*Dr. Nabraj Poudel
Representative event:
- A 44-year-old man, who smokes only when drinking alcohol, has had high blood pressure for 1 year but is not under treatment, has signs of diabetes (pre-diabetic) but has not taken medication to improve his diet and lifestyle as advised by the doctor, is a nightclub owner, has insomnia for 2-3 days, suddenly has chest pain at 3:20 am, takes medicine at home for half an hour, thinking it may be a gastric disease, the pain increases and he starts sweating profusely, and then begs his family. Although there is a large hospital nearby, he goes to see a doctor at a clinic he used to trust. While waiting for 1 hour, he faints once before the doctor arrives, the family panics and rushes him to the nearest large hospital. Before reaching the hospital emergency room, the patient faints again and is already dead. Despite several attempts by the doctors there, he cannot be saved.
- A 32-year-old man, who has been working in Qatar but has been unemployed for 2 years, has been drinking cigarettes, alcohol, and eating Western food with his friends, and has family stress, has a similar chest pain. Since he is at home, his father immediately (within 15 minutes) takes him to the hospital, tests are done, it is found that he has a heart attack, blood thinners are administered orally and through a needle, he is immediately taken to the Cath lab for examination and the blocked left main artery of the heart is opened (Angiography and Angioplasty) and his life is saved.
- A 24-year-old engineer whose mother died suddenly at the young age of 38, also suddenly comes to the hospital with difficulty breathing, heaviness in the chest and profuse sweating. Two months ago, he was examined at a hospital in the capital for swelling of his right leg and a blood clot in the vein of his leg, which he had not taken regularly despite advice to take medication. On examination in the emergency room, it was found that he had a heart attack. He was also immediately given blood thinners both by injection and by mouth, the patient was then taken to the Cath lab and an angiography was performed. The blood vessel was found to be open when examined, and he did not need to undergo angioplasty. A blood test, suspecting a hereditary disease, showed a deficiency of the body’s internal factor that thins the blood. Accordingly, he was discharged a few days later after being advised about the importance of taking regular medication.
These are just a few representative incidents. Not only that, but from time to time, we have heard news of young men dying while walking, working out, playing, or even sleeping. We are writing this article because we feel it is important to know the causes and prevention of this.
Background:
Our human body is amazing. As we know, the average life expectancy of a human is 100 years, but the average life expectancy of people in different countries of the world is different. The current average life expectancy of men in Nepal is about 68 years and that of women is 72 years. From 2007 to now, our average life expectancy has increased significantly
. At that time, human deaths (Infection Communicable) were caused by infectious diseases or bacterial diseases, but nowadays, it is found that more people die due to non-communicable diseases (non-communicable).
However, most of the non-communicable diseases occur after the age of 40 and that is why such diseases are now prevalent in society. These non-communicable diseases are called Risk Factors, such as high blood pressure, diabetes, fat-related problems (Dyslipidemia), obesity, old age, hereditary diseases, cigarette and alcohol consumption, lifestyle, Western eating habits, lack of physical exercise, increasing urbanization, mental stress, etc., which lead to chronic diseases such as heart, kidney, and brain, lung, and nerve diseases.
Heart attack is a condition in which the blood flow through the heart is reduced or completely blocked. Coronary Artery Diseases are a complex disease. The heart has blood vessels on the right and left sides to nourish the heart muscle. The left side of the heart has two main branches, which we call the three main arteries (right 1 and left 2) when we explain to the general public. These three main arteries flow from the outer part of the heart and have small branches to circulate blood to all parts of the heart.
If the above risk factors are present, the accumulation of plaque in the blood vessels of the heart and their narrowing is called coronary artery disease. Sometimes, even if it does not cause any problems for a long time, sometimes the plaque ruptures and blood clots, blocking blood flow, which is considered a heart attack. If blood flow is not restored immediately after a heart attack, there is a risk of the heart muscle dying, heart rhythm disturbances, heart failure, or death. That is why it is important to treat it as soon as possible and within 90 minutes of a heart attack. Complications can be prevented.
Now, looking at the actual subject matter – young-onset heart attack is considered to be a heart attack that occurs in people over the age of 45. According to current statistics in the world, an average of 6-15% of heart attacks is found in young people, which is constantly increasing. When it comes to our country Nepal, this type of heart attack is seen in about 10%, but if we look at the facts of Kaski District Padesh 4, it is seen in 12.9%, which is more than the figures of other places in Nepal as a whole. (Source – Birat Medical Journal 2018) The main reasons for this are increasing modernization, high blood pressure, diabetes, fat-related problems, (Dyslipidemia), obesity, old age, hereditary diseases, cigarette and alcohol consumption, lifestyle, Western eating habits, lack of physical exercise, increasing urbanization, mental stress, drug abuse, etc. 70-75% of such patients have been found to have cigarette and hookah consumption, insomnia and obesity. It has been observed that people who engage in unnatural behaviors such as sleeping during the day, staying up late at night, and eating Western foods are more likely to have heart attacks. Those who have heart attacks at a young age are more likely to have more serious complications and die before reaching the hospital than those who have reached adulthood. There is also less social acceptance of this, and the lack of motivation to continue taking medication after treatment makes it more likely that people will stop taking the medication.
How do you know if you ‘re having a heart attack?
Especially when doing something, walking quickly, or when physically exerting oneself in very cold or very hot weather, the middle part of the chest (slightly on the left side) becomes heavy or heavy (as if a 5/10 kg weight is placed on the chest), and that heavy feeling moves down the throat, into the armpits, and into the inside of the arms. Sweating profusely, palpitations, feeling dizzy, and thinking that you are going to die are signs of a heart attack. Sometimes, continuous vomiting, pain in the upper abdomen, and sudden fainting can also be signs of a heart attack. It is highly likely that a person who has been sleeping at night has died when he wakes up in the morning.
What is the first aid?
First of all, if the above-mentioned problem occurs, you should rest immediately. You should ask for help from someone nearby. If there is no one nearby, it is better not to walk, but to take deep breaths, cough, and try to induce vomiting. In some cases, panicking and thinking that you will reach your destination quickly can lead to the loss of your life.
How can it be prevented / reduced?
It is important to teach this in schools to prevent the disease from spreading in the first place. There should be a chapter on this in the textbooks. It is very difficult to break the addiction that is formed in school life – especially in grades 9, 10, 11, and 12.
Cigarettes, hookahs, and tobacco products, as well as alcohol consumption, should be completely banned as soon as possible.
Conditions such as diabetes, high blood pressure, and cholesterol should be checked regularly and kept under control.
Things like diet, behavior, sleep, and stress should be managed properly.
This should be emphasized as weight loss and regular physical exercise help to keep the body fit and reduce risk factors.
The government’s responsibility:
1) Curriculum development
2) Permission for alcohol/cigarettes/hookah/others should not be granted in places like restaurants that are opened for temporary profit in a haphazard commercial manner, and the permissions granted in such specific places should be monitored regularly.
3) Identify and manage properly businesses that not only cause food and drink problems but also increase unnatural activities (insomnia, stress, etc.).
4) Spreading social awareness.
Prof. Dr. Nabaraj Poudel
*Senior Cardiologist
Manipal Teaching Hospital, and Navya Heart Center
प्रतिक्रिया दिनुहोस्