The death of Kannada actor Puneeth Rajkumar has again brought into focus the increasing incidence of heart attacks among the young. Doctors, who said the trend is on the rise in the last few years, pointed out that over 30% of such “unfortunate” victims do not have any conventional risk factors or family history.
With several cases of people collapsing during a workout or after returning from the gym being reported, doctors said high-intensity exercise is a precipitating factor in such cases.
Puneeth too complained of chest pain after his routine workout in the morning and was taken to their family doctor where an ECG was done. He was then referred to Vikram Hospitals. Doctors at Vikram Hospitals said the actor was non-responsive and was in cardiac asystole when he was brought there. Also referred to as cardiac flatline, asystole is the state of total cessation of electrical activity from the heart, which means no tissue contraction from the heart muscle and therefore no blood flow to the rest of the body.
Sources said in Puneeth’s case, heart attack had set in just 30-45 minutes before he was rushed to the hospital. “He was talking till he was just 10 minutes away from the hospital, near Bengaluru Palace. Except for a family history, he had no risk factors or symptoms,” sources said.
Some doctors, who pointed out that a dehydrated state after vigorous exercise is responsible for such deaths, said it would be prudent to get a proper cardiac evaluation done before signing up for a rigorous gym programme.
C.N. Manjunath, director of the State-run Sri Jayadeva Institute of Cardiovascular Sciences, said he had recently seen two such young patients — a 17-year-old and a 23-year-old — who were brought to the hospital with a diagnosis of heart attack. “Both of them did not have conventional risk factors or a family history. We have also seen a few people suffer a heart attack two or three days after returning from trekking or temple visits on hills,” the doctor said.
An analysis of over 2,500 patients at the institute has shown that 30% of the patients did not have conventional risk factors or a family history. “In young heart attack patients, incidence of diabetes and high blood pressure is less when compared with older patients,” the doctor said.
Explaining the cause of the heart attacks in the young, Dr. Manjunath said: “During a heart attack, a few unfortunate patients develop ventricular fibrillation (electrical instability) and cardiac arrest within a few minutes, giving no time for them to reach a hospital or take treatment. This is because blood supply is cut off to the heart muscle. This is what happened in Mr. Puneeth’s case.”
“This can happen when a plaque ruptures. Within a few minutes, blood clot formation occurs and the artery gets closed, resulting in heart attack. This comes without any warning signs,” Dr. Manjunath said.
On the contrary, those who develop a gradual blockage will have warning symptoms for weeks to months prior to a heart attack. “When a person collapses, resuscitation should be done in the first three to four minutes. It is advisable that all public places, including gyms, bus/railway stations, malls, and multiplexes should have an emergency room with staff trained in advanced cardiac life support,” he said.
“Conditioning the body before exercise, especially the warm-up, and cooling down post exercise is a must. In people with a family history of cardiac issues, cholesterol level should be checked regularly. In case of minor and major blocks of the heart, coronary angiograms can help in detection,” said Ranjan Shetty, interventional cardiologist at Manipal Hospitals.