Sudden cardiac deaths among young people or the seemingly healthy may be making news lately but cardiologist Dr KK Talwar, who has pioneered some of the best ways of tracking cardiac arrhythmia or irregular beats and led the heart failure programme at AIIMS, has consistently found more stressors among young people over the years. “News cycles may come and go but the fact is genetically, as South Asians, we are more prone to heart attacks as compared to Caucasians and tend to suffer cardiac problems about 10 years earlier. The number of younger patients is growing,” says the Chairman of the Cardiology department at PSRI, Delhi.
A LOT OF YOUNG INDIANS REMAIN UNDIAGNOSED AND CONTINUE THEIR POOR LIFESTYLE
“I have often had young people come up to me, saying they are healthy and fit, burn up enough calories and that their immediate blood test reports have not shown any cause for worry. What they do not know is that apart from plaque bursts, that are mostly being talked about these days, there could be silent underlying heart conditions that have not been troublesome but manifest in a moment of strenuous exercise. Their seemingly normal routine blood reports encourage them to continue with their lifestyle. What they do not realise is their unhealthy food discipline (most people are ordering out rather than eating in thanks to food aggregators) smoking and binge-drinking on weekend nightouts are triggers. Over the last decade or so, the age of alcohol consumption has come down. So alcoholism is now emerging as a major problem among younger people. Without diagnosis of their underlying heart condition, these act as accelerators and stress the heart out further. So even if they exercise regularly, the lifestyle disorder is a major risk factor because it is overlaying the stress caused by exercise,” says Dr Talwar.
As Dr T S Kler, Chairman, Fortis heart and Vascular Institute, Fortis, Gurugram, says, “A lot of Indians look healthy but may not be medically healthy, given their underlying cardiac disease.”
WHAT ARE SILENT TRIGGERS?
“There may be genetic arrhythmic potential in the family, a spontaneous genetic variation, a thickened heart muscle (hypertrophic cardiomyopathy) and rhythmic disorders, which may not show up all the time till you get tested specifically for them. For example, the most common cause of sudden cardiac death in young people is a genetic condition that causes the heart muscle to grow too thick.This makes it hard for the heart to pump blood and can accelerate heartbeats during a fast-paced exercise. Sudden cardiac death is often caused by faulty electrical signalling in the heart. A very fast heartbeat causes the lower heart chambers (ventricles) to quiver instead of pumping blood. This irregular heart rhythm is called ventricular fibrillation and can build stress during heavy exercises. Long QT syndrome is a heart rhythm condition that can cause fast, chaotic heartbeats. It has often been linked to unexplained fainting and sudden death in young people,” says Dr Talwar. He also warns about the arbitrary use of protein and muscle-enhancing supplements by youngsters at gym, fearing they could be laden with steroids and could be interfering with heart functioning, particularly during exercises.
Sudden cardiac arrest leads to sudden death if the patient is not revived within the first six minutes of the onset of an attack. The human heart beats around 60-100 beats per minute and any fluctuation in this rate, either too slow (Bradycardia) or too fast (Tachycardia) is known as cardiac arrhythmia. So a sudden increase in heart rate can be fatal.
HOW DO WE PREVENT CARDIAC EPISODES, WHEN DO I GET TESTED?
Given the risk profile of young Indians, Dr Talwar recommends the following tests.
1) As soon as one hits 30, metabolic issues show up among most Indians. So do an annual screening of lipid profile, sugar, liver and kidney function as well as a regular ECG.
2) For those intending to take up gym activities, consult a doctor before the trainer. You must do a prophylactic check-up and cardiac evaluation for silent problems. Also tone down strenuous exercises, do not push your limits.
3) Do not have protein supplements without medical evaluation of what they are and can do to your body.
4) All Indians beyond the age of 40 must do a stress-test every year to see that no underlying disease is causing stress to the heart. This can pick up abnormality even if an echo cardiogram or blood test misses it.
5) Do not fear the Treadmill Test (TMT) as it is done under controlled circumstances and will help you identify the problem that ups your heart stress.
Dr Kler suggests ticking off two more boxes:
6) Every Indian above 20 years must get a blood sugar, ECG, lipid profile and an exercise stress test every year.
7) Annual exercise test for smokers, diabetics, obese and those at risk.
8) Have a cardiac check-up before signing up for running exercises or marathons.