Know more about young heart attacks and death

Dr. Suresh Davis

Heart attack is often thought as a disease of the elderly population and many times neglected by youngsters. But we often encounter young patients in our emergency departments and CCU. Since most of these youngsters being the only bread winners of their family and many of them are in the beginning of their carrier and family life, young heart attacks and death can be quite devastating to the family and to the community.  We will discuss in brief the warning signs of heart attack, the common cause of young heart attacks and how we can overcome this problem to a certain extent.

What are the warning signs of Heart Attack?

Chest discomfort: May I stress the point that it is not just a pain but more of chest tightness, uneasiness, heaviness, an inability to express the exact nature of pain. It sometimes mimics a gastric type of pain, with upper abdominal discomfort , belching , vomiting  .It may present even as a Jaw pain ,  neck pain or back pain   and sometimes pain extending from chest to the left shoulder and arm . One unique feature of this pain is that it usually lasts more than a few minutes and may even hours. It may be the worst pain that you have ever experienced in your life.

Symptoms other than chest pain:    Some patient’s especially diabetic patients may not experience the typical pain instead they may feel unusual shortness of breath, palpitation, giddiness, or tiredness. These are called angina equivalents. Don’t neglect these symptoms as it may be the only sign of impending heart attack.

Common Causes of young Heart attack?

One of the most common causes of young heart attacks is early onset of diabetes mellitus which often gets undetected. India is now the diabetic capital of the world and we Indians are genetically more prone to diabetes. Our sedentary lifestyle, visceral obesity and craving for western food and beverages have increased the incidence of insulin resistance ultimately leading to diabetes and heart disease .Diabetes is often sarcastically called as rich man’s disease. Maybe our purchasing power over the years have increased which has given way to young diabetes and heart disease.

Smoking  and tobacco use are  not only a risk factor for cancer but also a very important risk factor for young heart attacks .When we do coronary angiograms of  smokers  we  hardly see any tight blocks , instead we see minor ruptured plaques  and lots of blood  clot. This is a clear-cut evidence  that smoking causes blood vessel injury , activates the blood clotting factors and impairs healing.  Drug addicts are prone coronary spasm, heart attack and sudden cardiac death.

Family history of coronary artery disease and sudden cardiac death is not to be neglected. This is one of the risk factor we commonly see in young patients with heart disease and heart attacks.  A positive family history for coronary artery disease is defined as evidence of coronary artery disease in a parent or sibling before 55 years of age in men and before 65 years in women, such as a history of myocardial infarction, coronary artery bypass surgery, angina pectoris, or a positive Tread Mill Test diagnostic of ischemia. These may be due to genetic predisposition in these families to heart disease or due to certain lipid disorders running in families.

Other cardiac risk factors like high blood pressures, high cholesterol levels, sedentary lifestyle’s all contribute to young heart attacks.

Prevention

Prevention is better than cure is the good old saying and it holds very true as far as young heart attacks are concerned .Let’s start with exercise. 45 minutes of aerobic exercise, let it be walking, running or sports, at least 5 days a week be our motto. Do not consider weight lifting and body building as good aerobic exercises for the heart, they may even be harmful. Yoga, pranayama and stress management protocols can be added to your regular exercise schedule.

Diet rich in fruits and vegetables are a treat to the heart. Avoid fried items and junk fast foods as far as possible .Reduce the consumption of red meat and prefer fish based non vegetarian diet. Supplementation of tofu instead of paneer is more healthier for  vegetarians.

Early detection of coronary risk factors is the key to prevent cardiovascular disease in the future. All youngsters should have their Fasting blood sugars and Lipid profiles checked by the age of 30 years and even earlier if there is family history of cardiovascular disease. Cardiovascular disease not only involves coronary artery disease but includes strokes, carotid and peripheral vascular disease.

We often see individuals with Serum cholesterol between 200 – 250 mg % and LDL cholesterols between 130 – 160 mg % taking drugs for couple of months and stopping. This has no use as the cholesterol levels will rise again on discontinuation. Lifestyle modification and meticulous exercise will do more good than default drug use. Prolonged use of Lipid lowering drugs like statins have shown to reduce cardiovascular mortality even in patient with near normal level of bad cholesterol in many primary prevention trials.

When you suspect symptoms of heart disease as mentioned earlier do not hesitate to consult a cardiologist. A stitch in time saves nine but I tell you, a proper timely visit to a cardiologist saves life.

(The author is a consultant in Cardiology at Rajagiri Hospital, Kochi)