Mr A R W, a physically active gentleman, 28 years of age who had completed his science post-graduation and was preparing for a competitive exam returned home after a coaching class in Hyderpora, Srinagar. He was also looking for a job simultaneously. He had his usual dinner of rice, curry and yogurt following which he retired to his room. In the morning he was found motionless and cold in the quilt by his mother. She had gone to wake him up because he did not come out at the usual time. A doctor was called who pronounced him dead. There was a hue and cry in the family of 6 people, and it was labelled as a massive sudden heart attack.
There has been a surge in the number of young persons dying suddenly in the valley in the recent months. In several instances the age is even less than 30 years. Although males predominate but females have not been left behind. Death of a person at the prime of his/her age is a catastrophe for the family. The media both print, and the social media is full of such narrations where the death came without the said person having complained about any kind of illness preceding the demise.
Sudden death in an apparently healthy person is termed as a witnessed death within 1 hour of symptoms or no preceding complaints. The cause is a sudden cessation of circulation because of a chaotic very rapid but in effective rhythm of the heart called ventricular fibrillation (VF). Other less common cause is an abrupt stoppage of the contraction of the pumping function of the heart called Asystole. If detected within a few minutes, VF can be promptly reverted to a normal rhythm with a DC shock delivered by an apparatus called a defibrillator. Such machines are kept ready to be used at places like airports, railway stations and busy malls etc where any vulnerable person can be promptly rescued in case such an eventuality happens.
Undoubtedly the commonest underlying cause is a myocardial infarction (MI), (commonly known to public as a Heart Attack). It can be the first symptom of a heart attack due to abrupt closure of a major artery (coronary artery) supplying blood to the heart. Such catastrophes usually occur after a large heart attack this fact because all of them are not cardiologists. However, if symptoms of chest discomfort, sweating and breathlessness occur an early diagnosis is possible and prompt management can save lives.
Why are young people getting heart attacks more frequently these days? The answer is not simple and can at best be conjectural. Acquisition of high blood pressure, diabetes, high levels of blood cholesterol, obesity and cigarette smoking along with psycho-social stress are important factors. Urbanization and ambition to achieve a good status in the society at the earliest leads to impatience, adverse lifestyle and getting the risk factors at an early age is an important factor. Consuming unhealthy diets rich in fats and carbohydrates with very little, fruits and green vegetables etc is also seen more often these days. Sporting activities, exercise not being given enough importance also leads to premature heart attacks. Cigarette smoking continues to be common and is the most important cause of blockage of the coronary arteries. I have seen several instances of persons below the age of 40 years with chronic smoking as a habit getting incapacitating and large heart attacks. Many of them are auto rikshaw drivers with paltry incomes.
Illicit Drug Use as a Cause:
This is one of the causes of deaths in young people and is often not talked about, due to the stigma attached to it. According to experts there has been a whooping increase in the consumption of these drugs in the last 10 years. The political turmoil, unemployment, the aftermath of abolition of article 370, and lately the corona pandemic has led to severe psychiatric and psychosocial illnesses in the troubled valley. According to a United Nation study of 2014 there were at least 70,000 drug addicts out of which 6% were females. These numbers would have multiplied several folds. The common Substances used by drug addicts in Kashmir are cannabis, brown sugar, heroine, SP tablets, Anxit, Alprax, Inhalants like Fevicol, SR solution, thinners, shoe polish, paint varnish all have been used in desperate situations. Cannabis is grown illicitly in several parts of South Kashmir.
Use of multiple agents at a time leads to severe problems. It usually starts with cannabis and then alcohol, heroin, amphetamines, pain relieving medicines etc are added. Such lethal combinations can lead to dying in sleep because of cessation of respiration. Recently huge stores of cocaine have been busted in some parts of the valley. Cocaine is a perfect heart attack drug and leads to high BP, thickening of arteries, blockage of arteries and heart rhythm problems leading to cardiac arrest.
Structural defects of the heart, and certain uncommon conditions like cardiomyopathies, channelopathies, arrhythmogenic ventricles associated with abnormal ECG’s can also lead to sudden deaths at young ages.
An autopsy and a toxicologic studies are essential to clearly point out the cause in each individual. Family screening of such persons should be a part of the investigation to pick up other members who could be prone for it.
Take Home Message and Lessons Learnt:
The surge in young apparently healthy citizens in valley dying suddenly remains an enigma. While heart attacks because of sudden blockage of the arteries could be a cause, we need to realize that the illicit drug menace which is often not talked about can also be an important cause. Promotion of healthy lifestyle and awareness programs against drugs, need to be emphasised. More centres for de-addiction should be planned and opened on priority. A unified action by Governmental and non-governmental agencies along with police and all the law forcing agencies is the need of the hour. Youth is the future of a community and need to be protected and groomed.
Author is a Cardiologist, Recipient of Padma Shri and Dr B C Roy Award.