He watched India-Pak clash. Hours later, he died of a heart attack in his sleep

The 47-year-old president of the Mumbai Cricket Association was in New York to watch the big-ticket clash between India and Pakistan at the Nassau County Cricket Stadium on Long Island. After the mega match, he went out for dinner with friends and then turned in for the night. Amol Kale passed away in his sleep on June 10 after suffering a massive heart attack. He had reportedly not shown, or complained, of any symptoms associated with a heart attack. But Kale's case is not isolated. Doctors say there may be less typical symptoms seen among younger patients which makes them prone to such heart attacks either while asleep or as they are waking, even if they have no previous history of heart disease. 111156436Uncommon symptoms in younger patientsA specialist says that persistent chest pain, unexplained sweating, palpitations, breathlessness, indigestion, abdominal pain, lightheadedness and frequent waking up feeling unwell are symptoms that shouldn’t be ignored. “It is crucial not to neglect these warning signs and immediately seek medical attention for prompt diagnosis,” says Dr Anand Ram, consultant interventional cardiologist at Wockhardt Hospitals, Mumbai. He says the symptoms may differ based on age, with older patients experiencing more familiar symptoms like sharp chest pain, persistent shoulder and jaw pain, difficulty in breathing, cold sweats and nausea.“However, younger patients may have milder or atypical symptoms such as fatigue, episodes of vomiting, heartburn, indigestion, dizziness and persistent abdominal pain. These symptoms can be easily overlooked by patients, thinking they are too young for a heart attack," he says. Another cardiologist says that it is suprising to see more cases of heart attacks and strokes occurring early in the morning. But he explains that there are factors that might contribute to such events. “One reason is increased platelet reactivity during early morning hours, which causes clot formation. Additionally, people who snore have a high incidence of sleep apnea, leading to elevated blood pressure in the morning,” says Dr Prashant Pawar, cardiologist at Fortis Hiranandani Hospital in Vashi. Dr Rajesh Rajani, a consultant coronary interventionist at PD Hinduja Hospital says sleep-related heart events have increased among younger patients with no known issues and are often linked to obstructive sleep apnea. “Sudden heart attacks involve existing blockages that, when combined with obstructive sleep apnea, lead to oxygen deprivation. This results in a lack of blood supply to the heart, causing it to fibrillate, which can result in death during sleep,” says Dr Rajani. medium nocaption111158394Can such heart attacks be predicted or prepared for?The question over who should undergo tests, and when, remains a matter of debate. Prominent cardiologist Dr Devi Shetty had argued that there’s no such thing as a sudden cardiac arrest. “One tends to equate how fit you feel with how fit you are. Unfortunately, most of the time how fit you feel has nothing to do with how fit you are. Even if you climbed Mount Everest twice in a month, I still could not certify you as fit without physical examination and checking your blood test, ECG, echocardiogram, cardiac CT scan,” he wrote in a column for TOI+.Doctors have pointed to lack of awareness of the preventable risk factors as one of the key factors responsible for the rising rate of sudden cardiac deaths among younger Indians. Dr Shetty had also argued that every Indian male over the age of 40 may be a heart patient. However, there is no unanimity among doctors about this theory. Some believe this is panic-mongering and could induce people into undergoing checkup for no reason. Cardiologists have also said that while it’s not necessary to undergo tests before starting exercise regimens, it’s best to get checked if there’s any discomfort during or after a workout. Dr Rajesh Bendre, chief pathologist at Apollo Diagnostics, says regular electrocardiograms (ECG/EKG) to monitor the heart's electrical activity, stress tests, cardiac CT scans, and genetic testing will help youngsters understand their family history of heart conditions. “Youngsters should not ignore signs such as chest pain [angina], breathlessness, jaw pain, arm and shoulder weakness, irregular heartbeats, dizziness, and lightheadedness. They should consult a doctor for comprehensive heart screening," he says. But a major factor in such sudden heart attacks is sleep. Experts say untreated conditions like obstructive sleep apnea or just a lack of sleep due to other reasons significantly raises the possibility of a sudden heart attack. medium nocaption111158407“Studies have shown a possible link between sleep and heart attacks. People who are sleep deprived or do not get more than 7 to 8 hours of sleep significantly raise their chances of a sudden heart attack," says Dr Sameer V Pagad, senior interventional cardiologist at Gleneagles Hospitals Parel. “The body's circadian rhythm plays a crucial role in managing blood pressure and heart function during different phases of sleep. Factors such as age, family history, and late-night eating habits also contribute to cardiac events. It is imperative for everyone to go for regular cardiac screening after 25 to know the status of their heart health," he says.