Why seemingly fit people die of cardiac arrest
Experts reveal the hidden risk factors that could contribute to cardiovascular problems in people with no prior history or symptoms
Being seemingly healthy is no insurance against heart disease. Those who appear healthy, and are particular about diet and exercise, seem to be succumbing too. Today, heart attacks are striking at a younger age, making those in their 30s and 40s the new high-risk categories, possibly due to high-pressure lifestyles.
“A person who looks healthy could have been living with some blockages in his/her artery for a long time and this could lead to sudden cardiac arrest at times,” says Rishi Gupta, director, clinical services, at the Asian Institute of Medical Sciences in Faridabad, near Delhi. According to Abc.net.au, cardiac arrest is an electrical malfunction that disrupts your heart’s rhythm so that it stops pumping blood around your body. A heart attack occurs when there’s a blockage in an artery leading to the heart. This reduces the blood flow (and therefore oxygen) to the heart muscle. The heart usually doesn’t stop beating during a heart attack, unless your heart attack leads to cardiac arrest. Ashok Seth, head of cardiology at Fortis Escorts Hospitals, New Delhi, says: “Eight out of 10 times, the cause of a cardiac arrest is a blockage in the heart. For 20% of the cases, there could be a different reason.” He lists these as a clot in the lungs which stops oxygen supply to the heart, sudden bleeding in the brain, wherein all body mechanisms, including the heart, stop functioning, intake of toxic drug in huge amounts that can stop the heart’s functioning abruptly, a viral infection that leads to cardiomyopathy (irregular signal generated from an undetected weak heart muscle), or congenital heart defects that have gone undetected.
According to the Indian Heart Association, 50% of all heart attacks in Indian men occur under the age of 50 and 25% of all heart attacks in Indian men under the age of 40. The figures for women were not immediately available.
“The problem of non-detection of heart-related ailments is a very serious issue,” says Dr Seth. One in four people, even when they have 70% and more blockages, don’t show any symptoms, or report only certain vague ones like fatigue. “Last week, in a single day, three unsuspecting people, all in their 30s, were diagnosed with serious artery blockages of more than 70% at our hospital,” he says. One was there for a routine check, the other two were getting tested before undergoing some other surgery. All of them exercised regularly and not one of them had experienced any heart-related symptoms like fatigue or breathlessness.
The biggest reason behind the growing numbers and decreasing age in heart-related ailments is a low awareness of risk factors and inefficient testing procedures, particularly among the youth. “The symptoms to keep a look out for are shortness of breath, extensive fatigue for which the reason is not clear (in fact, a person’s ability to exercise may also diminish), build-up of fluid in the body somewhere, persistent cough or wheezing, lack of appetite, nausea, confusion, impaired thinking and increased heart rate,” lists Dr Gupta.
He says everyone above the age of 35 should undergo an annual cardiac check-up as Indians are genetically predisposed to develop coronary artery disease early in their lives. “Your treating doctor might be able to recommend some additional tests, which are able to pick up any blockage at an early stage, thus opening an opportunity to prevent death from cardiac arrest,” he adds.
According to Dr Seth, routine exercise tests like TMT (treadmill test) only pick up artery blockages beyond 75%. So to pick these up at a lower level, it is important for those above 40 to go for sophisticated cardiac tests like calcium scoring by CT scan—this holds particularly true for those with a family history, those who travel a lot, are overweight, diabetic, heavy smokers and exercisers. “If in a CT scan of heart arteries calcium is found, then early blockages, even 10-15% blockages, can be identified and specific treatments like aspirin and cholesterol-lowering drugs, etc., can be given so that the damage doesn’t progress and heart attack can be prevented,” he says.
Stress is very often a factor. “While it does not directly cause heart attacks, sudden, severe stress can lead to stress cardiomyopathy (or broken heart syndrome). Therefore, keeping our stress levels in check is as important as keeping our triglyceride and cholesterol numbers tamed,” says Nilesh Gautam, senior interventional cardiologist and head of the department of preventive cardiology and rehabilitation at the Asian Heart Institute in Mumbai. Those who internalize the stress are in greater danger.
Dr Seth says excess unaccustomed exercise can also be dangerous. Sometimes, youngsters get motivated to try out body-building activities like weight-lifting. Too much exercise in a short span can lead to problems. A thorough medical check-up is important before starting any high-intensity exercise as this may trigger rupture of the plaque, leading to a heart attack.
Dr Seth warns that smokers who exercise heavily are highly prone to heart attacks, even with 40-50% blockage. In fact, he says, they have been observing heart attacks even in young, heavy smokers with blockages of as little as 10%. That is because heavy smoking and exercise can lead to the formation of blood clots. So a lower percentage of blockage can also rupture suddenly, with a bad clot forming on top, thus blocking the artery totally and suddenly to 100%, and leading to a heart attack. “It’s almost like something gets stuck in a narrowed water pipe, stopping water flow suddenly,” he explains. “Plus women are more asymptomatic compared to men, so they need to be even more careful,” he adds.
“It is important to educate people that no one can be completely safe from cardiac arrest, and therefore it is important to keep the risk factors (diabetes, obesity, high blood pressure, etc.) down to a minimum, and, most importantly, catch the blockages as soon as possible, so that the right preventive treatments can begin,” says Dr Gupta.