many elements that go into a warm outfit and putting them all on can be tedious.

Although it can be annoying, Vassallo recommends wearing your hats, gloves and heavy socks whenever you will be in the cold for an extended amount of time.

Avoid excess alcohol

It is no secret the holiday season comes with a spike in alcohol consumption. However, it can have dangerous effects, shielding you from how cold you really are.

Vassallo recommends refraining from large amounts of alcohol, especially when you will be outside for long periods of time.

Do not overexert yourself

The shift in temperature also comes with a shift in outdoor maintenance, particularly in areas where snow needs to be shoveled often.

Vassallo recommends not doing it for any substantial amount of time and asking your doctor if it is safe, depending on your health.

Get help if needed

If you have any new symptoms of a heart condition, report it to a doctor immediately, even if it is Christmas.

Vassallo warns that people should go to a doctor if they feel severe chest pain, nausea, cold sweat, sudden fatigue or the sensation of heartburn. They should also report any arm and leg weakness, face dropping or speech difficulty, as those can be signs of a stroke.

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