The uncommon heart attack that killed actor Vikas Sethi and others

Actor Vikas Sethi, best known for his roles in TV shows such as Kyunki Saas Bhi Kabhi Bahu Thi, Kahiin To Hoga, and Sasural Simar Ka, passed away in his sleep on September 8 in Nashik. His family members said the 48-year-old actor showed no prior symptoms nor did he complain of any pain or uneasiness associated with the onset of a heart attack. According to his family, Vikas had no history of cardiac issues and maintained a regular fitness routine. Sethi’s case was similar to that of 47-year-old former Mumbai Cricket Association chief Amol Kale, who died in his sleep while in New York to watch the India-Pakistan match during the T20 World Cup in June. Doctors said that sudden heart attacks, even among seemingly healthy and younger people, are becoming more and more common. Absence of warning signs The actor’s wife Jhanvi Sethi said they were travelling from Mumbai to Nashik for a family function when Vikas complained of feeling unwell. She said when they reached Nashik he was dehydrated, was vomiting and an upset stomach. However, since he was reluctant to go to a hospital, Jhanvi arranged for a doctor to visit them at home.However, when she tried to wake up him up the next morning, Vikas was unresponsive. A doctor told the family he had died after suffering a heart attack in his sleep.A heart specialist said that symptoms like persistent chest pain, unexplained sweating, palpitations, breathlessness, indigestion, abdominal pain, lightheadedness and frequent waking up feeling unwell are symptoms that shouldn’t be ignored. “Indian ethnicity itself is a known risk factor for coronary artery disease and acute heart attacks. However, the recent rise in sudden heart attacks, particularly among young individuals, is largely due to lifestyle changes we have adopted over the past few decades,” said Dr CK Ponde, cardiologist at the PD Hinduja Hospital in Mumbai. He said that nearly 25% of all heart attacks globally occur when the patient is asleep. Sleep patterns are also a warning of how likely one is to suffer a heart attack. Dr Ponde said that getting less than six hours of sleep increases one’s heart attack by 20%, but sleeping more than nine hours raises it by 35%. A heart attack with uncommon symptoms Dr Anand Ram, consultant interventional cardiologist at Wockhardt Hospitals in Mumbai, said that symptoms of an impending heart attack during sleep differ based on age. Older patients may experience well known 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 said. medium nocaption113263890Another cardiologist said that it was surprising to see more cases of heart attacks and strokes occurring early in the early hours of the day. But he said there are factors that might contribute to this. “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,” said Dr Prashant Pawar, cardiologist at Fortis Hiranandani Hospital in Vashi. Dr Rajesh Rajani, consultant coronary interventionist at the PD Hinduja Hospital said that 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,” said Dr Rajani.Can such heart attacks be predicted, or prepared for, better?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 the 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. Many 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. medium nocaption113265068Dr Rajesh Bendre, chief pathologist at Apollo Diagnostics, said 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 said. But a major factor in sudden heart attacks is sleep. Experts say whether due to 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 nocaption113264130“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," said 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 said.