Heart attacks are on the rise and targeting the young

Smoking, high cholesterol & BP, obesity, stress and sedentary life are the culprits


Bangalore: Think you are too young to have a heart attack? Think again. With smoking, long & stressful working hours, lack of exercise and junk food being a common feature in young professionals today, incidence of heart disease and heart attacks in the 20s and 30s are on the rise. Some doctors say they’re even seeing patients as young as 17!


Read on as we quiz cardiologists on the symptoms, risk factors and emergency measures you can take to minimize the damage to your heart.


What is a heart attack?


Heart attack or myocardial infarction literally means the ‘death of the heart muscle’. It occurs when blood and oxygen supply is cut off to the heart muscle. KB Prasad, Senior Consultant Cardiologist, Apollo Hospitals, explains, “The relationship between the two is like that of your car and petrol - if your car doesn't have petrol, it simply won’t run.”


Heart is supplied with oxygenated blood and nutrients through two large, branching coronary arteries or vessels, one on the left and the other on the right. Through a period of time, in some people, there is a build up of plaque (a sticky substance that consists of cholesterol, white blood cells and fat) on the arterial walls of the heart.


This plaque build-up in the arteries is called Atherosclerosis. When this plaque gets disturbed, it breaks and lodges itself in various places in the heart. Perceiving this as a threat, the red blood cells and white blood cells attach themselves to the plaque just as they would in case of a wound or injury in order to heal and repair it.


This results in a blood clot – if the clot is very big it can completely block the artery. When this happens, the part of the heart served by the blood vessel is deprived of oxygen – this condition is called Cardiac Ischemia. If this is left untreated, the oxygen-starved region starts to die. This is called a heart attack or Myocardial Infarction.


Why is heart attack dangerous?


Heart attacks can be fatal. Doctors say the number one cause of death in heart attacks is the wait-and-watch attitude adopted by many people. Dr. Ranganath Nayak, Senior Consultant Cardiologist at Vikram Hospital, says the first few hours during and after a heart attack is called the ‘golden hour' because this is the time the patient can either choose to ignore the symptoms or seek medical attention.


“The longer the period that elapses without treatment, greater the damage. The part of the heart muscle that dies during a heart attack cannot grow back or be repaired, which is why people who have already suffered from a heart attack are even more at risk, as their heart is weaker,” he adds. 


Dr. Prasad advices patients suffering from a heart attack to immediately get someone to take them to a hospital equipped to handle cardiac emergencies and to avoid small nursing homes. "We have a phrase in my profession that goes ‘time is muscle'," he adds by way of explanation.


How does one recognize a heart attack?


Most of us associate heart attack with a person clutching his chest – after all, this is how heart attack is depicted in movies and television serials. But heart attack isn’t just about chest pain – the truth is that a heart attack can have many symptoms and can occur over a period of time or in a matter of minutes.


Dr. Yogesh Kumar Kothari, Senior Interventional Cardiologist & Electro Physiologist at Apollo Hospitals, says heart attack symptoms can be split into typical and atypical.


Typical symptoms (these are more common):

  • Tightness and pain in the chest
  • Sweating of the palms
  • Pain travelling to the back and in the stomach


Atypical symptoms

  • Shortness of breath and difficulty breathing
  • Coupled with burning sensations in the stomach & giddiness
  • Pain in the back of the left arm or in the neck and jaw


Silent Heart Attack (10% probability)

  • No symptoms


"People having a heart attack usually experience an instant and intolerable discomfort, where they have to make an effort to stand up," notes Dr. Prasad, adding that women may experience slightly different symptoms, with nausea and giddiness being the top indicators.


What should you do in a heart attack?


Seek immediate medical help. “Most patients mistake a heart attack for gas and ignore it, but the truth is that if you rush the patient to hospital, there is a 90-95 per cent chance of survival thanks to the kind of technology we have today," says Dr. Prasad.


Dr. Kothari suggests taking medicines like Sorbitrate or Aspirin while waiting for help to arrive. Keep it under the patient’s tongue and ask him or her to chew – if consumed with water, the tablets take longer to react.


If a patient collapses, give him CPR (cardio-pulmonary resuscitation). Ask your doctor for CPR basics – you can also learn more about CPR here.


How are heart attacks treated?


Treatment depends on the amount of blockage. With timely treatment (an hour after the symptoms surface), the damage to the heart can be limited. When a patient arrives at the hospital, an electrocardiograph or ECG is done and the patient is usually prescribed medication to unclog his blood vessels. Thereafter, other treatments commence.


Dr. Prasad explains, “There are three blood vessels, two on the left side and one on the right. If two of them are blocked, we perform angioplasty. If three are blocked, we perform bypass surgery. There are also some patients who arrive in such a severe condition that no surgeries can be performed. We give them medication and advice rest.” Like a bone fracture, it is imperative that patients take four weeks’ rest to recover.


Why heart attack is no more an old-age problem?


It’s a widely believed that heart attack occurs in older people. This is not true. Yes, the risk of a heart attack goes up in men over 45 years and in post-menopausal women, but it can strike anytime regardless of age.


In fact, Dr. Prasad says heart attacks are getting more and more common and we are seeing incidents of this condition rise in the younger generation. “Every month, I see 5 to 6 patients below the age of 40,” he adds. Dr. Kothari concurs and says it is not unusual these days to see people in their 20s or 30s having a heart attack. “I’ve even had patients as young as 17!” he exclaims.


However, Dr. Nayak offers another explanation. "People have a longer lifespan today. The average age in the 1940s was only 32; today it is 67 years. As people live longer, we see more people suffering heart attacks. And, it is just more dramatic when a young person gets it," he quips. Dr. Nayak says he treats only about 10 patients a year who are between the ages of 30 and 40. His largest patient group comprises those between the ages of 60 and 80.


Interestingly, there’s no difference in the survival rates between elderly patients and the younger population. Heart attack is a deadly killer – it kills with impunity regardless of age or sex.


Who is at high risk for a heart attack?


Doctors say smoking is the number one cause of heart attack. Why? Because smoking increases the risk of blood clots forming in your arteries – so the more you smoke, the greater your risk for a heart attack. The next big contributor is your genetic make-up – if you have a family history of heart disease, you are at greater risk.


Having diabetes also puts you at increased risk - high blood sugar levels can damage your blood vessels and lead to a range of complications like heart attack, stroke, angina, etc.  


Hypertension or high blood pressure is also dangerous because it makes the heart work much too hard. Blood pressure is the force exerted on the artery walls by the pumping of blood. High blood pressure implies your blood is pumping with more force than normal – this added stress can clog up your arteries and damage the heart.


High levels of cholesterol cause fatty deposits to build up in the blood vessels, making it harder for blood to flow, thereby upping the risk of a heart attack. Obesity (i.e. having a body mass index or BMI of 30 or higher) also puts you in the high-risk category – as do stress, junk food, sedentary lifestyle and over-consumption of alcohol.


Dr. Nayak lists five critical factors that are responsible for heart attacks – family history, diabetes, blood pressure, high cholesterol and smoking. "Patients may not be able to control the first or second factor, but the other three are definitely in their hands," he says. Dr. Prasad advises that after one turns 30, particularly if there’s a family history of heart trouble, it’s good to get regular check-ups done.


Is heart attack avoidable?


Regular exercise, eating healthy, taking your prescribed heart medication and going for regular check-ups, especially to test cholesterol and lipid levels, are what the doctors prescribe for a healthy heart. As Dr. Nayak says, “You can't avoid a heart attack, but you can keep yourself informed about the symptoms and take measures in case of an emergency."


Dr. Kothari, who has created a Pocket Pill app. on Android to help improve your heart's health, encourages post-heart attack patients to report any special symptoms to their doctor, to prevent further complications.


Doctors insist that life can go on as usual after a person suffers a heart attack. In fact, Dr. Kothari says a person can do everything as before, so long as he leads a healthy life. So, one can look at heart attack as a wake up call – it pushes you towards a healthy lifestyle.


- Poonam Vaidya (Saralhealth Bureau)


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