Actor Sidharth Shukla, 40, died after suffering a heart attack early Thursday morning. His death raises questions about how heart attacks and cardiac arrests even affect the fit and the young.
"Current scenarios show that neither age nor sex is now a bar for heart attack reports. While many with timely interventions survive, some move into a cardiac arrest," Dr. Lekha Pathak, Director of Cardiology, Nanavati Hospital told BOOM. She added that even though Shukla was a fit man, stress or straining himself post exercise could be a plausible reason for his body to go into overdrive.
"For the younger to be affected, stress, lifestyle changes, smoking, alcohol, drugs, and overexerting their body during exercise are causes for the increasing number of heart attack reports," Dr. Pathak added.
A preliminary postmortem report suggests that Shukla lost his life to chest pain and a presumable heart attack. Although used interchangeably, cardiac arrests and heart attacks are different. Cardiac arrest is when the heart suddenly stops beating, leading to the person to collapse and the heart needs to be revived. In a heart attack, a person's heart does not stop functioning but the blood flow to the heart is obstructed. A heart attack could lead to a cardiac arrest.
"A heart attack is a primary event of an affected heart muscle while a cardiac arrest is a secondary event, " says Dr. Ajit Menon, interventional cardiologist at Lilavati and Reliance Foundation Hospital, Mumbai. By the time Shukla was taken to the hospital, he was declared dead before admission.
Sudden cardiac arrest deaths accounted for around 2 lakh deaths in India in 2012, according to Dr. Manoj Gerela, a Governor at the Indian Association of Clinical Cardiologists. Globally, around 31% of deaths are due to cardiovascular diseases, says the World Health Organisation. However, there is no clear distinction to understand how many of these deaths are caused by sudden cardiac arrests.
According to the Global Burden of Diseases, cardiovascular diseases contributed to 28.2% of deaths in India in 2016. A further division to understand the proportion of sudden cardiac arrests is not provided.
In a study conducted in a hospital in Hyderabad in 2012, sudden cardiac arrests accounted for 10.3% of the 1,699 recallable deaths. India has not maintained any other statistical records of total deaths caused due to cardiac arrests, says another study from 2014.
What Are Cardiac Arrests
"Cardiac arrests are caused by either ventricular tachycardia or ventricular fibrillation in the lower chamber of the heart," Dr. Menon explains. Explaining the difference between the two, Dr. Menon said that tachycardia is when the heart beat goes beyond the normal heart beat rate while fibrillation is when the heart starts quivering and does not pump blood out from the heart.
Heart attacks, on the other hand, are due to blockages in the blood circulation while cardiac arrests are more "electrical in nature". "Irregularities in the beating of the heart called as arrhythmias are the reasons for sudden cardiac arrests," added Dr. Gerela who is a practising cardiologist at Asian Heart Institute, Mumbai.
It is pertinent to understand the difference between heart attacks and cardiac arrests as there is a wider scope for treating a heart attack. A cardiac arrest has to be medically tended to immediately.
Signs And Risk Factors
While cardiac arrests are sudden, some minor signs such as serious chest pain, dizziness, heaviness and discomfort in the jaw, hands, and legs, and heavy breathing have been observed in several patients who suffered from cardiac arrest. "There are no warning signs, the person suddenly falls but there are definitely risk factors for the disease," said Dr. Menon.
Previous history of myocardial infarction and heart attacks, stress, underlying co-morbidities of diabetes, and hypertension are some of the common risk factors witnessed by cardiologists when attending to cardiac arrest patients. Even inherited disorders, heart defects, and genetic history could lead to cardiac arrests.
Earlier, older age was considered to be a contributing factor to cardiac arrests but recently newer observations have dispelled this thinking. "We have witnessed many young patients with diabetes, excessive stress, succumbing to cardiac arrests, these days, " said Dr Gerela.
Cardiac Arrests Even Affect The Fit
It is widely believed that exercising and staying fit are prerequisites to avert any disease. Shukla regularly kept a check on his health.
"Exercise provides protection against diseases yes, but it does not necessarily avoid cardiac arrests," says Dr. Aashish Contractor, Rehabilitation and Sports Medicine expert at Reliance Foundation Hospital.
In a blogpost from 2013, Contractor, the Medical Director for the Standard Chartered Mumbai Marathon asserts that participants who are fit have also collapsed after their prolonged run. He writes that from various studies "vigorous exertion was thought to lead to rupture of the blockage in the blood vessels, leading to clot formation, which leads to an abnormal heart rhythm knows as ventricular fibrillation and ultimately death."
Other factors of low sodium in blood and increased body temperature account for 10 percent of deaths in the studies he cites. Dr. Contractor further insists that people should not ignore any mild warning signs if they appear.
CPR and Golden Hour
Normally people give cardiopulmonary resuscitation (CPR) to revive those who are unconscious after an arrest.
CPR is only given when a person collapses and stops breathing. "It is given only during cardiac arrests and not during heart attacks," says Dr. Menon.
Outlining how CPR is carried out, Dr Gerela says it is important to follow the 3:1 ratio. "Start with a thump on the chest bone, three thrusts, puff one breath in the mouth and continue till medical assistance is availed."
But there is a catch. The first 3-5 minutes are the most crucial inorder to revive and shock the heart. Defibrillators that provide shock therapy should be made available immediately. Dr. Gerela calls this the 'golden period'.
Dr. Menon, however, does not agree in labelling this as the golden hour or period. "The patient does not have the luxury of the golden hour like in heart attacks. Continuous chest compressions in the first few minutes are crucial. The golden hour in heart attacks requires easing blood flow, here you have to revive and restart the heart instead."
Precautionary Measures
Following a healthy lifestyle while ensuring to be free of other co-morbidities is one of the simplest precautionary measures. Visting a physician at any signs of distress is also important.
Dr. Contractor also writes that people and especially athletes should get a routine check annually through a stress test, an electrocardiogram to measure the heart's activity, a 2D- echo test that checks all the valves of the heart, and a full sugar, lipid profile along with the body mass as they are great indicators for cardiac risk.
Dr. Gerela concluded by saying that it was necessary for people to be aware about their bodies. The Indian Association of Clinical Cardiologists runs awareness and medical camps regularly