Why sudden cardiac arrests are killing so many young Indians

The head of the Mumbai Cricket Association Amol Kale died of cardiac arrest while he was in New York to watch the India-Pakistan match in the T20 World Cup. He was 47In August, India’s startup community expressed shock over the sudden demise of Ambareesh Murty. The 51-year-old co-founder of online furniture store Pepperfry was an avid biker and trekker. He died due to a cardiac arrest during a road trip to Leh.In July, a 20-year-old engineering student fell unconscious after running a 10-km marathon in Madurai and died within a few hours.Dr Gaurav Gandhi (41), a well-known cardiologist, died after suffering a heart attack at his residence in Jamnagar, Gujarat, in June.Sad and shocking, these are some of the widely reported cases of what doctors term as sudden cardiac death (SCD) in recent months. Young people are increasingly falling victim to SCD, not just in India, but across the globe.In India, an estimated 6-8 lakh people die of SCD annually, with a good proportion of them being under the age of 50, according to a recent research published in The Lancet, one of the world’s top medical journals.The study by 30 international experts, which was published in September, says that despite the advances in the medical field, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world, which they call “unacceptable”.Likely causesDr Haresh G Mehta, consultant (interventional cardiologist) at SL Raheja Hospital in Mumbai’s Mahim says a number of factors ranging from unhealthy lifestyle to impact on the heart from Covid-19 could be behind the rising incidents of SCDs. In some cases, stress and overexercising have also led to heart problems.“Individuals who are at high risk, those suffering from diabetes, high blood pressure, obesity etc should take utmost care of their health, since these underlying problems could have a severe impact on their heart health,” Dr Mehta cautions. Dr Vidya Suratkal, cardiologist at Lilavati Hospital, Mumbai says that the incidence of sudden cardiac arrest in young Indians is 12–16%, which is higher than in other ethnic groups worldwide.She flags lack of awareness of the preventable risk factors and ignorance of the disease as some of the key factors responsible for the increasing rate of SCDs among Indians.“It is important to look out for signs and symptoms to make sure that your heart problem gets diagnosed at the right time. If one experiences symptoms such as chest pain, nausea, difficulty in breathing, discomfort in the jaw, neck, shoulder, among others, they should seek help immediately as their heart is in distress,” Dr Mehta advises.Potential Covid linkThe Lancet study shows a 20% rise in sudden cardiac arrest (SCA) among young people, mostly in their 30s and 40s, says Dr Kumar Narayanan, senior consultant cardiologist and electrophysiologist at Medicover Hospitals, Hyderabad. He was among the 30 experts from 30 countries – such as the US, India, China, Japan, Brazil, the Netherlands, Australia among others – who took part in The Lancet research.While many developing countries are facing an epidemic of cardiovascular disease driven by changing lifestyles, scientists are yet to confirm if deaths are due to factors linked to the Covid-19 pandemic.“Sudden deaths due to cardiac arrest have been reported in young people after Covid-19, but there is no sufficient evidence to confirm the cause. The Indian Council of Medical Research [ICMR] is conducting a study [to determine] factors associated with sudden deaths among adults aged 18 to 45 years across 40 hospitals/research centres,” Dr Narayanan adds. One theory is that the coronavirus may cause a condition called myocarditis or inflammation of heart muscles. Complaints of palpitation are very common after Covid-related myocarditis.Patients often exhibit fluctuation in heart rate from very fast to extremely slow after recovery from Covid. Some patients tend to have a severe infection of the heart muscles and can experience extreme weakness of the heart leading to heart failure. There is also a possibility of irregular heartbeats or arrhythmia, which can lead to sudden cardiac arrest, the experts say.According to Dr Vivek Mahajan, consultant (interventional cardiology) at Fortis Hospital, Kalyan, Maharashtra, the virus can directly infect both arteries and veins. The latter carry impure blood to the heart and the former supply oxygenated blood (pure blood) to our organs.“Infection in blood vessels could result in clotting of blood, a condition known as deep vein thrombosis. These clots may also block the blood supply to the lungs, leading to pulmonary embolism. This could be life-threatening if the clot is a large one,” Dr Mahajan says.“The arteries of the heart are particularly vulnerable to choking due to clot formation, heart attacks and these are commonly seen among Covid patients. Complications may occur even in milder forms of infection and also after the recovery. Blood thinners like Rivaroxaban may be beneficial to prevent these complications in patients at a higher risk,” he adds. According to Dr Suratkal of Lilavati Hospital, coronavirus not only impacts the lungs but also the heart. Many individuals with no prior history of heart disease have experienced sudden cardiac arrest after contracting Covid-19, she points out.“By identifying those at the highest risk for sudden cardiac death due to viral infection, we can potentially implement preventive measures such as closer monitoring or earlier interventions. Regular cardiac screening after 25 years of age is essential for each and everyone to know the status of their heart health,” the cardiologist opines.Low CPR awarenessAccording to the World Health Organisation (WHO), close to 18mn people die due to cardiovascular diseases every year, out of which maximum deaths occur due to cardiac arrest.Cardiopulmonary resuscitation, commonly known as CPR, is the most critical step in managing out-of-hospital cardiac arrest. It is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.However, only 2% of India’s population are aware of CPR, The Lancet study says. This is far below the target of 62% set by the American Heart Association Emergency Cardiovascular Care (AHA-ECC).“In India, where the likelihood of an ambulance reaching so quickly or bystanders performing CPR or using AED [automated external defibrillator] is very low, we can estimate that the survival rates would be less than 5%. So, if we want to improve survival rate, we need to find ways to ensure prompt CPR and AED use for every victim of SCA,” Dr Narayanan states.The Lancet study suggests that “governments should enact legislation to empower common people to respond in an emergency and also to improve participation such as making CPR training mandatory to get a driver’s licence”.How to reduce SCD burdenSome of the key measures that The Lancet research proposes to reduce SCD burden are:1. A multi-disciplinary approach is needed to address SCD. Collaboration of experts from several fields such as cardiology, emergency medicine, critical care, public health, pathology among others may help properly address the different aspects surrounding the problem. There is also a need to establish sudden death expertise centres which can function as nodal agencies to guide SCD care and research.2. Newer tools such as big data and artificial intelligence may be used to analyse information from large numbers of SCA/SCD cases to identify patterns and risk markers, which can be used to improve SCD prediction and prevention.3. Registries should be established to collect accurate data regarding SCD from different areas in order to understand the magnitude of the problem and drive response measures.4. Automated external defibrillators (AEDs) should be made widely available and common citizens should be trained in CPR. Social media and apps should be used to make awareness about SCD and CPR.5. Access to resources such as genetic testing and other modern techniques needs to be improved for prevention of SCD.