Why the young die of heart attacks
You may have a smooth unwrinkled skin but do you have that spring in your step that carries you easily up a flight of stairs? You may have six by six eye-sight and a slim figure but do you have the agility and flexibility to jump up and answer the door when you are spread out on the couch? If you don’t, then you may be young in years, but not in your heart. Those with strong, young hearts can do all the above things, and much more. That is why they have a young heart in the first place. ‘The process of blockage of arteries starts at birth, but the speed at which happens depends a great deal on our energy expenditure, besides the genes and diet,’ says Dr. Shantesh Kaushik, cardiothoracic and vascular surgeon. So you may be just thirty years old, but your heart may be much older…
What determines the age of your heart?
Two major aspects determine the age of the heart: the health of your arteries and the health of your heart muscle. If you don’t move, your heart muscles become flabby. And arteries start getting blocked. You could be just 30, in the prime of your life, but your heart could have aged. Such a heart won’t pump sufficient blood and through it, life-giving oxygen. Everything will be fine until one day your heart can’t take the load anymore. Dr. Sudhansu Bhattacharya, cardiac surgeon, compares it to the working of a car. ‘Think of defective blood vessels as a narrow fuel pipe. As long as you are in 1st or 2nd gear it’s alright, but the minute to go into 4th or 5th the car will stall.’ A heart which does not get an adequate supply of blood from the artery stalls too.
The terrifying reality is that as long as we don’t go into fifth gear, we may never know that there is a problem with our heart, not unless we go in for diagnostic tests, as arteries get blocked gradually. Dr. A.V. Ganesh Kumar, Chief Interventional Cardiologist at Hiranandani Hospital says, ‘The heart has to pump more blood during exertion or some emotional upset, and this can cause a heart attack.’ There may be no warning signs before this, not as long as we are cruising along in second gear. ‘If the patient has breathlessness and fatigue, these are signs that it’s already late, that the blockage has progressed to an advanced stage,’ says Dr. Kaushik.
A partically blocked artery can cause trouble
Even more chilling – an artery need not be completely blocked for the heart to give way. ‘It’s a mistake to think that an artery has to be blocked eighty to hundred per cent before a heart attack takes place,’ warns Dr. Kaushik. In fact, younger people who have heart attacks often have partically blocked arteries. Why does a partically blocked artery cause a heart attack?
Dr. Kaushik explains, giving an example of a smoker, though something similar can happen to a non-smoker. A sudden clot formation which causes the artery to give way. ‘A certain percentage of smokers who have heart attacks have only 40% blockage in their arteries,’ he says. The nicotine can cause a clot to form and the artery to rupture.
‘There can be a sudden clot formation and within minutes the blood flow via that artery can stop,’ says Dr. Ganesh Kumar. ‘When this happens, when the artery is only partially blocked to start with, but because of underlying conditions and/or external factors, there is stoppage of blood due to say sudden clot formation, the heart often starts to beat chaotically in reaction, often at 300 beats per minute. You can die in a few minutes,’ he says.
This kind of heart attack is more dangerous than if the blockage happens gradually. Older people usually suffer from a gradual blockage. ‘In that case the heart has time to form natural bypasses,’ explains Dr. Kaushik. Also, older people are more likely to have heart check-ups, stress tests, all of which can warn him of what could happen.
Youngsters can be caught by surprise
So how can youngsters be forewarned? How can they find out if they are at risk from a heart attack? ‘Just assume that your heart is ageing, and body fat is a good indicator,’ advises Dr. Kaushik. A waist of over 32 inches for women, and 36 inches for men is the danger sign. ‘Fat goes on the abdomen only when the arteries and internal organs have had more or less enough,’ he adds. There are other risk factors like family history, diabetes and urban lifestyle factors like smoking, lack of exercise, a fatty diet and a stressful life.
Indians at greater risk
We Indians come a poor second to the world in most of the above factors. In fact they are genetically predisposed to heart disease. ‘Studies show that Indians living abroad suffer from a greater incidence of heart disease than the local population,’ says Dr. Ganesh Kumar. He feels that lack of exercise could be a factor, but our diets too could be a cause. Indians tend to eat a lot of fried food…and in fact consume a fair amount of Trans Fats. Call them Trans Fats or Killer Oils, they are found in products like margarine and vanaspati and are commonly used for frying. They are very dangerous to heart health. And commercial food invariably contains transfats. In India we tend to eat a lot of fried food and this means a higher consumption of trans fats. In fact sweets, chocolates, biscuits and cakes all contain trans fats.
‘There are also indications that our arteries are narrower,’ suggests Dr. Ganesh Kumar, although he acknowledges that research is still being done in this area. The result is plain to see however. There is something in the genetic make-up of Indians that make them prone to heart disease! Dr. Kaushik has a plausible theory. He believes that ‘a shortage of food in the past has genetically programmed Indians to store fat more efficiently than other races.’
Indians also tend to suffer from more incidences of ‘diffused’ heart disease. ‘This means that instead of an artery getting blocked in just one place, it gets blocked in various places, sometimes the whole,’ explains Dr. Ganesh Kumar. This hinders treatment.
The patient who survives an heart attack in time to reach the hospital and gets quick intervention is lucky, because effective treatment needs to be given within 3-6 hours. ‘Otherwise the heart tissue can be damaged permanently,’ says Dr. Ganesh Kumar. Damaged heart tissue means quality of life suffers and a rapid acceleration into old age.
So worry less about that line on your forehead that tells you that 30 is just round the corner, and worry a lot if your body suggests that your heart has touched 40. You might be able to fix that wrinkle, but fixing a heart means procedures like angioplasty, by-pass surgery or even an organ transplant. If you’re lucky.
(An abridged version of this appeared in the Times of India in 2006)
Dr A B Mehta, head of cardiology department, Jaslok has these tips to offer:-
If a person collapses at a public place, like an airport, the first hour is critical if he is suffering from cardiac problems. The maximum damage and number of deaths occur during this time. Help should immediately be given so that the movement of the heart muscles and the flow of blood are brought under control. Blood flow should not be left at minimal or zero levels
The patient should be given immediate first-aid. For cardiac arrest, the first-aid would include administering a defribillator shock along and intubating the patient so that a breathing pathway is created.
Hospital and healthcare phone numbers should be readily available. It is advisable to call up a hospital and find out if it has enough beds instead of simply landing up there and surprising the doctors. That way precious time is saved by contacting a hospital with a vacant bed and driving to it immediately.
Ensure that a cardiac resuscitation trolley is handy. It must contain an intra-venous set, emergency drugs, intubation apparatus and a defribillator.
It is preferable to have either an ICU or ICCU (cardiac care) ambulance available, as continous treatment can then be administered to the patient on the way to the hospital.
A study commissioned by President Kalam in 2006:
A low-fat, high fibre vegetarian diet, an hour of yoga and a long walk reduce heart disease by 12 %.
Yoga reduces angian, chest pain and improves pumping of pure blood into the aorta by 30%
Walking reduces bad cholesterol, production of stress hormones including Epinephrine by 31 %
Other Statistics from the same study:
The prevalence of cornonary artery disease in India has increased from 1% in 1960 to 11% in 2001. It afflicts about 15% of the adult population today.
CAD is 10 times more prevalent amongst Indians in the younger age group (30-40 years) compared with the rest of the world.
Indians have low levels of good cholesterol (HDL)
Heart Risk – Race and Ethnicity:
Caucasians – 22%
Japanese – 30%
Africans – 44%
South Asians – 60%
These statistics show that India is in the middle of a heart disease epidemic.
(A revised version of what was published in the Times of India)
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