While millions of fans will watch the World Cup final with their hearts in their mouths, cardiologists are issuing a warning: that tension can have consequences for some people.Scientific evidence shows that high-intensity matches can increase the risk of heart attacks, arrhythmias and other cardiovascular events among people with heart disease or other risk factors.And it is not just a theory. One of the landmark studies, published in The New England Journal of Medicine after the 2006 World Cup in Germany, found that cardiovascular emergencies increased 2.7-fold during Germany’s matches.Two decades later, research by Bielefeld University, published this year in Scientific Reports, again confirmed that top-level football sends heart rates soaring and stress levels rising, even among fans watching from the sofa.When the body experiences the match as a threatAccording to Spanish cardiologist José Abellán, the body responds to a World Cup final in much the same way as it would to a dangerous situation.”It is an exciting and stressful situation. There is a release of stress hormones that activate us. Surges of cortisol and catecholamines are released, putting us in a state of stress.”That hormonal surge raises blood pressure, speeds up the heart rate and promotes the formation of blood clots. In most people it does not cause any problems, but it can trigger a cardiovascular event in people whose hearts are already weakened.”If my cardiovascular health is optimal or good, nothing is going to happen to me. But there is no doubt that a stressful event, for someone whose cardiovascular health is compromised, can act as that trigger.”Who should take extra careThe greatest risk is for those who have already suffered a heart attack, have stents, suffer from hypertension, diabetes, high cholesterol or a history of arrhythmias.But Dr Abellán insists that the problem is not just the match itself.”What you need to look after is everything around the match. These are days of national jubilation when it is not just the game, but I watch it after a big feast, with junk food, with alcohol or with other drugs.”In fact, the cardiologist recalls that there is even a syndrome known as ‘Holiday Heart’ or ‘party heart syndrome’, linked to arrhythmias after excessive alcohol consumption.It is a disturbance of heart rhythm, usually atrial fibrillation, which can appear after high alcohol intake, something common at weekends, celebrations or major sporting events. If that excess is combined with the emotional stress of a final, the risk can increase, especially in people with a cardiovascular history.When to worryFeeling your heart racing during a final can be normal. What should not be dismissed as nerves is crushing chest pain, sudden shortness of breath, or palpitations that persist even after the excitement has passed.”The third symptom, and I would say the most important, is crushing chest pain. If I suddenly feel as though I have a weight on my chest that spreads to my shoulder, neck or back, and it comes with sweating… well, that is not just nerves,” the doctor says.And the specialist’s advice leaves no room for doubt: “If you have any of these three symptoms, get checked. Get checked.”Enjoy the match, but use your headThe good news is that football, on its own, does not cause heart attacks. The real risk arises when pre-existing cardiovascular disease is combined with intense stress, alcohol, heavy meals, smoking or lack of sleep.That is why Abellán’s advice is simple: enjoy the match for what it is, a sporting spectacle.”People should remember that it is sport, it is a competition… Watch it calmly, with family and friends. And food, alcohol, all of that should be consumed in moderation,” he concludes.We all want to suffer with Spain for 90 minutes. But the best ending, if it comes, will be celebrating a second star… with our hearts intact.