Gujarat Hardlook: Young hearts at risk — amid caution over Covid link, experts warn of other triggers

His father Dharmesh Modi shares with The Indian Express, “Raj was my only son. That day, he came home from work in the evening and we all had dinner. Later, he went for the regular garba practice. After the first session of practice, he felt something unusual and had chest pain. He sat on a chair and suddenly collapsed. He was taken to a private hospital where doctors declared him dead on arrival.”

Cardiac emergency calls across Gujarat (Express)

However, Raj had never been infected by coronavirus, his father said, and had taken both doses of the vaccine against Covid. An automobile engineer, Raj had also got the visa to go to London for a master’s degree before his unexpected death, his family said.

Parul Soni went through a similar personal loss.

On October 20, the fateful day, her son Vaibhav, 13, complained of chest pain while riding a bicycle in a residential complex in Dabhoi town of Vadodara district. The family rushed him to a local hospital, where he underwent tests, including an ECG. Doctors did not find anything abnormal with his reports and sent him home. After a few hours of rest at home, he complained of pain in his chest and arms, and within minutes, he had collapsed. When the family rushed him to the hospital again, he was declared dead on arrival due to a suspected cardiac arrest.

“Since that day, I have only been thinking of the reasons leading to the collapse of my healthy son in my arms… He had no ailments or congenital health problems. He did not even contract Covid or take the vaccine. I have not been able to understand what happened..,” says Parul as she copes with the grief.

Jamnagar witnessed a similar shocker in June when 41-year-old cardiologist Dr Gaurav Gandhi died due to what was suspected to be cardiac arrest. Discomfort had led him to get an ECG done but the reports were normal.

Medical community was stunned because he was young, physically very active working daily for nearly 14 hours, a non-smoker, and a teetotaler. There was no medical history to indicate that he may be susceptible to heart ailments, and neither did he have any recent history of Covid infection.

Caution during garba

It is not uncommon in Gujarat for young boys and girls to dance away into the night during the Navratri festivity. This year, however, it was different. Even before the nine-day revelry for the Hindu festival began, the Gujarat government had advised garba organisers to deploy mobile ICUs and ambulances. The aim was to provide immediate medical attention, especially to those who may be suffering cardiac arrest-like symptoms.

Recently, Union Health Minister Mansukh Mandaviya while quoting a study by the Indian Council of Medical Research (ICMR) cautioned of a possible Covid link, when asked about the incidents of sudden death from heart attacks during the garba season. He urged survivors of severe Covid infection to avoid strenuous activities.

Union Health Minister Mansukh Mandaviya (Express Photo)

Experts on Covid link

Cardiologists, however, say that it is too soon to draw links to conclude if a severe Covid infection can affect the heart in the long term, especially in the absence of long-term population-based studies and heart ailments being multifactorial.

Experts that The Indian Express spoke with underlined a possibility of links to inadequate sleep, smoking, alcohol, and even substance abuse.

Dr Anish Chandarana, interventional cardiologist at the Marengo CIMS Hospital in Ahmedabad, says that the shift of prevalence of heart ailments among the younger population has largely lifestyle as a risk factor, and has been on the rise for at least a decade.

“According to me, Covid has not made any significant difference to the prevalence of heart ailments, especially now, when we are well past it. It did have an impact in the short term when we were in the midst of the pandemic and we were seeing blood clotting in patients suffering a severe infection. The shift to a younger population is driven by extreme emotional dysregulation, lack of quality and regularised sleep, substance abuse including smoking, alcohol and cannabis, lack of exercise, and unhealthy food,” says Dr Chandarana.

Kanu Desai (Express Photo)

Surat-based interventional cardiologist Dr Asif Raheem from Hiba Hospital in Adajan, whose youngest patient is a 16-year-old Class 11 student, highlights that “sedentary lifestyle, junk food, stressful jobs, and domestic stress” besides tobacco and alcohol consumption could be linked to the heart ailments. “Lastly, the post-Covid period has added burdens on the emotional, financial, and health front”, says Dr Raheem.

Meanwhile, Dr Chandarana points out that “the festive season of Navratri sees an increase in irregular sleep and increase in substance abuse”. To this, Dr Sameer Dani, director, of cardiology services, Apollo CVHF Heart Institute, underlines, “If you are embarking on an unusual activity, say an intensive exercise regimen…yes…playing garba during Navratri would also count as an exercise-intensive activity… and if you are at a risk for developing heart ailments, get your heart checked beforehand so that you are aware at what level your heart health is and you can commence your activity accordingly.”

Senior Consultant (Interventional Cardiologist) Dr Abhisheka Tripathi of Zydus Hospital further adds that dancing till late at night during Navratri also means a disruption in sleep pattern as well as inadequate sleep. Sudden bouts of intensive exercise by way of vigorous dance without allowing enough rest to the body may then increase the risk of heart ailments.

“Smoking, hyperlipidemia, hypertension, diabetes, and now Covid all are in some way interconnected and can, in combination or alone along with genetic susceptibility, cause coronary heart disease,” says Dr Raheem, attributing the recent incidents to the ‘Holiday Heart Syndrome’. Holiday heart syndrome is a condition that happens due to excessive drinking, according to WebMD.

“It’s atrial fibrillation (AFib), or an irregular heartbeat, that’s associated with binge drinking. While It can happen any time of year, it’s most common around end-of-year holidays when festivities are at an all-time high,” reads the description by the US-based health news website.

Uttar Pradesh Governor Anandiben Patel (Express Photo)

In a month, Hiba Hospital gets an average of 20 patients who are below 30 years old and 40 who are below 40 years old, and the incidence of heart disease has risen from “11 per cent in 2000 to almost 30 per cent in 2023,” according to Dr Raheem. “Earlier there were one or two cardiac cases in a month, now I am getting one case a week”, says Dr Raheem.

Dr Raheem further explains, “Usually, a person who leads a rather undisciplined lifestyle by eating lots of oily food, consuming alcohol, smoking, and partying late into the night may be at risk.”

On Covid link, Dr Chandarana elaborates, “If we look at MRI of the heart post-Covid, global literature established that micro-level changes having a negative impact on the heart were seen in around 13-15 per cent of the people. They had no heart ailments otherwise. What we need to study now is that these 13 or 15 patients out of 100 Covid-affected people who showed signs of inflammation of the heart… do they have fibrosis in the heart? Fibrosis is what can lead to cardiac arrest. This would be of tremendous interest.” Additionally, Dr Chandarana, Dr Dani as well and Dr Tripathi say that they are seeing patients as young as 25 coming in with episodes of sudden heart attacks with no considerable risk factors, which implies that a genetic condition cannot be discounted.

Experts on cardiac arrest

The Health and Family Welfare Department of the Gujarat government held a press conference on Saturday to talk “heart to heart”. Four top cardiologists including, Dr Chirag Doshi, director at the UN Mehta Institute of Cardiology and Research Centre of the Ahmedabad Civil Hospital, allayed fears about incidents of sudden cardiac arrests among the young. Cardiologists say that while sudden cardiac arrest happens 80-90 per cent of the time due to a heart attack, in about 15-20 per cent of the cases, it may happen without a heart attack or stoppage of heart function in cases of sudden death.

This happens, as per the experts, because the heart suddenly becomes irregular in pumping blood — either because the heart muscles need more blood supply or because of instability in some part of the heart muscles, indicating that despite a good blood supply, the electrical conduction system of the heart is not functioning properly.

How to keep your heart in check

Even drug overdose, especially cocaine, can be lethal in two ways — one is due to sudden spasms in the artery which in turn result in a reduction of blood supply, despite there being no arterial blockage, or electrical instability, experts point out. Dr Milan Chag, consultant senior interventional cardiologist at Marengo CIMS Hospital in Ahmedabad, says, “Not all sudden deaths are due to heart attacks. One is cardiac arrest and another is heart attack. Heart attack is primarily triggered by blood circulation issues and cardiac arrest on the other hand is due to issues in electrical signals to the heart and can stop the heart in 3-4 minutes, leading to sudden death. This can be due to congenital reasons or heart muscle disorders.

The instances of adolescents dying while doing regular tasks, a majority of them can be said to be due to cardiac arrests and we find a family history in many of these cases. Scientifically, an autopsy can tell us with certainty whether a death was due to heart attack or cardiac arrest.”

Adding to this, Dr Bhavesh Roy, senior interventional cardiologist with Zydus Hospitals in Ahmedabad, says, “Immediate and timely CPR to a cardiac arrest patient is key. It does not require high-end equipment but rather uninterrupted CPR… that is till there is a pulse. If one is taken to a hospital in this condition, the patient’s heart can be restarted through a defibrillator shock.”

No significant increase in heart attack cases among young year-on-year, experts observe

Dr Chirag Doshi, director at UN Mehta Institute of Cardiology and Research Centre in Ahmedabad, one of the biggest heart-dedicated superspecialty facilities in the city, said that in the year 2018-2019 — the pre-Covid era — nearly 8-11 per cent of patients were young, that is younger than 40. After the pandemic hit, data shows that heart attack cases among the young (patients less than 40) stood at 12 per cent of all heart attack cases. There is no statistically significant change, added Dr Doshi.

“During Covid, in 2020, we were seeing 9 per cent of the young heart attack patients with a COVID-19 history, of which 5.5 per cent required hospitalisation. Now, we are seeing that around 5.5 per cent of the young heart attack patients had a Covid history, of which around 3.5 per cent had required hospital admission during their bout of COVID-19,” Dr Doshi added.

Dr Milan Chag, consultant senior interventional cardiologist at Marengo CIMS Hospital in Ahmedabad, said that at his hospital, on average, between 2010 and 2020, reported that heart attacks among young people were 9.6 per cent of the total cases, and post Covid, from 2020-2023 so far, the figure stands at 9.7 per cent.

Sharing data of heart attacks, Dr Bhavesh Roy,  a senior interventional cardiologist with Zydus Hospitals in Ahmedabad, said that 7 per cent of its heart attack patients were young in 2016-17 while 80 per cent were in the age group of 40-70 years.

In 2021-22, young patients made up 6 per cent of total heart attack patients at the hospital, the expert highlighted.

(With inputs from Parimal Dabhi and Aditi Raja)