With the rising number of cases of cardiac arrests during gym workouts and sporting activities, Punjab Health Minister Dr Balbir Singh recently issued a health advisory titled, ‘Prevention of Sudden Cardiac Arrest Among Gym Goers and Sportspersons’. The advisory flagged undiagnosed medical conditions, unregulated dietary choices, and unchecked, unsafe, and quick-result supplements, energy drinks, and performance enhancers that had harmful effects on their heart and liver, and steroid-based products.
Professor Rajesh Vijayvergiya, Department of Cardiology, Advanced Cardiac Centre, PGIMER, Chandigarh, describes the recent surge in sudden cardiac arrests as a silent threat among us. While heart disease has long been a leading cause of mortality globally, sudden cardiac arrests among young and middle-aged adults call for urgent public awareness and action, Vijayvergiya underscores.
The startling shift
“Heart disease is no longer restricted to the elderly or those with known chronic illnesses. Increasingly, it is affecting individuals under 40, including students, athletes, professionals, and homemakers,” Vijayvergiya explains.
The interventional cardiologist further says sudden cardiac arrest (SCA) occurs when the heart suddenly stops beating due to an electrical malfunction, resulting in the immediate cessation of blood flow to the brain and vital organs. It can cause death within minutes if cardiopulmonary resuscitation (CPR) is not initiated promptly. In contrast, a heart attack, or myocardial infarction (MI), is caused by a blockage in the coronary arteries that reduces blood flow to the heart muscle. Although both are medical emergencies, their mechanisms and treatments differ significantly.
Underlying coronary heart disease, causing a heart attack, is the most common cause of SCD in the elderly population, comprising about 80 per cent of cases. On the contrary, SCD in young people aged less than 40 years have heart attacks in about one-third of individuals, the remaining two-thirds either have diseases of cardiac muscle known as cardiomyopathy or specific electrical abnormalities such as Long QT Syndrome, Brugada Syndrome, and Wolff-Parkinson-White Syndrome, causing arrhythmias.
Triggers such as intense physical activity, dehydration, electrolyte imbalance, and substance use — stimulants, anabolic steroids, gym supplements, recreational drugs, or even excessive caffeine further elevate the risk of heart disease. Lifestyle factors like stress, sleep deprivation, smoking, uncontrolled hypertension, and undiagnosed diabetes also contribute to cardiac vulnerability, even in the young and seemingly healthy individual involved in strenuous exercise or competitive sports. Athletes who suffer from SCD during sports activities commonly have either cardiac muscle diseases like hypertrophic or arrhythmic cardiomyopathy or electrical disturbances/arrhythmias, instead of heart attacks. A pre-screening and regular annual health checkup of athletes can prevent this complication during sports activities.
COVID-19, vaccines, and the cardiovascular system
Vijayvergiya says the COVID-19 pandemic introduced new variables in cardiovascular health. Emerging evidence has shown that COVID-19 infection, even in mild or asymptomatic cases, can lead to myocarditis, inflammation of the heart muscle, which increases the risk of arrhythmias and sudden cardiac death. This risk persists even after recovery, particularly among young individuals who resume intense physical activity. While COVID-19 vaccines have played a critical role in reducing severe illness and mortality, some rare cardiac side effects have been reported, particularly vaccine-associated myocarditis, predominantly in young males after mRNA-based vaccines. Most cases have been mild and self-limiting, but a few have led to complications, the interventional cardiologist adds.
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According to Vijayvergiya, the overall incidence of vaccine-induced myocarditis remains significantly lower than cardiac complications caused by COVID-19 itself.
“Continuous post-vaccination surveillance and research are crucial for monitoring long-term effects. However, the benefits of vaccination overwhelmingly outweigh the risks in preventing COVID-related cardiovascular events.”
Obesity a major factor
Obesity is a significant contributor to cardiovascular risk. It can result in autonomic imbalance, prolonged QT interval, structural changes such as ventricular hypertrophy, chronic inflammation, and myocardial fibrosis, all of which predispose the heart to fatal arrhythmias. They are also prone to having hypertension and diabetes, which are risk factors for heart attacks.
The dangers of weight-loss and slimming products
In the quest for quick weight loss, many turn to unregulated slimming pills or herbal supplements. “These may contain banned substances like sibutramine or potent stimulants such as ephedrine and ephedra, which can dangerously elevate heart rate and blood pressure, sometimes leading to SCD, especially during physical exertion,” Vijayvergiya underscores.
Anti-ageing drugs and their hidden risks
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Anti-ageing therapies, though popular, lack comprehensive safety data. Many such drugs, including glutathione, growth hormones, testosterone, and nicotinamide adenine dinucleotide (NAD⁺) boosters, are used off-label or in unregulated settings. These compounds may influence cardiovascular parameters by increasing blood pressure, thickening blood, or accelerating metabolism, which can lead to arrhythmias or thrombotic events. Injectable skin-whitening agents like glutathione and Vitamin C lack FDA approval and may cause organ toxicity or life-threatening reactions like Stevens-Johnson Syndrome.
A heart under constant attack
Our fast-paced modern lifestyles overload the heart. Factors such as processed food, late-night work, poor sleep, excessive screen time, and unregulated exercise regimes can create cumulative stress. Supplement misuse, sedentary behaviour, and chronic mental strain disrupt heart rhythm and promote inflammation, weakening the heart’s ability to recover and increasing the risk of SCD.
One in five Indian women between 15 to 49 years has untreated hypertension
Cardiovascular disease is the leading cause of death among women globally, surpassing even breast cancer. Yet, symptoms in women are often misdiagnosed. Nausea, fatigue, and shortness of breath are frequently mistaken for symptoms of gastric issues. Hormonal changes, depression, and unregulated cosmetic hormone treatments may elevate cardiac risk.
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“One in five Indian women between 15 to 49 years has untreated hypertension. Early detection and awareness are critical,” says Vijayvergiya.
Don’t ignore these symptoms
Before a sudden cardiac arrest, the body often sends subtle warnings: Dizziness or fainting
Acute onset of shortness of breath
Chest discomfort or tightness at rest or during exertion
Heart palpitations
Unexplained SCD in family members under the age of 30 years
These signs are frequently dismissed as stress or exertion. However, they may indicate serious heart issues. With the out-of-hospital cardiac arrest survival rate under 10 per cent, early CPR can double or triple survival chances. Unfortunately, CPR awareness remains low in India.
What can you do?
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Vijayvergiya advises regular screening of ECG, blood pressure, lipid profile, and if required, echocardiography or treadmill after the age of 40 years. If the above warning symptoms are present, the screening should be done at a younger age. The interventional cardiologist further recommends following actions:
Know your family history about hypertension, diabetes, heart disease and SCD
Maintain a heart-healthy lifestyle. Avoid smoking, drugs, and unregulated supplements
Learn CPR. It can save lives in critical moments
Advocate for public CPR training and Automated External Defibrillators (AED) installation in schools, gyms, and public places
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Workplaces and educational institutions should prioritise health screening and CPR education. Fitness centres and sports clubs must mandate pre-participation cardiac evaluation
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