Sweating it out too fast may be risky Mumbai:
“I am the eighth wonder of the world, am I not?’’ asks
28-year-old Jignesh Shah, a tad too cheekily for someone who is
lying on an ICCU bed. The Ghatkopar resident, however, has a
reason to feel special—barely 24 hours earlier, he was brought
to Hiranandani Hospital in Powai in the throes of a massive
heart attack. After an emergency angioplasty was performed to place a stent in his right artery, he was back to his cheery self on Friday morning. But isn’t he too young for a heart attack? The MBA graduate gives an answer delineating the underlying causes (‘smoking since high school’ and ‘work-related stress’), a trigger (‘excessive gymming within a span of 24 hours’) and a solution (‘no more smoking’). Jignesh also sees humour in his situation: “I am managing my first heart attack pretty well as I am young. What if this had happened when I am 45?’’ His cardiologist Dr Ganesh Kumar, however, sees Jignesh’s hospitalisation as a part of the emerging trend of heart attacks among the young. “Improper or sudden activity, like strenuous gymming, could be a trigger,’’ says the doctor. In June, he operated upon an Andheri-based gym instructor, 42-year-old Henry James, who developed chest pain while discussing disputed property matter at a meeting. “I was the Junior Mr Bombay in 1989 and was shocked with this unexpected heart attack,’’ says James, who has cut down on eating red meat. Fortyseven-year-old Murli Menon, a CEO of a mid-sized firm based out of Powai, too, was shocked to realize that he had suffered a heart attack barely a month after his stress test showed no problems with his heart. “I played squash in the afternoon after a break of a year and ended up with a heart attack.’’ So, what is the cause of these sudden heart attacks in seemingly healthy and young individuals? The business fraternity was shocked when SAP India CEO Ranjan Das collapsed at the age of 42 two months back. Ditto with the death of RIL executive director Ravi Mohan aged 52 years. According to doctors, the biochemistry of heart attacks among the young that is different. Says Dr Ganesh Kumar, “The inner lining of the arteries is lined with endothelial cells. A layer of LDL (bad cholesterol) lies below this layer. Sudden activity, unexpected and unaccustomed, could lead to a surge in adrenalin that ruptures the endothelial lining breaks, exposing the foreign LDL to blood.’’ This gives rise to clotting and a 100 % blockage at the site, or, in other words, a heart attack. The LDL layering is also called soft plaque. “Most of the patients only have 20% to 30% blockage that doesn’t show up in stress tests. It is too insignificant to hamper blood flow in the arteries,’’ says the doctor. But when faced with a trigger —a bad day in the office, intense physical activity that one is unaccustomed to, an argument— it is the first to rupture. Even lack of sleep could lead to the rupture. Dr V T Shah, a cardiologist at Nanavati Hospital in Vile Parle states, “Everyone knows that the exercise is good for the heart, but people forget the circadian rhythm (the rhythm of life). It is based on one’s daily routine.’’ As per the circadian rhythm, there are two periods in a day when there is a surge of adrenalin in blood. One would be en route to work before the routine (office work) sets in and the next would be in the evening when one is travelling home. “When stress is more during this periods, the plaque could rupture, leading to a heart attack,’’ he adds. Dr A Contractor, who is charge of cardiac rehabilitation of patients who hav suffered heart attacks,points out that daily exercise regime is good for the heart. “It is only when does excessive exercise or is stressed out that these events act as a trigger in a diseased heart,’’ he says. What is the solution? According to Dr Ganesh Kumar, “Instead of relying only on stress test, people could have a CT Angio once in five years.’’ But Dr Ashwin Mehta has an easier method: doctors could workout the Farmingham risk scale for heart diseases. “Those with risk factors like diabetes, family history and smoking should be put on a dose of statins that could stabilise soft plaque blockages and prevent sudden heart attacks,’’ he adds. —Names of some patients have been changed ADVICE BEFORE HITTING THE GYM If a sedentary person, especially over 35 years of age, starts exercising, it’s recommended that he/she consults a physician before starting. Around 30 minutes of moderateintensity physical activity (such as brisk walking) on most days of the week would be a good goal for those who are sedentary. Start with 10 minutes a day, and increase by ten minutes each week When previously sedentary individuals can adopt this regimen comfortably, they should strive for the goal of more vigorous exercise, provided there are no contraindications —Aashish Contractor, cardiac rehab specialist, Asian Heart Institute |