Written by Dr. Palani Kannan
Recently, the death of 35-year-old cricketer Imran Patel after a sudden cardiac arrest while walking back to the pavilion during a match has raised questions about why young people, particularly athletes or those into active sports and fitness, are prone to heart disease despite exercising and maintaining discipline. The sudden death of South Korean actor Park Min Jae, 32, has compounded that worry.
Let’s understand both first. A heart attack is the result of blockages and clotting in arteries which restrict blood flow to the heart. A sudden cardiac arrest is not caused by a blockage but by a sudden shutdown of the heart’s electrical impulses. However, if the heart attack can change the heart’s electrical impulses, then it could become a trigger for a sudden cardiac arrest. A heart attack is quickly identifiable from changes in the ECG (electrocardiogram). A sudden cardiac arrest doesn’t give you time, the patient collapses.
KNOW YOUR TRIGGERS
1. Unrecognised genetic disorders: Genetic conditions such as Hypertrophic Cardiomyopathy (HCM), which end up thickening the heart muscle and enlarging it, may not be detected until physical exertion triggers abnormal heart rhythms and shuts down the heart.
2. Intense physical strain: Since sportsmen work out hard, overexertion during exercise or competition can raise blood pressure and heart rate to dangerous levels, potentially leading to overwhelming the heart. Sometimes, heart rhythm abnormalities happen because of continuous and intense heart activity. This is called an athlete heart, where the heart muscle fibre can be in a disarray and the increased stress can cause irregular heartbeats in the heart’s pumping chamber, leading to sudden cardiac arrest. These changes happen because the sportsperson’s heart adapts to increase its ability to supply blood and oxygen to the tissues that are being exercised during a sport.
3. Lifestyle factors like dehydration, irregular sleep patterns and insufficient recovery time can add to the risk at times. Dehydration is an important but commonly neglected cause. Inadequate fluids cause blood to become viscous, hence the heart works harder to pump blood. Along with electrolyte imbalance, dehydration can cause the heart’s electrical signals to become irregular, cause arrhythmias or even cardiac arrest. The thickened blood can also cause blockage in arteries.
4. Environmental Stressors: Extreme heat or cold, prolonged sweating, or rapid changes in body temperature can make the cardiovascular system work much harder to pump blood. For those with underlying conditions like diabetes, cholesterol or with a family history, even short-term stress like these can dislodge plaques from the arteries, resulting in a blood clot that, in its attempt to repair the torn wall of the arteries, could grow large enough to block blood flow and trigger a heart attack.
• Mental stress: Emotional pressures, seen in mostly competitive sports or in cases of performance anxiety, can cause an adrenaline rush that stresses out the heart.
PREVENTING HEART EPISODES
I would recommend an echocardiogram and a regular cardiac evaluation, proper hydration and electrolyte balance, proper rest and recovery after intense exercises, monitoring and managing stress levels. Control co-morbidities like hypertension and diabetes, quit smoking, keep to a balanced diet and exercise.
(Dr Palani Kannan is Consultant Interventional Cardiologist, Apollo Spectra Hospital, Chennai)
