By Dr. Arun Srinivas, MD, DM (Cardio), FESC, FACC Chief Cardiologist and HoD, Heart Institutes, Apollo BGS Hospitals, Mysuru 

After the unfortunate and premature demise of Kannada matinee idol Puneeth Rajkumar, there has been increased awareness and lot of panic in the young adults in the State regarding their health, particularly the heart. It has resulted in a large number of them coming to hospitals for cardiac check-ups.

Fortunately, almost all of them are fine and have no evidence of heart disease. It is also true that we have seen an almost 50 percent increase in incidence of heart attack in the young and our ICU statistics reveal that almost 60 percent of our patients in the ICU are less than 60 years of age. We need to introspect and educate our citizens regarding this.

Why is heart disease increasing in the young adults?

It is mainly due to the following factors: Smoking, obesity, lack of exercise, unhealthy eating habits, alcohol consumption, increase in stress and a very abnormal sleep cycle. Most young adults now-a-days sleep well after midnight and wake up late, hence causing imbalance in their hormones, leading to abnormal nerve activity and increasing risk of high blood pressure, blood clots and resultant heart attack and stroke.

Why do heart attack patients die suddenly?

Many heart patients die suddenly known as Sudden Cardiac Death. Death occurs within 1 hour of onset of chest pain.  Like Puneeth Rajkumar, many heart attack patients die within few minutes of the chest pain or on the way to the hospital before initiation of treatment. Sudden Cardiac Death is due to a complication called “Ventricular Fibrillation” or a very rapid irregular heart beating followed by complete standstill of the heart, called “Cardiac Arrest.” A DC shock delivered with a defibrillator can instantaneously correct the ventricular fibrillation and reverse the cardiac arrest.

How can we prevent Sudden Cardiac Death?

The most important aspect of prevention is time. If the person can reach the hospital immediately, many of these patients can be saved. Once the patient reaches the hospital, chances of survival are greater than 95 percent. Shifting the patient with chest pain by ambulance rather than by a personal vehicle can be life-saving.

Well-equipped ambulance with Oxygen, Defibrillator and trained personnel can monitor the ECG and treat complications in the ambulance to prevent sudden cardiac death.  Hence, we need access to an extremely efficient Emergency Healthcare System with well-equipped ambulance and trained staff if we have to save our patients with heart attack.

What is the best treatment for heart attack?

Heart attack occurs due to complete blockage of an artery supplying blood to the heart. Larger the artery blocked, larger is the attack, larger the damage to the heart and higher the risk of complication.  Earlier the blood supply is restored to the heart muscle, smaller is the damage and faster is the recovery. The best treatment to clear the blockage and restore blood supply to heal the heart attack is by Angioplasty and Drug Eluting Stent implantation. This is called Primary Angioplasty and 95 percent of patients with heart attack will survive if the Angioplasty is done within 1 hour of onset of pain – called the Golden Hour.

Who are the adults at risk of heart attack?

All adults above the age of 40 years with risk factors of smoking, high blood pressure, diabetes, obesity, high cholesterol, severe stress (stress can be emotional stress, financial stress or even physical stress or extreme exercise), family history of heart disease and lack of exercise are at risk of heart attack. 

Those with more than one of the above risk factors need to have a complete health check up on a yearly basis and treat the risk factors adequately to reduce their chances of attack.

Can heart attack be prevented?

Heart attack can be prevented to a great extent and postponed by more than 10 years by following a healthy lifestyle.

• Early to bed and early to rise.
• Regular exercise at least 30 minutes daily (60 minutes  if you are overweight). 
• Maintain blood pressure less than 140 / 90mg / dl.
• Maintain blood sugar less than 120mg/dl fasting and less than 180mg/dl post prandial.
• Maintain LDL (bad) cholesterol less than 70mg/dL.
• Achieve and maintain ideal weight for height.
• (Height in cms minus 100, for a height of 170cms, ideal weight would be around 70kg).
• Achieve ideal abdominal girth to prevent Central Obesity (Ideal waist circumference is 50 percent of the height).
• Consume a predominant fruit and vegetable diet with small amounts of fish/chicken and minimal animal fat and red meat.
• Completely avoid smoking and minimise alcohol — maximum of 2 drinks per week.
• A healthy lifestyle is the best option to prevent various non-communicable diseases like Heart Attack, Stroke, Cancer, Diabetes, Hypertension and Obesity.