Sonali Phogat died of a heart attack on Tuesday (File Photo: Instagram)Forty-one-year-old Sonali Phogat, a well-loved Tik Tok star, Big Boss contestant and BJP leader, complained of uneasiness and was even rushed to hospital. But she could not be revived from a heart attack. This adds to the growing list of young people, particularly those known to maintain a fit and curated lifestyle, who are succumbing to either a heart attack or a cardiac arrest. What explains this paradox? Does that mean, every Indian should get a routine heart check-up done early?
Why sudden attacks?
Explaining these sudden episodes, cardiologist and President, Public Health Foundation of India, Dr K Srinath Reddy says, “Heart attacks are caused when there is a sudden blockage of blood supply in one of the coronary arteries that supplies blood to the heart muscle. Chronic obstruction of 70 per cent or more in a coronary artery produces angina or chest pain on exertion, since available blood supply does not meet the increased oxygen demand of the person who is either exercising or into trying physical action. But a heart attack (acute myocardial infarction) can occur when soft plaques that form in the coronary arteries rupture and cause a large clot to form. This may come without any prior warning symptoms. Even plaques of 30 per cent can rupture and set up the formation of a large obstructive clot.”
A common misconception is that a blockage results from deposits of fat (lipids, cholesterol) and cells on the artery wall – similar to blocks in household plumbing. This is incorrect, according to Dr Tushar Gore, managing director, Resonance Laboratories. “The blockages are a result of cells and cholesterol particles breaking through the barrier of endothelial cells and infiltrating the lining of the artery. As a result, there is a bump in the artery wall like a pimple. This is known as plaque or stenosis. The plaque need not bulge into the artery but could protrude outwards as well. The sudden attacks are caused by smaller blockages. These are ‘clinically silent’ and do not restrict blood flow (and, therefore, cause no symptoms) but cause problems if they break apart. This is the second factor. Break-up and disruption of such blockages inside the coronary artery initiates blood clotting mechanisms to ‘repair’ the injury from the plaque disruption,” he says.
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Young Indians remain undiagnosed. Should heart screening be mandatory now?
So, three things need to be detected: Presence of small plaque, likelihood of plaque disruption (known as vulnerability), and the clotting intensity of blood. Reliable non-invasive diagnostic tests are available only for the first – detection of small plaque. Nevertheless, testing (even if it were to be available) for each of these will not offer a guaranteed window into the future because all the three factors change depending on lifestyle and environmental conditions.
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. “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.
“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, 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.
Even 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.”
Why we need to test
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.
“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. Do not have protein supplements without medical evaluation of what they are and can do to your body. 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 echocardiogram or blood test misses it,” says Dr Talwar.
How lifestyle and proper sleep matter
“Plaques form in the coronary arteries due to injury caused to the blood vessel lining, by factors causing inflammation. High blood pressure, smoking, diabetes, unhealthy diets, stress, inadequate sleep or infection do that. Fat in the circulating blood then deposits at the site of injury to grow the plaque. Each of those chronic causes of inflammation can also acutely precipitate a plaque rupture leading to a heart attack, if there is a sudden or severe rise in one or more of those factors. Vigorous exercise too can cause plaque rupture or trigger electrical disturbances in the heart leading to cardiac arrest. If one is on an intense daily engagement cycle, there’s no option but to let the body rest and get a good night’s sleep in between,” adds Dr Reddy.
Need to find silent triggers in our genetic history
“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.