In recent times several instances of young fit persons collapsing with cardiac arrest soon after a decent work out have come to notice. There has been a lot of media coverage especially as some celebrities in prime of their lives succumbed suddenly. Naturally a lot of people are uncertain if it is even safe to exercise in the gyms which they have inhabited for years. Time to put this entire issue in perspective.
Our heart has two muscular pumping chambers called ventricles which get an electric impulse through an internal wiring that triggers a contraction about 70 times each minute. For this process to sustain lifelong, nutrition must reach the heart muscles through three main soft pipes like coronary arteries.
Some individuals are at a high-risk to develop cholesterol deposits called plaques within the lining of these coronary arteries. These soft plaques slowly grow to bulge into the lumen of the coronary arteries causing obstruction to flow of blood carrying the nutrients. Such individuals include those who either have a family tendency for heart blockages or smoke or have diabetes or high blood pressure or a high blood cholesterol level or have a sedentary lifestyle.
The plaques may slowly progress to a level where they start obstructing and slowing down the blood flowing through the coronary arteries. This stagnating blood can suddenly curdle up to form a clot that chokes the narrowed passage resulting in abrupt stoppage of blood flow to that region of heart muscle, damaging it irreversibly in the next few hours. This is a heart attack which apart from irreversible muscle damage also carries a 50 percent risk of suddenly triggering a sparking within the electrical wiring in the damaged muscle. This sparking has the potential to seize the heart to a standstill called cardiac arrest.
A heavy unaccustomed exercise or a bout of severe anxiety stimulates the sympathetic adrenergic system of the body. This has a potential to create severe spasm of coronary arteries that can at times lead to rupture of a soft plaque which may be just 20 – 40 percent stenosis and not yet obstructive. The contents released from a ruptured plaque come in contact with blood and trigger immediate clot formation which occludes the artery causing a heart attack. Such heart attacks due to rupture of minor plaques are seen more in younger people who don’t even get the prior warning symptoms of angina.
How does one address this situation rather than panicking?
Of course, a good lifestyle is most important which includes healthy eating; no smoking, stress management techniques and graded exercise build up under guidance within tolerance levels. Those at higher risk have to be more careful in detecting early plaque formation within their coronaries utilizing current imaging technology under supervision of their physicians. Early and aggressive intervention with lifestyle and drugs can save many such young lives if detected in time.
Dr Atul Mathur is Executive Director of Cardiology and Chief of Cath Labs at Fortis Escorts Heart Institute, New Delhi
