In Your Teens, and Surviving a Heart Attack
World Heart Day:No congenital heart issue, non smokers, non drinkers. Why are teens in India getting heart attacks?
We bring you stories your teenage heart attack survivors, why they got heart attacks in the first place, and what could have prevented them from taking place.
Dhruv Sharma* 18 years
Speak to Dhruv for just 2 minutes and you’ll quickly realise he’s like any other teenager – too many balls in the air and eager to get a jump start in life, gunning for a scholarship, tinkering with app-based technology even as he pursues his graduation in Visual Arts at a university in Bangalore. It’s when you ask him about running that you can quite literally feel the unmistakable sadness and utter despondency in his voice – “Yes I do miss running marathons..”, he says speaking haltingly.
Dhruv, an avid marathon enthusiast, had his first heart attack last September at the age of 17 when he was participating in a University marathon. “I felt strain in my chest, I even stopped for a few minutes, but it became severe. That’s when I fell and became unconscious.” When he finally came around he found himself in an ambulance being rushed to the hospital
Pranav Mehta* 20 years
Pranav still recalls with trepidation the day he excused himself from class for a swig of water and collapsed from a heart attack. He was 19 then. “I still live with the fear that it’ll happen again”, he admits. Unlike Dhruv, Pranav finds himself desperately clutching at straws while he navigates the very tedious path of severely limited career options. “I can’t lift anything heavy, I can’t exert myself. What do I do??!!,” he asks in exasperation. “I’ve even given up on my dream of joining the police force.”
Umesh Shetty* 17 years
Obese and desperate to shed weight rapidly, Umesh went on a crash diet comprising mostly of liquids. A week later he had a variant of heart attack called NSTEMI (Non-ST-elevation myocardial infarction).
Non-smokers, Non-alcoholics, No Congenital Heart Issue
The kicker in all these cases, the common thread that binds these teens - They all didn’t have any congenital heart issue, nor were they smokers nor did they consume alcohol. For most part they even tested negative for both conventional and unconventional risk factors. It’s a medical whodunnit that has killed off young dreams and aspirations in one single heart attack!
Why Heart Attacks are Happening in the Wonder Years?
Apart from more or less known and conventional risk factors like smoking (even hookahs for that matter), consuming alcohol, diabetes, hypertension, obesity, spiked cholesterol levels, familial history, protein C and S deficiency, hypercoagulable state (excessive tendency for clotting), etc., cardiologists and cardiac surgeons say there are unconventional risk factors as well like Accelerated Insulin Resistance Syndrome. Insulin resistance syndrome essentially includes a group of problems like obesity, high blood pressure, high cholesterol, and type 2 diabetes.
According to Dr. Rahul Patil, Interventional Cardiologist and Head, Premature Heart Disease Division at Bengaluru’s Sri Jayadeva Institute of Cardiovascular Sciences and Research, “Indians are genetically more predisposed to insulin resistance compared to other populations.”
Why Are Teens Getting Heart Attacks?
- Improper Diet
The usual culprits: Not eating on time, skipping meals, prolonged fasting, eating processed food, binge eating, consuming oily, fatty, excessively sugary or salty foods, no balanced meals, no fresh fruits and veggies.
“Don’t go for these drastic diet plans that force you to shed 10 kilos in a month; in some persons suddenly going from a high carb to say a liquid diet will result in oxidative stress that your body will not be able to tolerate,” warns Dr. Aravind S., Consultant Cardiologist, Apollo Hospitals, Chennai.
- Compromised Sleep and Biological Clock
Doctors across the board agree that sleep is sacrosanct for heart health. Pulling late-nighters, night shifts (like in the BPO industry) over an extended period of time can prove to be fatal. “When your biological clock gets disturbed, thickening of blood happens, and if there’s a stressful situation it increases chances of formation of blood clots.”, explains Dr. Ramakanta Panda, leading Cardiovascular Thoracic Surgeon and Vice Chairman, Asian Heart Institute, Mumbai.
- Lifestyle and Inappropriate Food Choices
Experts say we’ve illogically embraced the burgeoning world of processed foods instead of consuming locally grown foods like millets that are complex carbs which take time to be absorbed and digested, thereby ensuring longer satiety and slow release of sugar into our system.
- Stressful and Sedentary Lifestyle
Also responsible is a sedentary and highly stressful lifestyle and pushing oneself to extremes to deliver with little or no respect for the body’s physical and mental limits.
- Poor Oral Hygiene
This might come as a shocker, but then not taking care of your pearly whites and mouth can cause bacterial infection to travel to the heart. If there’s a minor blockage there, it could result in inflammation, causing it to break away and result in a heart attack.
At times there could be no risk factors at all and yet a person gets a heart attack, in which case doctors could suspect some kind of inflammation. But the jury may well be out on what’s causing it.
Heart Attacks and Teens: Trends in India
Although there is no nationwide registry as yet that specifically captures data and trends in teenage heart attacks, doctors say they are seeing an increase in incidence in the past one decade or so. Dr. Patil estimates that Jayadeva Hospital alone has seen about 10-15 such cases from 2017 to date.
He adds that the average age of the first heart attack amongst Indians is 10-15 years younger than in western populations. The overall incidence and prevalence of heart attacks is 3 to 5 times higher as compared to other populations.
Says Dr. Panda,
“A few years ago we operated on a 17 year-old girl. Recently I saw a patient who got a bypass at the age of 16, now he is 27 and needs a second bypass. They both had angina and no congenital heart issue. I’ve seen 10-12 patients who’re below 20. They come at an advanced stage.”
“Traditional tests such as the treadmill or stress echo tests for blockages don’t reveal them (it will be negative in such patients) as the blockages in the arteries are not critical, it could just be a minor clot which could rupture and lead to a heart attack.”, explains Dr. Vishal Rastogi, Additional Director, Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi. Many a time even an angiogram might not reveal them.
Additionally, a combination of multiple minor risk factors could be far more dangerous than having one major risk factor. Dr. Panda proceeds to illustrate this with a simple example –
“Let’s say a person who weighs 90 kilos, has no diabetes or BP. This person has far less risk of developing heart disease than someone who weighs 65 kilos (rather than 60), BP of 130 mmHg (as opposed to say 120), blood sugar 120 mg/dL (instead of 110). Many doctors don’t know this and tend to ignore these minor risk factors.”
Teenage Heart Attacks are Different
According to Dr. Panda in older adults the body develops an alternate route for circulation in case of a blockage that occurs due to decades of cholesterol deposit. Youngsters don’t have this natural defence because the blockage could be very minor. Even with say just 10% cholesterol deposit, if there’s a rupture, it could result in a massive heart attack. They might not even have symptoms and when heart attack occurs it’s very fatal in youngsters.
Sri Jayadeva Institute of Cardiovascular Sciences and Research is collaborating with St. John’s Research Institute in Bangalore and National Centre for Human Genetics to study the newer, non-conventional risk factors, underlying genetic causes especially in familial cases of heart attack and premature coronary artery disease, conduct clinical studies on the natural history of and for statistics on patients under 40 years of age.
Air pollution, including PM 2.5 (fine particulate matter) and carbon monoxide levels, is yet another aspect which needs to be studied as a potential risk factor.
How Can You Tell a Teen is Having a Heart Attack?
Shockingly in a lot of cases they’re mistaken for heartburn, gastritis, indigestion, even acidity. Considering it’s a highly unexpected occurrence, all doctors consulted concurred on one recommendation – having a high index of suspicion.
Here are a few tell-tale signs and symptoms:
- Sudden, persistent, severe discomfort in the centre of the chest or behind the breastbone (retrosternal), could even be a heavy, dull pain. In fact any pain that’s between the lower jaw and upper abdomen.
- It could radiate along the left arm or forearm, jaw, neck.
- Could aggravate with exertion. Might get mildly relieved with rest.
- One might not be able to pinpoint a single source of the pain.
- Cold sweat
- Some might even say there’s a sense of impending doom as well.
That said it’s extremely critical to act with speed and decisiveness to reach the person in distress to a hospital well within the golden hour so that the heart can be revived as quickly as possible.
Dr. Patil is quick to point out that at a young age it needn’t necessarily be a cardiac cause, but if it lasts for more than half an hour it requires medical attention.
Dr. Panda maintains that conventional symptoms are very few and if there’s a familial linkage they’ll get angina.
- Balanced high-fibre diet, eating on time.
- Have a heavy breakfast and early dinner.
- Incorporating fresh fruits and veggies, Omega 3 Fatty Acids into your diet.
- Sticking to home-cooked food (as a corollary avoid processed, sugary, salty, oily, fatty foods, refined carbs like cakes, biscuits, chips, etc.).
- Regular aerobic exercises, playing a favourite sport like say Tennis. A ballpark is taking 10,000 steps a day for an active lifestyle.
- De-stress with Yoga, Meditation, Pranayama
- Strictly set aside some “Me Time”
- Sleep for at least 7-8 hours (avoid late nighters/ shifts if possible)
- Go in for a yearly medical check if you have any pre-existing risk factors.
“Schools should integrate diet and lifestyle recommendations into their curriculum”, insists Dr. Patil stressing on the merits of early community-based interventions aimed at prevention.
Dr. Rastogi cautions, “The psychosocial aspect is also important because a person who is so young and in his prime, about to take up a job or finishing his studies, if he faces this kind of disease, he’ll be lost and would require support. They might even need to be on medications lifelong.”
As for Dhruv and Pranav, even though they continue to live in the shadow and indeed painful memory of what happened to them, they’re watchful of what they eat, bracing up for a tough life ahead. Dhruv is aiming for a job in the defence services against all odds and Pranav is making his peace with the idea of a desk job somewhere. He continues to be on medication, while Dhruv practices isolation exercises to manage his stress.
* Names have been changed and location details withheld to protect the identity of the students
(Aruna Ramesh Balaji is a freelance writer, fitness instructor and former television journalist. She firmly believes that one of the gateways to a happy life is good health made possible by significant lifestyle changes. It’s her most cherished goal to make available the collective wisdom, both ancient and contemporary, of masters and experts in the fields of health and fitness, so readers such as yourself can lead healthier and more fulfilling lives.)
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