Why young hearts are under attack

Renu Sud Sinha

“There could be several factors behind these cardiac arrests where young persons collapsed during or after intense physical activity,” says Dr Naresh Trehan, noted cardiovascular and cardiothoracic surgeon and chairman, Medanta Heart Institute, Gurugram. “Some heart diseases are congenital. If these go undetected, these can have serious consequences as children get older. One such disease is called hypertrophic cardiomyopathy. The heart muscle gets thick, making it harder for the heart to pump blood. Such persons while doing intense exercise and other such activities can collapse.”

• A 19-year-old boy died of a reported heart failure while dancing at a wedding in Telangana on February 25. Three days earlier, a young cop (24) died of cardiac arrest while working out at a gym in Hyderabad.
• In Meerut, a young man (25) out for a walk with his friends died on the spot after a heart attack.
• In her twenties, Hetal of Bhavnagar died of a heart failure in the middle of her wedding rituals in February last week.
• In yet another case of sudden cardiac arrest, Shyam Yadav (38) of Telangana died while playing badminton.
• Sushmita Sen (47), one of the fittest stars, on the other hand, was fortunate enough to recover from a heart attack recently.

Has Covid been a precipitator for this sudden rise? “Initially, when the virus infected people, doctors thought it was affecting only the lungs. But later autopsies done in Italy found that it was affecting every organ. We then started looking at the heart muscle and found that 20 per cent of those affected in the Delta wave had inflammation inside the heart muscle. Once such inflammation happens, the heart becomes prone to ventricular fibrillation or irregular beats, meaning that the heart is not producing/pumping any blood so people collapse. This seems to be the case as many youngsters are suddenly collapsing while jogging, dancing, playing, etc. We are still finding people who have long Covid after-effects,” says the Padma Shri awardee.

Dr Subhash Chandra, an interventional cardiologist at BLK-Max Super Specialty Hospital, Delhi, is not fully convinced whether Covid had any major role to play in many sudden cardiac deaths. “Many young athletes falling unconscious on the field may have had some congenital anomalies of the heart that affects its electric rhythm. There is a possibility that such patients also had a family history of coronary artery disease (CAD). Covid could be remotely contributing to pro-coagulant activities in these young patients,” adds the specialist of nearly 35 years’ standing in the field.

“In India, we are getting premature blockages in the arteries. It is happening a decade earlier in the 40s’ age group than in the West. The CAD or narrowing or blockage of coronary arteries, usually due to plaque buildup, is happening at 40-45 onwards. A large part of it is genetics and the lifestyle. People are not conscious about their health, they don’t exercise, diet is fat rich. Also, in India, due to our genetics, the incidence of metabolic X syndrome is very high. This syndrome presents itself as a combination of various medical problems — high levels of insulin resistance, low HDL (good cholesterol), high LDL (bad cholesterol) and high percentage of visceral or belly fat,” adds Dr Chandra.

“Besides, these seemingly healthy young people don’t get themselves tested. Almost 50 per cent of them, even gym goers, if tested or put to heavy exercise or any cardiac test, would be unfit or called as heart unhealthy,” adds the interventional cardiologist.

“Stress levels are high and the young have erratic lifestyles. There is misuse of tobacco, alcohol, bodybuilding supplements. Sleep cycles are erratic due to clubbing and late-night partying, perhaps. Environment pollution also contributes its bit. If you club all these with family history, the propensity to plaque building increases,” says Dr Chandra.

Hypertension and diabetes are also on the rise among those in their thirties as food habits have changed and people are less active. However, sudden intense erratic exercise/work-out after a sedentary lifestyle can cause plaque rupture and clots in those with even minuscule artery blockage and can cause sudden death, says Dr Manoj Kumar Rohit, professor, department of cardiology, PGI, Chandigarh.

“Post-Covid, there’s an increase in body’s tendency to form a clot. There have been clot-related heart failure deaths at PGI. We have also had cases of heart attacks in patients as young as 21 years, but we can’t say that was because of Covid,” adds Dr Rohit.

It is ironic that despite awareness, heart attacks are rising and patient age getting younger. Because people rarely listen, rues Dr Trehan. “When we tell them to stop eating fried food, smoking, drinking, you think the world is going to stop? No. They hear it and ignore,” he adds.

So, how do we check this alarming trend? “The only preventive option is inculcating heart-healthy habits from the beginning. Having a healthy lifestyle, eating a balanced diet, regularly exercising, avoiding smoking, binge drinking, junk food, etc. Early routine screening for high BP, lipid profile, sugar testing, etc, for youngsters is highly recommended. Those with a family history or above 40 can add ECG, stress echo, to these tests,” recommends Dr Chandra.

Dr Trehan goes a step ahead. “Instead of preventive health, it is time we move to predictive health/medicine. Under this model, we can identify those at risk, particularly those with a family history of heart disease, BP, sugar, high cholesterol, etc. Complete screening before 25 and even gene sequencing is recommended in such cases. Once they understand the danger, they pay attention and modify habits.”

Dr Chandra suggests more awareness campaigns and community-based teaching of cardiopulmonary resuscitation (CPR) that can help save many lives.

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