Thirty might be the new 60, as as far as coronary artery disease is goes. Satish Kumar discovered this in a rather unpleasant way. The thirty-seven-year old merchant navy officer skipped his daily walk with his wife one day a couple of months ago because he was feeling breathless.
“I didn’t think it was anything to worry about,” said Kumar, father to a nine-year-old boy. “I was also having some pain in my lower jaw and decided to go to the dentist.” Kumar’s dentist did not find anything wrong with his teeth or gums.
Suddenly, in the first week of August, Kumar felt heaviness in his chest. He thought it might be indigestion but decided to go to a hospital where he was told that it was his heart. "I didn’t feel like I was having a heart attack or something,” said Kumar.
“He was not ready to believe,” said Dr VT Shah, the cardiologist who performed a computer tomogrpahy angiogram on Kumar to take detailed X-ray pictures of his heart. “The angiogram showed that he has five blockages and only then [Kumar] was convinced to undergo an angiography.”
Kumar underwent the procedure by which a thin hollow tube called a catheter with a dye was passed through an artery in his leg and moved up to his heart. The dye highlighted his five blockages. Kumar’s worst fear came true with the angiography confirming that his blockages needed urgent surgery. The more routine angioplasty would just not cut it.
“It was a bad case," said Shah. "Three of his blockages were in a single artery and placing stents would not help.”
On August 29, Kumar underwent a bypass surgery where the damaged arteries were replaced with healthy arteries taken from another part of his body. At the hospital, it is not common to see a 37-year-old getting heart surgery. “Everyone kept on asking me 'who is the patient?' and I had to say I am the one who is getting a heart operation,” said Kumar.
Dr Shah said that bypass surgeries in such young patients are unheard of. “It’s mostly the people in their 60s and 70s who are advised a bypass but in [Kumar’s] case the disease was too extensive,” he said. “10 years ago, his case would have surprised me but not today.”
Diseased hearts of 30-year-olds
Over the years the proportion of people in their 20s and 30s developing coronary artery disease has only increased, said Shah. A study by the National Intervention Council, an association of cardiologists in India, found that one in ten Indian who underwent an angioplasty procedure last year was below 40 years of age.
The council's chairman Dr NN Khanna recalled a case of a 17-year-old Delhi boy who required an angioplasty after he was detected of a critical heart blockage. “He was addicted to smoking,” said Khanna. “He also had a family history of heart diseases.”
Doctors more often blame what they call the “fast” lifestyle that involves smoking and high stress for the increasing number of people developing coronary artery diseases - conditions where blood vessels in the heart narrow because of the deposition of fatty plaque. Such hardened blood vessels compromise the pumping capacity of the heart which doctors describe as the ejection fraction rate. “The lower the rate more the heart damage,” said Shah.
Now, these hardened blood vessels need to be opened up so that the heart can pump to its full capacity. “If these hardened vessels are not corrected there is a risk of a blockage which can trigger a heart attack,” explained Shah. In Kumar’s case there were five such blockages. One blockage was a 100% meaning it had completely blocked the passage of blood in the vessel. Doctors said that Kumar was sitting on a time bomb with a heart attack waiting to strike.
Diabetes and blood pressure also make a person vulnerable of developing a coronary artery disease, said doctors. Despite medical interventions, ischemic heart disease continues to remain the leading cause of death among Indians, according to a 2010 report by the World Health Organisation. Ischemic heart disease is a broader term to describe heart diseases that occur because of narrowed or hardened blood vessels in the heart.
Kumar who does not smoke and drinks occasionally blames his hectic working hours. “When we are picking or dropping oil from the ship, we work continuously for 18-20 hours. There is also a lot of responsibility, it kept me worried,” he said. He has taken a few months off to recuperate from the big surgery.
Cardiologist Khanna said that Indians are losing seven years of their productive life because of non-communicable diseases which includes coronary artery disease according to a World Health Organization’s research. “We are a young nation and the government has to focus not just on prevention in terms of health check-ups but improving the quality of life of the working class,” he said. “It is time that companies start looking at the happiness quotient of their employees. If they take sick, the overall productivity of the company will be adversely affected.”
Meanwhile, a study led by senior cardiologist Dr Upendra Kaul at Fortis Flt. Lt. Rajan Dhall Hospital between 2011 and 2015 among 12,152 patients found that only 0.3% of all patients were below the age of 30 years. “Our study debunks the myth that young Indians are developing heart disease earlier compared to their western counterparts,” said Kaul.
Kaul’s study raises the question about whether people are unnecessarily undergoing angioplasties for a heart conditions that can be managed with medicines. “I cannot comment on that but our study proves that it is myth that young people are getting heart attacks,” said Kaul.
The Asian Heart Institute’s managing director Dr R Panda said that one-third of the patients who come to his hospital after they have been advised an angioplasty can be managed with medicines and lifestyle alterations. he believes that many doctors are playing off the fear of their patients to recommend angioplasties.
“A patient has to ask the doctor about the risk that the block poses," he said. "If an angioplasty will reduce the risk to life, it should be done, but if it is going to improve the quality of life, the patient should take the call.”
Last week, two patients who walked in at Surana Sethia Hospital in Chembur for second-opinions were told that they did not need angioplasties. “One of them had a 20% blockage which could be easily managed with medications,"said Dr Prince Surana. "He was told that he has an 80% blockage at another hospital. This is just a minuscule number of cases, most patients are advised a procedure only if they need it.”
The Surana Sethia Hospital claims to perform the highest number of angioplasty procedures in Mumbai.
Women succumb too
Over the last two years, Star Health, a private health insurance provider has seen a 95% rise in the number of claims by women for hospitalisations as a result of coronary artery disease. Dr Vijay Surase, a cardiologist from Thane is not surprised as his clinic has witnessed an increasing number of women patients. “Some years ago my clinic would only have male patients but now I treat an equal number of women,” he said.
Heart disease has been thought of as a man’s disease for years. “Women are protected because of their hormones but they are losing this protection because of their lifestyle choices they are making,” said Khanna. “Not many women know that the regular used of contraceptive pills put them at the risk of developing heart disease.”
"It is bound to happen," said Surase. "[Women] too are having an erratic lifestyle with bad food habits along with smoking and drinking.”
Surase recently performed an angioplasty on a 35-year-old IT professional who has an ejection-fraction rate of 25% which had damaged her heart. The normal ejection fraction rate is 55% to 75%. “The procedure went well but she will require a prolonged cardiac rehabilitation for the damage done to her heart,” said Surase.
Indraprastha Apollo Hospital’s cardiologist Khanna said than women need to be more careful as the symptoms they develop while having a heart attack are very vague. “They don’t have the typical chest pain. Hence, they have a higher chance of dying of a heart attack,” said Khanna.
Kumar wished that he was aware of the telltale signs of a heart attack. “You hear and talk of such disease in your 50s and 60s. No one in my family has ever been hospitalised and I could not accept that I was undergoing a bypass,” he said.
Shah who treated Kumar said that many young people are in a denial which only leads to delay in diagnosis and treatment. “The faster the treatment, the lesser damage to the heart,” said Shah.