Widely conceived to occur in 'obese' and 'high-on-cholesterol' people, recent instances of young people 'collapsing' from heart attacks may tell a different, alarming story.

Many videos have emerged showing people doing everyday activities such as walking on the street, working out at gyms, and dancing at weddings before seemingly 'dropping' due to a heart attack but eminent cardiologists feel the reason could be 'unaccustomed exercise' or 'over exercise' that could precipitate heart attacks in the young.

Over the past couple of years, there has been a surge in cases of heart attacks, especially between 25 and 50 years of age including several celebrities, a singer, and the recent case of a comedian. This has brought to the fore some widely held misconceptions about heart attacks and cardiac arrests and the need to address them.

Biologically, what is going on? "Heart attacks happen due to sudden blockages in arteries that supply blood and nutrition to the heart," says Dr Nitish Naik, professor, the Department of Cardiology, All India Institute of Medical Sciences.

"There is fat plaque build-up in the artery. It ruptures and enters the blood vessel, forming a clot and suddenly choking it," explains Dr Ajay Kaul, chairman of Cardiac Sciences, Fortis Hospital Noida, and in charge of cardiac surgery and cardiology.

But what causes this to happen? "People who smoke, have a sedentary lifestyle, are morbidly obese, have poorly controlled blood pressure or diabetes, or have high cholesterol levels are prone to develop such conditions," says Naik. However, it is not as simple as that. Undertaking strenuous activity at the gym may also be the cause.

"Unaccustomed exercise can precipitate a cardiac arrest, therefore, untrained exercise should not be done," says Dr Viveka Kumar, principal director & chief of Cath Labs, Pan Max - Cardiac Sciences.

"Yes, over-exercise can cause rupture of plaques in the coronary vessels, leading to cardiac arrests," says Dr Vijaya Kumar, senior consultant, and interventional Cardiologist, Ujala Cygnus BrightStar Hospital, Moradabad.

"Plaque rupture is the disruption of the cap of the plaque build-up, leading to the exposure of plaque material to the blood in the vessel. A rapid sequence of events follows, resulting in clot formation, blocking the blood flow," explains Dr Vineet Bhatia, Associate Director, Department of Cardiology, Max Hospital, Patparganj, New Delhi.

But it is not just unaccustomed exercise. There is talk of COVID too causing heart attacks. So, how much is COVID a contributor? "Statistically speaking, in young people, 15-18 per cent of the cases," says Viveka Kumar.

"It is true that COVID has caused a lot of problems. COVID leads to blood clotting. COVID leads to heart and lung problems and cardiovascular diseases," says Kaul. So, how can one know if COVID or over-exercise is the culprit causing heart problems? "Evaluation. Go to a doctor, and they will tell you whether COVID was limited only to your lungs or not," says Kaul.

In the fight against COVID, vaccines have been instrumental. However, COVID vaccines have also been known to cause some heart attacks. How worried should we be about this being the case? "Benefits far outweigh the risks. Vaccination has a lot of other problems. Yes, it has. But the numbers are so small, that you need to ignore them. Secondly, it is COVID that can lead to heart problems more," says Kaul.

"According to a recent report in the British Medical Journal, COVID-19 vaccines may rarely (1.7 out of 100,000 people) lead to myocarditis. The benefits of vaccination far outweigh the risk of adverse reactions," says Bhatia, justifying taking the COVID vaccine.

"On the other hand, a review of 51 studies in a leading British medical journal, The Heart, which included 48,317 people with COVID-19, found that cardiac ailments, high blood pressure, and diabetes were associated with a higher risk of severe disease or death due to COVID-19 across all age groups," he adds.

Cardiologists agree on the notion of getting a cardiac risk evaluation or consulting with a physician to inform oneself if long COVID is causing heart problems, of their exercise requirements or if one is genetically predisposed to getting a heart attack. "Before going to the gym, people should first get a cardiac evaluation for fitness," says Viveka Kumar.

What does getting a cardiac evaluation entail? "We look at everything. We ask patients about their family history. We tell them to get their cholesterol checked, their sugar tested, to take precautions and step up their exercise regime if need be," says Kaul.

Among gym-goers, the intake of protein supplements has steeped and doctors generally seemed to be against this trend. "Why can't you take fish, mutton, chicken, or eggs? Dal, rajma, and soya also are very good sources of proteins," says Kaul.

According to Bhatia, "They overlook the fact that a smart diet plan and using existing protein sources can build muscle, strengthen bones, and power our body functions. However, wanting quick and overnight results and often peer pressure prompts people to use over-the-counter supplements available in an unregulated market."

Coming back to heart attacks, there have been suggestions that people should keep aspirin 300 in their pockets. How reliable advice is this for everyone? "While doctors prescribe aspirin to prevent clot formation, aspirin has a serious problem of stomach bleeding. A doctor knows best when to get started on aspirin. Self-medication of aspirin is dangerous," says Kaul.

"Aspirin is an important drug in our armamentarium while treating heart attacks but if consumed inappropriately, it enhances the risk of bleeding. It is best to take the drug only under medical supervision," says Bhatia.

On people resorting to herbal remedies upon surviving heart attacks, neither of the doctors could vouch for their safety or their effectiveness. "They have not been tested in any major clinical trials, so their role in managing such patients is dubious and, in fact, may even be detrimental. They should be proscribed," says Bhatia.

"If you take good care of your health, don't eat junk food, eat chapatis and vegetables cooked at home, then one should be fine," says Kaul.