The death of 39-year-old cardiac surgeon, Dr. Gradlin Roy, at Saveetha Medical College in Chennai, Tamil Nadu, from a sudden cardiac arrest while performing duty rounds raises questions about the risks of stress and burnout.
On the face of it, Dr Roy was expected to live, considering he was in a hospital setting when he had a sudden cardiac arrest, which is a cessation of the heart’s electrical impulses and pumping. He was surrounded by colleagues who immediately administered CPR (cardio-pulmonary resuscitation) and other advanced treatments. Since he had a 100 per cent blockage in his left main artery, he underwent angioplasty, a procedure to unblock it and was even put on an ECMO machine, which functions as a temporary heart and lung support system.
Dr Ranjan Shetty, lead cardiologist and medical director at Sparsh Hospitals, Bengaluru, says, “His death has brought attention to why many young cardiologists are vulnerable because of the toll that a high stress environment, burnout, long duty hours, irregular diet and sleep patterns takes on their bodies.” He himself has seen at least two cardiologists die in a hospital setting when he had been present. A proponent of CPR training for everybody, Dr Shetty says, “Without it chances of survival from sudden cardiac arrest are almost nil, but with it, chances of survival are 40 per cent. Death happens when the sudden cardiac arrest has damaged a significant portion of the heart muscle.”
Why a left artery blockage is dangerous
A 100% blockage of the left main artery cuts off about 50 per cent of the blood supply to a critical section of the heart muscle, damaging it completely. This can cause the heart’s normal electrical signals to become erratic, what we call arrhythmia. The most dangerous is ventricular fibrillation, where the heart’s lower chambers beat chaotically, preventing the heart from pumping blood effectively. This causes sudden cardiac arrest and can be fatal within minutes as oxygenated blood cannot reach organs.
Why are we seeing more doctors die of cardiac complications?
Stress and burnout lead to chronic inflammation, which weakens the blood vessels in the heart, making them prone to wear and tear. Now their damaged walls allow “bad” or low density lipoprotein (LDL) cholesterol to enter and get trapped. This leads to plaques and blockages.
Many studies have highlighted how a doctor’s lifespan is actually lower than the general public. A 2017 study by the IMA in Kerala found that doctors died nearly 13 years earlier than the general public. It reported the mean age of death for a Malayali doctor as 61.75 years, while the life expectancy for a person from Kerala was 74.9 years.
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Doctors also tend to ignore symptoms like sudden and unexplained fatigue, mild pain, nausea and light-headedness as exhaustion.
What are triggers for young doctors and busy professionals?
Doctors work long, irregular hours under immense pressure and emergency situations, 80-hour work weeks being common. This leads to poor lifestyle choices, including irregular eating, lack of sleep, unhealthy diets and insufficient physical exercise. The stress impacts their mental health status too, leading to high anxiety and depression. Medicos have a higher suicide risk than the general population.
Retention of tension is hypertension. Young doctors and professionals must keep their BP levels in check. High BP with stress leads to overproduction of stress-related hormones in the body. These damage artery walls too.
What about genetic conditions young people must be aware of?
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Some Indians inherit a condition, which increases their levels of LDL cholesterol and make them not only vulnerable to developing heart disease at a younger age but expose them to a higher risk of mortality. This disorder, called hypercholesterolemia, allows cholesterol to build up regardless of your weight, diet, habits and exercise. Within LDL cholesterol too, the ratio of ‘small dense’ LDL fraction to the ‘big buoyant’ fraction is important (the smaller closely packed particles being more damaging to blood vessel walls).
You can do a full lipid panel test for apolipoproteins A1 (ApoA1) and B (ApoB), which are proteins essential for transporting fats (lipids) in the blood. ApoA1 is the main component of “good” or high density lipoprotein (HDL), and ApoB is the primary protein for LDL. Their comparative ratio is a risk marker. You may find people with ‘normal’ total cholesterol levels having heart attacks because these figures are abnormal. Keep your LDL levels low to less than 70 mg/dL, preferably 50 mg/dL.
