Heart ailments in young population

Chhatrapati Sambhajinagar: World Heart Day special

Dr Shraddha Runwal Gadiya, DM, interventional Cardiologist speaks to Dr Mangala Borkar.

Q: What are the causes of sudden cardiac death in the young?

*Acute myocardial infarction

*HOCM- a part of the heart muscles ‘overgrow.’

*ARVD

*Channelopathies like Brugada Syndrome, Long/Short QTc syndrome.

*Aortic Dissection. (internal tear in the main blood vessel, the aorta)

*Dilated Cardiomyopathy (heart muscles become weak and overstretched, cannot pump blood properly)

*Past Infection with Covid is also a potential risk.

Q: Risk factors of heart attack in young persons?

*Family history of coronary artery disease.

*Smoking, tobacco.

*Hypercholesterolemia

*Uncontrolled Diabetes Mellitus (DM).

*Sedentary lifestyle, obesity

*Emotional stress.

*Excess consumption of fast food, packed or fried food, vanaspati ghee (mithai and bakery products)

Q: If there is a strong history in the family, what precautions should siblings take?

*Regular exercise 30 minutes/day at least 5 days a week Eg. Walking, Jogging, Yoga, Pranayam, Swimming, Badminton.

*Weight maintenance.

*After 30 years of age, get the following blood tests done regularly:

Fasting Lipid Profile (Including Total Cholesterol, LDL (Bad) Cholesterol, HDL (Good Cholesterol), Triglyceride and apoB levels.

*Serum Homocysteine levels, Lipoprotein A levels, hsCRP levels.

*Advantage: High levels of these factors in blood, if detected and treated by appropriate medications, can reduce the familial risk of coronary artery disease.

*Fasting blood sugar, Hba1c levels if there is family history of DM.

*Get your annual ECG, 2D ECHO TMT/ 4D ECHO GLS done.

*24 hr ambulatory BP monitoring for young patients with borderline blood pressure levels.

*Increase the use of extra-virgin olive oil, groundnuts, almonds, walnuts, green leafy vegetables and fruits in diet.

*Take regular medications if one has hypertension/DM/thyroid disorders.

Q: How can other heart ailments in young patients be detected and treated?

*A simple ECG and 24 hr Holter monitoring can detect conditions like:

Brugada Syndrome, Long/Short QT Syndrome, ARVD. ICD can reduce risk of sudden cardiac death in the above.

SVT (sudden onset palpitations) can be corrected with electrophysiological study and removing the focus in the heart by ablation.

*A 2D ECHO can detect conditions like:

HOCM (Increased thickness of muscles of partition in heart between left and right side),

ÀRVD (Increased thickness of right ventricular tip).

Aortic dissection (sudden tear of aorta in conditions like accelerated hypertension, Marfan syndrome [patients with long limbs])

Dilated Cardiomyopathy (reduced pumping of heart), Valvular Heart diseases (Leakage/blockage in heart valves), structural heart diseases like PDA, ASD, VSD (a hole in heart)

Aortic Aneurysm (excess increase in size of aorta)

Timely detection and treatment is the key in these ailments.

Q. What are the new medicines for high cholesterol?

Oral drugs like statins, ezetemibe, bempedoic acid, fibrates and even injectable 2weekly injections like alirocumab and evolocumab are available.

Q. Who should undergo a coronary angiography?

*One who has had a heart attack (Acute Myocardial infarction)

*Patients with positive TMT (Stress test), reduced GLS (<-15%)

*Patients with risk factors and history of unexplained breathlessness on exertion, resistant typical chest pain

*Those who have undergone angioplasty/bypass, with new onset persistent chest pain/breathlessness.

*Coronary artery Aneurysms in children with Kawasaki disease.

*Patients with high calcium score on CT- angiography.