More evidence to help convince patients to quit vaping to save their heart

Fraser Olender, the 33‑year‑old chief steward from the reality TV show Below Deck, recently shared a harrowing health scare: He suffered a heart attack triggered by vaping‑related lung injury. ^[]

Olender has since recovered and quit vaping—a decision he’s publicly urged others to make—but the episode is resonating with physicians because it highlights patient behaviors that can dramatically increase heart risks.

Here's what happened

In a candid Instagram post, Olender described being rushed to the hospital with severe chest pain and breathing difficulty.

"The most tragic aspect is that these injuries are entirely preventable," said neurosurgeon @dr.z_neurosurgery in a TikTok video. "The best way to safeguard your health is to avoid starting to vape altogether. For those already vaping, it's crucial to consider quitting; it's never too late to prioritize your well-being."

Patient habits that amplify risk—plus relevant slang, defined

While vaping itself carries inherent dangers, certain patient habits can significantly increase the likelihood of injury:

Rapid succession of hits: Chain-hitting or “doing rounds” without pauses increases pulmonary irritation, systemic absorption, and cardiovascular stress. ^[]

Spilling or skin exposure to e-liquid: Nicotine and THC liquids can be absorbed through the skin. Even small spills on hands or clothing can contribute to systemic toxicity. ^[]

Using unregulated or homemade cartridges: Patients sourcing THC or nicotine liquids from informal channels risk exposure to vitamin E acetate, heavy metals, or other toxic additives, which have been implicated in EVALI outbreaks. ^[]

Mixing multiple substances: Combining nicotine and THC, or vaping flavored liquids alongside concentrates, can exacerbate inflammation and vascular stress. ^[]

Ignoring early warning signs: Many patients downplay cough, shortness of breath, chest tightness, or GI upset. Delaying care can allow inflammation to worsen, increasing risk of cardiac events or hospitalization. ^[]

Clinicians should recognize that EVALI is more than a pulmonary issue. Nicotine and other aerosolized chemicals can ^[]:

• Elevate heart rate and blood pressure, increasing myocardial oxygen demand

• Irritate pulmonary alveoli and vascular endothelium

• Trigger coronary vasospasm or arrhythmias

Practical guidance for patient counseling

Here are actionable talking points for clinicians emphasizing habits that heighten risk:

1. Ask about vaping behaviors, not just frequency. Probe for things like excessively long inhalations, rapid chains of hits, mixing substances or using homemade cartridges, and any skin exposure to e-liquid.

2. Highlight early warning signs. Even mild cough, shortness of breath, chest pain, or nausea should prompt evaluation, especially if multiple risk behaviors are present.

3. Emphasize the dose-risk relationship. Patients may think vaping “a little” is safe—but prolonged, high-volume inhalations or repeated exposures significantly amplify risk.

4. Offer cessation support. Encourage transition to FDA-approved cessation tools rather than switching back to combustible tobacco. ^[]