Delhi’s air stayed heavily polluted in October, recording an average Air Quality Index (AQI) of 223 — the second-worst for October in five years. Delhi spent nearly two-thirds of October breathing ‘poor’ air or worse — 11 days in the ‘poor’ category, seven in ‘very poor’ and none in the ‘good’ category. Experts say consistent exposure to high AQI poses a significant threat to heart health by increasing the risk of inflammation, blood clots, and high blood pressure that can lead to heart attacks and strokes.Dr Mukesh Goel, a cardiologist, tells Ankita Upadhyay that even short-term exposure can trigger chest pain, shortness of breath, or palpitations in people with existing heart conditions as the heart is forced to work harder in a polluted environment. Edited excerptsWhat happens to the heart health of a person who is exposed to such severe AQI?When a person is exposed to extremely poor air quality — like an AQI above 400 or 500 — the fine particulate matter (PM2.5 and PM10) enters the lungs and can also travel into the bloodstream. These particles cause inflammation and oxidative stress, which damage the lining of blood vessels, increase blood pressure, and make the blood thicker. Over time, this raises the risk of heart attacks, strokes, arrhythmias, and heart failure. Even short-term exposure can trigger chest pain, shortness of breath, or palpitations in people with existing heart conditions. As the heart is forced to work harder in a polluted environment, it accelerates wear and tear on the cardiovascular system.How are lungs and heart health connected?The lungs and heart work together as one continuous system — what affects one, impacts the other. The lungs oxygenate the blood, and the heart pumps that oxygen-rich blood to the rest of the body. When pollution damages the lungs, it reduces oxygen intake and increases inflammation. The heart then has to pump harder to compensate for the reduced oxygen levels. In addition, the same inflammatory response that affects lung tissue can also harm the blood vessels and heart muscle. Over time, this can contribute to hypertension, coronary artery disease, and other cardiovascular complications. Essentially, polluted air burdens both organs at once, leading to a cycle of declining respiratory and cardiac health.What are the risk factors for someone with pre-existing health conditions in such high AQI?People with pre-existing conditions like asthma, COPD, hypertension, diabetes, or heart disease are especially vulnerable during high pollution periods. Their lungs are already compromised, and their cardiovascular systems are more sensitive to inflammation and reduced oxygen levels. In these individuals, exposure to toxic air can quickly worsen breathlessness, chest tightness, or trigger arrhythmias and angina. Elderly people, children, and those who smoke or live sedentary lifestyles face added risks. For someone with diabetes or obesity, pollution can also worsen insulin resistance and systemic inflammation, further straining the heart. In short, even limited outdoor exposure can lead to severe health events for high-risk individuals.Story continues below this adHow should a person take care of their heart health in high pollution cities?In cities with high pollution, protecting the heart health requires a combination of prevention and lifestyle care. One should track AQI daily and avoid outdoor exercise or commuting during peak pollution hours. Using N95 masks outdoors and air purifiers indoors can significantly reduce exposure. Staying hydrated helps the body flush toxins, and a diet rich in antioxidants — such as fruits, vegetables, nuts, and seeds — helps counteract oxidative damage. People with existing heart or lung conditions should not skip medications and should monitor blood pressure and oxygen saturation more frequently. Regular health check-ups and vaccines for flu or pneumonia can also prevent secondary infections that strain the heart further.What are you seeing in the OPD currently? Do you see a surge in this season every year and does this have anything to do with pollution?Every year, around late October to December, there is a visible surge in patients complaining of breathlessness, chest tightness, palpitations, and fatigue. In cardiology OPDs, there is often a spike in angina and heart failure cases during this period. Many of these episodes are linked to poor air quality combined with cold weather that constricts blood vessels and worsens pollution’s impact on the heart. Even people without diagnosed heart disease often report unusual tiredness or elevated blood pressure. So yes, the seasonal rise in cardiac and respiratory cases has a strong correlation with high pollution levels and stagnant winter air.Story continues below this adWhat do you do to ensure your family members remain safe?On a personal level, keeping family members safe starts with minimising the exposure. We keep windows closed during high AQI days and run air purifiers in main living areas. Outdoor activities and workouts are shifted indoors, and children and older family members are encouraged to wear masks when stepping out. Meals are rich in fruits, leafy greens, and omega-3s to reduce inflammation. Steam inhalation and saline nasal rinses help clear pollutants from the respiratory tract. Most importantly, we regularly monitor indoor AQI and ensure everyone stays hydrated and adheres to any prescribed medication. These small, consistent habits go a long way in protecting heart and lung health during this season.Dr Mukesh Goel is a Senior Consultant, Cardiothoracic and Cardiovascular Surgery, Heart and Lung Transplant Surgery at Indraprastha Apollo Hospitals.