According to Dr Sivarani Sathasivam, consultant cardiologist and physician at ParkCity Medical Centre, heart attacks are becoming more common among young Malaysians.
“Previously, heart attacks would generally only occur among people above 60 years old. However, we have seen a drastic increase in heart attack patients who are below 40 years of age.”
She relates this issue to the modifiable and non-modifiable risk factors of a heart attack:
• Non-modifiable – Age and genetic factors such as family history of heart attack at a young age (especially first-degree relatives)
• Modifiable – Conditions such as diabetes, high blood pressure and high cholesterol, in addition to smoking, physical inactivity and obesity as a result of lifestyle choices
Dr Sivarani says youths are developing more of these modifiable risk factors and most of them go unnoticed until it is too late.
Early knowledge, better prevention
Dr Sivarani sees a need for early detection and treatment and advocates for earlier health screening from as young as 30 years old, especially if the person has a family history of heart attack and other existing conditions such as diabetes, high blood pressure and high cholesterol.
Health screening is important because even patients at high risk may not experience any symptoms until the heart attack occurs. Dr Sivarani says, “Normally, younger patients come in for a different sickness such as a fever or cold.
“However, when we check their vitals and notice their blood pressure, blood sugar level and cholesterol levels are high, we will screen them for heart disease. This is when we discover blockages in their arteries.”
Unfounded fear of pills
The risk of dying from a heart attack depends on the severity of the attack, and not on the age of the patient. Therefore, it is advisable to seek medical treatment as soon as you know you have diabetes, high blood pressure or high cholesterol.
Some people may be in denial because they are asymptomatic, but Dr Sivarani cautions that the first symptom you experience might just be a heart attack. The decision to refuse treatment and instead opt for traditional medicine, exercise and diet without a doctor’s guidance is also not advisable.
The fear of taking medication is a factor, but Dr Sivarani says that it is actually worth it to start medication early, especially when it means you can enjoy good health and to prevent complications that may cause irreversible damage.
She says, “Be brave and face your fear. While it is true you may have to take medication for the rest of your life, your quality of life will certainly be better.”
When the heart’s rhythm speeds up
Your heart will always pump quickly when doing strenuous physical activities. It responds to the increase in demand of the exercising body. However, if your heart is pumping fast without a reason, you may have supraventricular tachycardia (SVT).
Ara Damansara Medical Centre consultant cardiologist Dr Ahmad Nizar Jamaluddin says SVT refers to abnormal rapid heart rates that originate above the ventricles (supraventricular) in the atria or AV node.
Common symptoms of supraventricular tachycardia may include a fluttering of the chest, rapid heartbeat (palpitations), shortness of breath, a pounding sensation in the neck, chest discomfort, sweating, pale appearance, dizziness and, in rare instances, fainting or near fainting.
Dr Ahmad Nizar says the underlying causes of SVT are:
• Abnormal automaticity (5% of patients) – The heart’s pacemaker sets the rhythm of the heartbeat. However, abnormal areas of electrical activity can trigger and sustain an abnormal rhythm.
• Abnormal conduction (95% of patients) – The upper and lower chambers of the heart are separated electrically by a fibrous ring and the atrioventricular node (AV node) is the only pathway for signals to travel from the atria to the ventricles.
Some people are born with extra muscle tissue bridging the fibrous ring. In the right conditions, electrical current carried to the lower chamber may find itself travelling back into the upper chamber through these bridges, thus causing a short circuit, resulting in rapid heartbeats.
For some, their SVT attack is related to an obvious trigger, such as psychological stress, lack of sleep or physical activity. For others, there may be no identifiable trigger.
Certain conditions can also contribute to the development or increased severity of SVT, including pregnancy, surgery, chest infections, heart failure and thyroid disease. Over time, untreated and frequent episodes of SVT may weaken the heart and lead to heart failure, particularly if you have other coexisting medical conditions.
SVT is generally diagnosed in childhood and young adults, but Dr Ahmad Nizar has observed that SVTs can occur in adults in their 60s, as well.
If you feel or suspect that you are having an attack, the next step is to go for an electrocardiogram (ECG). However, some attacks occur infrequently or in too short of a span to be recorded at the hospital. Hence, patients can be equipped with portable ECGs:
• Event loop recorder – For sporadic episodes of SVT, keep a portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.
• 24-hour ambulatory ECG – For patients with frequent SVT attacks, the portable ECG device can be worn for a day or more to record your heart’s activity as you go about your routine.
• Implantable event loop recorder – This device is inserted under the skin near the heart for up to three years. This is usually for patients with very rare but severe symptomatic episodes of SVT.
If arrhythmia cannot be identified during those tests, provocative tests may be required to trigger your arrhythmia. These tests may include:
• Stress test – For some people, supraventricular tachycardia is triggered or worsened by stress or exercise. During a stress test, you’ll be asked to exercise on a treadmill while your heart activity is monitored.
• Electrophysiological testing and mapping – In this test, thin tubes (catheters) tipped with electrodes are threaded through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart.
In addition, the electrodes will allow the heart to be stimulated and made to beat at rates that may trigger or stop an arrhythmia. This allows the location of the arrhythmia to be identified and the underlying mechanism to be determined.