By Artika Bansal
New Delhi: Countries have been witnessing a surge in cardiovascular diseases and India is no exception to this. Despite having less than 20 per cent of the world’s population, India accounts for approximately 60 per cent of the world’s heart disease burden, informs Indian Heart Association (IHA).
The most common heart ailment noticed is myocardial infarction, commonly called as heart attack, where the artery that supplies blood and oxygen to heart muscle is unexpectedly blocked. There is chest discomfort, shortness of breath, hypertension and it requires immediate medical attention. What was thought to be a concern for elderly, now is being reported and diagnosed more among young adults. This makes the Indian CVD epidemic more serious, denotes cardiologists.
Experts have listed the rapid increase of heart disease in the population, early age of disease onset and high case fatality rate as particular causes of concern. Speaking at a national conference for doctors, Dr CN Manjunath, Director of Sri Jayadeva Institute of Cardiovascular Sciences and Research, had warned that India will have the notorious distinction of recording the highest number of cardiac deaths by 2030 in the world. Therefore, it is significant to create awareness about heart disease among the youth and encourage them to get regular preventive health check-ups.
The cause of heart disease burden
The heart disease burden has only been increasing according to the records, but the recent surge of cases reported in young population has been alarming. Adding to the grim reality, a number of celebrities have succumbed to heart attacks and its complications, which makes the question all the more relevant, as to why the younger population has become more vulnerable to heart disease.
Speaking to ETHealthworld, Dr Sushant Srivastava, Chairperson, Heart and Lungs Transplant, Artemis Hospital, Gurgaon, shared “Nearly 50 per cent of heart attack deaths occur in India in people aged less than 50 and 25 per cent of heart attack deaths occur in India in people aged less than 40, so obviously Indians have a predisposition for heart disease, and it occurs in them at a younger age. If we were to compare the incidence of heart disease or heart attacks with other populations, in Indians it is three to four times more common than in Americans and 20 times more common than in the Japanese.”
Coronary artery disease is the most common cause of heart attacks. The other risk factors that predispose one to heart diseases are some modifiable and non-modifiable factors. Predominantly sedentary lifestyle, smoking, alcohol, stress, lack of exercise, high cholesterol levels, hypertension, diabetes, are among the factors that can be and should be controlled as precaution. Family history is one factor that cannot be controlled but one should be aware of. A genetic heart disease passed on by ancestors can become a cause of concern.
Commenting on family history as a risk factor, Dr Srivastava said “People who are especially at risk are those who have seen a cardiac death in male family members aged less than 55 and female family members aged less than 65. So, if you have a family history of early cardiac death then you are particularly at risk and you should get your check up done regularly.”
Gender differences exist in cardiac illness
Heart for both male and female might look the same but there are significant differences. Compared to men, women have smaller hearts and narrow blood vessels. This adds to how heart disease can present and progress differently in men and women. Dr Dheeraj Gandotra, Additional Director, Cardiology, Fortis Hospital, Noida, said “Heart disease is not just a man’s issue. Women tend to have heart disease later in life than men. Chest pain is the most common symptom in both men and women.”
Further, women also face atypical issues like pain in the neck or upper back. Both are prone to almost same risk factors, however, conditions related to pregnancy and PCOD also predispose women to heart diseases. Due to the small arteries in women, the disease is not clearly seen on scans so women are sometimes given “all clear” sign even if they are at risk, this makes diagnosis difficult. For treatment, women are given less aggressive treatment as compared to men. The drugs remain the same but the dose of each drug might differ, men may be given slightly higher dose than women.
According to a study published in journal JAMA Internal Medicine, it was reported that throughout life, men were about twice as likely as women to have a heart attack. With no difference in chances of fatality in heart attacks, the key is to maintain good heart health.
Understanding signs and symptoms of a heart attack is crucial
Heart attack symptoms may vary for every person as it depends on the severity of the disease. In some cases, symptoms are clear enough to seek medical attention while in others, a healthy person with no symptoms can also suffer a heart attack. This is why heart attacks are explained as a silent epidemic.
Informing about the symptoms, Dr Balbir Singh, Chairman, Cardiology (Pan Max), Max Healthcare, said “Symptoms of heart attack to look out for include uncomfortable pressure, squeezing, fullness and pain in the centre of the chest, lasting for more than a few minutes or intermittently erupting. Pain or discomfort in one or both arms, back, neck, jaw or stomach, shortness of breath with or without chest discomfort, cold sweat, nausea or light-headedness are some other symptoms to be aware of. For females, symptoms of breathing difficulties are more than chest pain.”
“In recent times young patients present symptoms of bloating, acidity, gas, dizziness, and breathlessness” added Dr Gandotra. These symptoms should be taken seriously, especially if the symptoms appear while exercising or due to stress, as has been noticed in recent cases. Such people are advised to consult a cardiologist in time.
The severity of morning heart attacks
The most common time for heart attacks is considered to be in the morning. Adding to this, a study published in the journal Heart, led by Dr Borja Ibanez from the National Centre for Cardiovascular Diseases (CCD) in Madrid, warned that the morning heart attacks are more severe and can be more damaging. This is believed to be true due to the circadian rhythms.
Circadian rhythms are a product of the body’s internal clock regulated by brain’s central clock and all the cells in the body. The circadian system regulates the physiological parameters. Dr Srivastava explained the process and said “In the morning hours, the body releases more stress hormones such as epinephrine, norepinephrine and cortisol and these hormones increase the heart rate. The body thus requires more oxygen. So, when the demand is high, the heart is placed under stress and heart attack becomes more likely. These stress hormones also increase something that prevents blood clots from breaking down. So, if there is a heart attack in the morning and a clot forms in one of the important coronary arteries in the morning, it is less likely to break down and so an acute coronary syndrome is likely to progress to a heart attack in the early hours of the morning.”
Thus, it becomes important to maintain a healthy heart to lead a healthy life. Fortunately, being alert and aware, following self-care and a healthy lifestyle, can help avoid the risk of this fatal disease. Monitoring parameters such as blood pressure and sugar levels regularly to keep them under control, moderation in alcohol intake, managing stress, enough sleep, are all important as per the diagnosis of recent heart cases. Commenting on the current lifestyle aspects and preventions, Dr G R Kane, Consultant, Cardiology, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, shared “Lifestyle management is our single most effective shield in preventing us from any heart disease. A healthy routine can help us in mitigating the risk of a heart attack. Some of the healthy heart habits can be: a heart friendly diet and reduction in intake of processed food, daily exercise and optimal physical activity and routine preventive health check-ups”.
“What triggers a heart attack is usually stress and sleep disturbances which act along with circadian rhythm to lead to a heart attack.” added Dr Kane.
When the heart attack strikes, it causes damage to the healthy heart muscle. Hence, it is important for those who have had a heart attack or have a previous history of cardiac disease, to get the heart evaluated for any post-complications. These complications are progressive in nature and need to be taken care of before it’s too late. The delay in evaluation and treatment can lead to more damage to the heart muscles. The complications include low pumping of blood, chances of heart failure, valve leakages or hole in heart, and cardiac arrhythmias.
Dr Srivastava shared “In rare cases a part of the external wall of the heart can break down. This is called cardiac rupture. When this happens, in most cases, because there is catastrophic internal bleeding, the patient dies before reaching the hospital. Only in cases where patients were able to reach hospital in time, get operated and underwent emergency surgery have survived.”
Data suggests that the heart disease burden is increasing in India. Cardiologists believe alcohol consumption, smoking, stress, and an unhealthy sleep routine, add to the deteriorating heart conditions of young Indians. In such situation, it is advised to follow the precautions for heart care and seek advice from a cardiologist at the right time.