KOCHI: Reports of people in their 30s and 40s suffering heart attacks have become increasingly common. The perception that heart disease is largely ‘a problem of old age’ does not hold any longer.
Yet, many remain unfamiliar with the basic warning signs, or mistake them for something less serious. And some just choose to be indifferent.
Pop culture has taught us that a heart attack begins with a sudden clutching of the chest — dramatic and fast. In real life, however, the warning signs can be far subtler.
Heaviness while climbing stairs, unusual breathlessness after a short walk, unexplained sweating or discomfort that disappears with rest are often ignored.
“They are the body’s way of signalling that something is wrong. Most people associate a heart attack with chest pain, and rightly so. But there are also some classic warning signs like feeling of pressure, heaviness, tightness or burning in the centre of the chest,” says Dr Sunil Roy T N, senior consultant, interventional cardiology, Aster Medcity, Kochi.
“The discomfort may spread to the arm, neck, jaw or back. If it appears while walking, climbing stairs or during physical exertion and improves with rest, it should not be ignored. Sweating, breathlessness, nausea, dizziness and loss of consciousness can accompany the discomfort.”
When ‘gas’ is not gas
Early symptoms can also be mistaken for digestive problems, particularly among younger people.
Dr Fazil Mohamed Azeem, senior consultant cardiac surgeon at SP Medifort Hospital and PRS Hospital, Thiruvananthapuram, recalls a 42-year-old woman who initially went to the gastroenterology department with complaints of bloating.
“The doctor, however, suspected a cardiac problem. She was found to be having a heart attack and was referred for immediate cardiac treatment.”
The concern extends beyond recognising an impending heart attack. Heart disease can develop silently over years, with high blood pressure, diabetes, high cholesterol, smoking, obesity and physical inactivity gradually increasing cardiovascular risk.
Dr Fazil says he is seeing more younger patients with severe coronary artery disease. “I have seen three such cases in the past couple of days. One was a 42-year-old lady with heart blocks. Another is a 44-year-old man with severe coronary artery disease,” he says.
He also recalls a 41-year-old man who had his first heart attack at 38 and underwent multiple angioplasties. He eventually succumbed to another heart attack recently.
“This is the harsh reality. Cardiologists are seeing patients in their mid-30s and early 40s. Quite a lot of them these days,” says Dr Fazil.
Risk factors
Both the specialists note that lifestyle changes are among the primary reasons behind the rise in such cases. Lack of exercise, changing dietary habits and increasing stress can all add to cardiovascular risk.
That does not mean lifestyle is the only factor. Genetic predisposition can also put apparently young and healthy people at risk. “A family history of heart attacks, for instance, is a reason to consider screening at a younger age,” says Dr Fazil.
He also cautions against sudden strenuous exercise. “One cause of sudden death in people who do heavy exercise is electrical instability of the conduction system of the heart — ventricular fibrillation, a kind of short-circuiting,” he says.
Another rare condition is aortic dissection, in which a tear develops in the wall of the aorta, the major blood vessel carrying blood away from the heart. “Heavy exercise puts a lot of strain on the aorta, which sometimes might tear,” says Dr Fazil.
“These risks underline the importance of knowing one’s individual risk before taking up strenuous exercise. So before joining a gym for heavy bodybuilding, it would be wise to have a cardiac checkup.”
Some risk factors cannot be changed. Age and family history are among them. The risk rises in men after 45 and women after 55, while having a close blood relative who suffered a heart attack at a young age can also increase the risk.
“Smoking, high blood pressure, diabetes, cholesterol, obesity and physical inactivity are lifestyle-related risk factors that can be addressed,” says Dr Sunil.
Diabetes is another concern. Dr Fazil says patients in their mid-30s, 40s and early 50s sometimes reach hospital without knowing they have already suffered a heart attack.
“People with diabetes tend to have multiple blockages which can lead to what is called a silent heart attack,” he says.
Screening and tests
For people with multiple risk factors, Dr Fazil recommends discussing screening with a doctor, particularly after 40. These include diabetes, high cholesterol, high blood pressure, being overweight, a family history of heart disease and a highly stressful lifestyle.
“Above the age of 40 it would always be good to have some kind of an executive checkup to try and work out whether you are at risk of developing a heart attack at a younger age,” he says.
Prevention, Dr Sunil adds, should begin early. “Many people do not know their blood pressure, cholesterol level or blood sugar. This trend needs to change,” he says.
“Regular physical activity, a balanced diet, maintaining a healthy weight, quitting smoking, controlling blood pressure and diabetes, and getting adequate sleep can all help reduce cardiovascular risk. Brisk walking is one of the most powerful prescriptions for heart health. One can start with just 20-30 minutes.”
The aim, ultimately, is not to wait for the heart to send a dramatic warning. “Know your vital numbers,” Dr Sunill says.
“Get screened if you have risk factors. Seek medical attention if you experience warning signs. When it comes to heart attacks, the best treatment is preventing the first one.”
EXERCISE & HEART HEALTH
Regular physical activity lowers the risk of heart disease and helps control blood pressure and cholesterol.
But fitness isn’t immunity. Young, apparently fit people can still have underlying heart conditions.
Know your risks. Stress, poor sleep, unhealthy diet, smoking, diabetes, high blood pressure and family history can raise heart risk.
Start gradually. Walking, swimming and cycling are good ways to build cardiovascular fitness.
Don’t overdo it. Sudden, intense workouts or heavy weightlifting without proper assessment can strain the heart.
Check before starting. If you have risk factors or symptoms, consult a doctor before starting workouts.
Fitness is a gradual process. Increase intensity progressively and follow proper guidance.
Dr Sunil Roy T N, senior consultant — interventional cardiology
WHAT THE NUMBERS SAY
19.8 million people died from cardiovascular diseases worldwide in 2022 — about 32% of all deaths, according to WHO
2.57 million people died from cardiovascular diseases in India in 2019
188.3 million Indian adults aged 30 – 79 had hypertension, but only 15% had their blood pressure under control, according to a 2020 study
Kerala
Cardiovascular disease is among the state’s major health burdens.
A 2019 statewide study found 30.4% had raised blood pressure, 19.2% raised fasting blood glucose and 60.2% abdominal obesity
Only 12.4% of people with hypertension and 15.3% of those with diabetes had their conditions under control.
In 2023, diseases of the circulatory system accounted for 26.44% of medically certified deaths in Kerala.