Heart attack at a young age. Why?

We often come across a casualty in our community, about the sudden demise of a young person due to a heart attack at a young age. We feel very bad. A young man may be the only one earning in the family. His family may not be prepared for this unexpected loss and no one will accept this at any cost. The only thing we as a doctor can do is to educate the whole community to prevent this.

If we try to find out the unlucky one beforehand we may fail miserably. Because, even with the advancement of medical sciences, we do not have a perfect answer on how to find out who is the unlucky one. But it does not mean we can not do anything. This following information will help you to understand the disease and precautions to be taken. Read this keeping your family in mind and share to your young friends. We will start with the basics of a heart attack first,

What is a heart attack at a young age?

The heart is a muscle and it keeps on pumping 70 times per minute, a lac time a day for the whole life, without any rest. This requires energy and it requires continuous blood supply. The blood vessels which supply blood to this working muscles are called coronaries, that is why blockage in Coronary is called Coronary Artery Disease. Coronary arteries are 3 to 5 mm in size and they are sufficiently large enough to increase the coronary blood supply by 3 to 5 times of their resting values. When this occurs at an age of less than 40, it is called a heart attack at a young age.

Plaque = Blockage

The coronaries are affected by diabetes, cholesterol, smoking, hypertension, ageing factors, and many other unknown factors. This causes deposition of fat-like substances within the wall of the blood vessel. This deposition of fat within the wall of coronary is called PLAQUE.

Plaque causes narrowing of the coronary lumen and so blood flowing through this coronary decreases and increment in coronary blood flow is limited. This causes angina when blockages are more than 70%. When plaque size increases further, it ruptures and blood clots over this ruptured plaque. The mixture of fat blockage ( Plaque ) and clotted blood over it causes complete occlusion of coronary artery and heart attack starts.

If blockages are more than 70%, chances of plaque rupture are very high and the patient also has angina. We can detect this group of the patient by stress test and can treat them on time before they present a fatal heart attack.

In young people, plaques are not causing significant blockages. But they are there and they can rupture. So, even if 20% blockages when ruptures, remaining 80% of patent lumen gets clotted within an hour or so and the patient develops massive heart attack. So, now you must be eager to know what causes this plaque to rupture.

Plaque Rupture

Our Indian studies have shown that smoking is one of the leading culprits for the heart attack at a young age. Smoking causes inflammation like state in the body with the weakening of plaque. Smoking promotes abnormal cholesterol deposition in high amount in small plaque.

Another major risk factor for this is very high bad cholesterol which goes undetected for years.

Heavy exercise sometimes can cause pressure damage to a blood vessel with a tear in the blood vessel which then clots and causes a major heart attack.

How heart attack at a young age differs from the one at later age

young age patient realises it late

The active young person will not suspect heart attack as a cause of his unusual chest symptoms, He may attribute this to a muscle pull, exercise-related or acidity and avoids asking for ECG.

can cause more damage

As blockages were only minor, there was no collateral help from other blood vessels. Patients with single tight block have tiny connections with another patent coronary blood vessel. We call this as collateral circulation or Natural bypass. A young person has not developed this collateral circulation. Their heart muscle downstream does not get any help from other patent blood vessels.

but over long term, better outcome

If diagnosed and treated on time, heart attack at a young age results in a better outcome as compared to a heart attack at old age. They have fewer complications, fewer chances of the redevelopment of blockages and better improvement in heart function.

Treatment – stent really needed?

Major aspects of treatment for this remain the same. They receive blood thinner tablets and injections. Then the patient goes for Coronary angiography for diagnosis confirmation and finding out the culprit blood vessel.

This group of patients are more likely to have minor blockages with larger blood clot over it. Hence, we do more of thrombus aspiration (sucking out thrombus) and repeat angiography.

Use of Coronary imaging helps a lot

Coronary imaging means passing a catheter inside the coronary blood vessel to see the plaque in a better way. This helps to avoid stenting.

In many cases of a heart attack at a young age, we have managed patients with the only thrombus removal procedure. With the help of coronary imaging, we can avoid putting stent. Remember, Once the patient undergoes stenting, we can not remove the stent. He will be on a blood thinner for a lifetime. So, we are happy when we are able to avoid putting a stent at a young age.

I hope this article will be help in understanding heart attack at young age.