In the last two and half years -- since the beginning of the Covid-19 pandemic -- we have heard many news reports of otherwise apparently healthy people in adult groups dying of cardiac arrest and other heart ailments. The fact is that even before the pandemic, cardio-vascular diseases or the diseases related to heart and blood vessels have been the biggest contributors of all to mortality in India. Every year, an estimated 26 lakh people (one in every four deaths that happens in the country) die due to cardio-vascular diseases. Two in every five of these cardiovascular deaths are preventable.
When it comes to heart ailments, Myocardial Infarction (MI), or heart attack, is the most referred health incident; however, there are three distinct entities of incremental risk/severity -- angina, heart attack and cardiac arrest. Angina is the most common heart-related complaint. As we grow old, with every passing year in our life, the accumulation of fat in the arteries of the heart reduces the blood circulation to heart. This manifests as an initial complaint of pain in the left side of the chest that radiates towards the shoulder. It is a sign of “angina”. If the patient does not get medical attention at this stage, it may progress to the stage when blood supply to a part of the heart is completely stopped: this is termed as MI, or heart attack. In most MI cases, the heart may continue to beat; but if the blockage to the blood vessels, to either a large part of the heart or in the blood vessels which supply to a small but vital part is stopped, the heart may stop beating. This condition is called cardiac arrest. These three situations evolve over a period of time and usually in a progressive manner. However, people without any history of angina may have myocardial infarction or cardiac arrest as well.
The burden of cardio-vascular ailments in India is increasing every passing year. Obesity, due to sedentary lifestyles and a preference for junk food and unhealthy diets; the consumption of tobacco products; the rising share of the adult population with high blood pressure and diabetes (and some with both); deranged blood lipid profiles, and a high level of stress and anxiety are contributing to the increased risk of heart diseases. If we read the factors once again, we know these are linked to our lifestyle, so the risk can be reduced if we change to a healthier life.
Regular exercise of around 30 minutes a day or 150 minutes in a week is good for health. A balanced diet and timely meals; regular and adequate sleep of around eight hours, stopping smoking; reducing excessive use of alcohol can reduce the risk of heart diseases. If you have diabetes or hypertension, have a high cholesterol or triglycerides levels, start seeking medical consultation and follow the treatment advice. There is a deep connection between physical and mental health. Yoga and meditation can reduce your risk of heart disease.
A healthy lifestyle reduces risk but doesn’t bring it down to zero. So, it’s important to educate yourself and family members about the signs and symptoms and some do’s and don’ts for heart-related emergencies. The symptoms of “angina” include difficulty in breathing or heaviness in the chest, excessive sweating along with pain in the left side of the chest that radiates towards the tip of the shoulder. People who have had “angina” in the past are at a higher risk of MI. Such individuals and their families should keep some medicines like Sorbitrate, Aspirin and nitro-glycerine in an emergency kit at home. Though these medicines should only be administered on the advice of a medical doctor, their availability at home will reduce the delay in sourcing them in an emergency situation -- once advised over the phone by a doctor.
There are a few other basics which people need to know. The person suspected to have an angina or heart attack should not be made to walk or get physically exerted. He or she should be made to sit or lie on a bed. Taking the stairs or even walking up to an ambulance could be risky. Then, people also play down the potential heart attack risk with gas or acidity. The key difference is that in acidity, there is usually a belching or vomiting-like feeling and the pain is often localised. Knowing the differences in symptoms and taking some interventions before reaching hospitals can be life-saving.
Then, in cardiac emergencies, the situation can change very quickly. Within moments, the heart can stop beating, the person may fall unconscious and his pulse may stop, this is an indication of a “cardiac arrest” -- an emergency. If the cardiac arrest lasts for more than two to four minutes, the person may die. In such a situation, before a doctor or ambulance can reach, cardiopulmonary resuscitation (CPR) -- a simple but life-saving intervention -- needs to be started. In the absence of a trained person, any family member or even a bystander can initiate the CPR with instructions over a phone or video call from a doctor or ambulance staff.
Clearly, community members can also play a role in preventing serious heart events. In families with members having past incidents of angina or MI, at least one person in the family could be trained to perform CPR. It can save the life of family members or anyone in a cardiac emergency. At the community level, resident welfare associations (RWAs) can keep these medicines ready in emergency kits in a shared space, with wider information to others. The RWAs can facilitate the training sessions on cardiac life support and CPR for interested resident members. In rural areas -- where it may take some time for an ambulance to arrive or take a patient to a hospital -- gram panchayats can keep these life-saving drugs in first-aid kits. Some people in every village of the country should get training in CPR.
Heart diseases are preventable. If you have reached till this point of reading, it shows your interest to protect your heart. Let’s take some action and make it a habit. Please put down the newspaper and go for a brisk walk for 30 minutes, and incorporate a healthy lifestyle into our daily routine.