As the World Cup kicks off, cardiologists are warning fans with pre-existing heart conditions that the emotional intensity of matches can put a serious strain on the cardiovascular system.

“Intense emotions, whether positive or negative, can act as ‘precipitating risk factors’ for cardiovascular events such as heart attack,” cardiologist and European Heart Network board member Paola Santalucia told Euronews Health.

Strong emotional excitement, like feeling fervent about your national team making it to the next round or a nail-bitingly intense penalty shootout, could be dangerous for people with pre-existing heart disease, Santalucia said.

Those affected by other risk factors such as hypertension, obesity or smoking should also exercise caution during emotionally charged matches, she added.

Strong emotional excitement can increase heart rate, blood pressure and stress hormones such as cortisol. In some cases the heart can race as fast as 150 beats per minute — a level comparable to sprinting.