After a lull, last week India reported the deaths of two teenagers due to suspected heart attacks. A 15-year-old lost his life due to a heart attack in Greater Noida while playing in school, while a 16-year-old boy died of suspected cardiac arrest in Telangana.
Heart illnesses have been known to afflict older people but now such issues have been increasing among youngsters as well. While the deaths of teenagers due to heart attacks is an unfortunate trend, doctors across several states told News18 that it’s important for parents and teachers to recognise, prevent, and treat these sudden events.
“Cases of teens suddenly collapsing after exerting physical effort make the news oftentimes. Fortunately, these types of cardiac events don’t happen as often as it may seem,” Dr Maninder Singh Dhaliwal, a paediatrician at Faridabad-based Amrita Hospital, told News18. “Sudden cardiac arrests (SCA) in young people is rare but not unheard of. When it does happen, it often leads to death if it’s not treated within minutes.”
A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life. Sudden cardiac death (SCD) is triggered by a cardiovascular cause that occurs within one hour of the onset of symptoms.
Dhaliwal said that paediatric sudden cardiac death occurs in fewer than three out of every 100,000 children. “And about 25 cases occur during heavy exercise and sports, as per Western data. In comparison, sudden cardiac death occurs in about 135 of every 100,000 adults.”
BLAME COVID?
Experts believe that such incidents have increased following the outbreak of the Covid pandemic. It has been established by several studies across the globe that even a mild Covid-19 infection has harmful effects on cardiovascular health.
“We did see an increase in the number of cases of post-Covid myocarditis after the pandemic peaked but could this be the cause of the increased risk of sudden cardiac death, I am not sure,” said Dr Sushil Azad, deputy head of the department of paediatric cardiology and adult congenital heart diseases, Amrita Hospital, Faridabad. “Another reason especially in young adults (above 25) could be the increased incidence of coronary artery disease, especially with risk factors.”
Similarly, Dr Aparna Jaswal, director, cardiac pacing and electrophysiology, at Fortis Escorts Heart Institute, New Delhi, said that the number of cardiac arrests has certainly increased in the country.
“The reason for the increase amongst the young is largely lifestyle diseases,” she pointed out. “We do understand that the Covid pandemic has done something to the blood vessels of the body and an increase in heart attacks can be attributable to it. There is an increase in the incidence of coronary artery disease and problems in the post-Covid era. The coronavirus has made us vulnerable to develop more instances of these problems.”
‘NO LONGER SURPRISING’
Experts call it a “worrying trend” which needs to be tackled in time.
Dr Munna Das, cardiology, adult and electrophysiology, Narayana Multispeciality Hospital, Howrah, also echoed a similar trend.
“We are witnessing that heart disease is now the leading cause of disease burden and contributes to a significant number of deaths in younger citizens in India,” he said.
Das said that cases of heart attacks and emergencies in individuals between the ages of 25 and 35 are “no longer surprising”.
“We are dealing with 3-4 young patients around 25-35 years of age coming to our emergencies every month. Advanced treatments are available now, but as a preventive measure, we strongly recommend wider cardiac screening in high schools, colleges, and even among athletes. Screening should include a review of risk factors, blood pressure, heart-related symptoms, family history, and stress-related issues,” he said.
For Dr Anand Kumar Pandey, director, interventional cardiology at Dharamshila Narayana Superspeciality Hospital, the trend is “concerning” and “coronary artery disease is the most common issue”.
“Additionally, abnormal enlargement of cardiac muscle cells, leading to heart failure, irregular heart rhythms, angina, and increased heart attack risk, is a severe condition observed among the young population,” he said.
Pandey said that ignorance towards a healthy lifestyle is a significant cause along with other risk factors including poor diet, obesity, and physical inactivity.
CAUSES OF SUDDEN CARDIAC ARREST AMONG YOUNGSTERS
The Centers for Disease Control and Prevention (CDC) estimates that about 2,000 young, seemingly healthy people under age 25 in the United States die each year of sudden cardiac arrest.
Sudden cardiac arrest is thought to be a leading cause of death in young athletes, but it also affects young people not involved in organised sports. However, the causes of cardiac arrest usually depend on a person’s age.
Azad from Amrita Hospitals explained that in people over 35, most cases of cardiac arrest are caused by coronary artery disease, but in young people, the causes of cardiac arrest may vary.
One reason could be “hypertrophic cardiomyopathy”. It is usually inherited and often undiagnosed and this is the most common cardiovascular cause of sudden cardiac arrest in young people. “Muscle cells in the heart’s lower chambers, called ventricles, thicken. This can cause abnormal heart rhythm, especially during exercise,” he said.
Other reasons could be “primary arrhythmias or abnormality of the electrical activity of the heart”.
In people with structurally normal hearts, sudden cardiac arrest can sometimes be caused by undiagnosed genetic conditions that affect the heart’s electrical impulses.
Myocarditis could be the third reason which is usually triggered by an infection in which the walls of the heart are inflamed. “Most myocarditis cases in children happen due to viral infection,” Azad said.
Coronary artery disease is also common in young adults beyond 35 years but not uncommon in young adults due to lifestyle issues such as smoking, obesity, drugs, and a family history positive for early coronary artery disease.
Dhaliwal from Amrita Hospitals, however, clarified that “not all children with heart disease are at increased risk of having a sudden cardiac arrest”.
“Even if they do have an increased risk due to their diagnosis, many can still safely participate in exercise with appropriate restrictions and monitoring and permission as per their doctors," he said.
HOW CAN YOU PREVENT SUCH EVENTS?
According to the experts, it is important to know your family history as this may help in predicting and thus preventing such events.
Doctors strongly advise wider cardiac screening in high schools and colleges. They also recommend that screening should include a review of risk factors, blood pressure, heart-related symptoms, family history, and stress-related issues.
“In relation to teens, it’s necessary that every school teacher or physical trainer, gym trainer, or school sports teacher has updated basic life support training also known as BLS training,” Dhaliwal said.
Doctors suggest that teachers or physical trainers must also know about using AED (automated external defibrillator), an automated instrument which recognises abnormal, life-threatening heart rhythm and, if necessary, delivers an electrical shock, to help the heart re-establish an effective rhythm.
Getting a medical fitness certificate from a doctor or a paediatrician is very important, for any sports activity. As a parent, do inform the doctor about the family history of early sudden cardiac death (before the age of 50), experts recommend.
