A heart attack can occur at any age, even among seemingly young and healthy adults, writes Meera Murugesan.
HOLIDAY is supposed to be a time for rest and relaxation. When Dian Rachmat and his family arrived in Kuala Lumpur for a much-needed break, they were looking forward to taking in the sights and spending some quality time together.
But just a day after arriving and while Dian was seated at the restaurant in their hotel, enjoying his buffet breakfast, he felt an extreme tightness in his chest and pain.
The 42-year-old director of a travel agency sought assistance and an ambulance was called to transport him to hospital.
Dian, a father of three, had no idea that he was suffering from a heart attack. Prompt arrival at the hospital followed by an emergency balloon angioplasty and stenting saved his life.
As a man in the prime of his life, Dian had not expected to suffer a heart attack. He had been diagnosed with diabetes three years ago but he felt he had the condition under control. He ate healthily and exercised regularly.
Like many people, he assumed that heart disease would only strike the elderly.
These days, we are seeing younger patients being affected by heart disease, some of them even in their late 30s or early 40s, and occasionally even younger, says Dr Norazlina Mohd Yusof, consultant cardiologist and clinical head of medical services and clinical lead for cardiology at Prince Court Medical Centre.
Dr Norazlina says studies suggest that risk factors now tend to develop at an earlier age.
Ministry of Health (MOH) statistics show that more than 35 per cent of Malaysians above the age of 35 are hypertensive and the number increases to 55 per cent among those aged 50 and above.
Hypertension is a very strong risk factor for heart disease.
People who are seemingly fit or exercise regularly are not spared from heart disease either.
Dr Norazlina says one patient, a 38-year-old male engineer, came in after two hours of chest pain.
He jogs regularly and had no other risk factors except for raised cholesterol but ECG and blood tests confirmed a heart attack.
Another patient, a 39-year-old woman who runs marathons regularly, had only one risk factor: her father had had a heart attack in his late 50s.
She too was confirmed to be having a heart attack when she came to hospital.
Both patients underwent emergency angioplasty to open up their blocked arteries and are now doing well.
YOUNG NOT SPARED
The symptoms of heart disease or heart attack among younger people are very similar to that of an older person.
Typically, there is central compressive chest discomfort which radiates up to the neck or into the jaw and down the arms.
This is usually accompanied by profuse sweating, nausea and sometimes vomiting, and feeling faint or even losing consciousness.
“It is also true that some patients do not feel any symptoms at all, especially diabetics. This is even more dangerous because there are no preceding warning signs.”
Dr Norazlina explains that as society becomes more affluent, our diet becomes unhealthy especially with a high sugar content, leading to obesity and diabetes.
The demands of modern living with long working hours and sleep disturbances also leads to unbalanced, stress-filled lives. All these increase the risk of hypertension.
Many individuals are not getting enough exercise either, especially as they spend hours with their handphones or computers.
Young people who smoke are markedly increasing their risk while psychiatric illnesses, especially depression, are also associated with heart trouble.
CATCH IT EARLY
Early detection and screening are crucial when it comes to heart disease.
“Your first heart attack could be your last. Early detection and screening are thus crucial. It is, in fact, the unpredictability of a heart attack that makes it very dangerous,” says Dr Norazlina.
Statistics show that 55 per cent of patients who develop their first heart attack don’t even make it to hospital. Of those who do, 10 per cent still die in hospital despite treatment.
An unhealthy lifestyle, such as being sedentary and / or being obese, leads to cardiovascular disease.
Dr Norazlina stresses that it is never too early to live healthily — and also never too late to reduce your risk.
If you have risk factors such as hypertension, diabetes, a strong family history of heart disease or stroke, smoking or raised cholesterol levels, it is a good idea to start screening early, for example, by 35 years, even if you don’t have any symptoms.
Go for simple tests such as checking your blood pressure, bearing in mind that one can feel perfectly healthy and yet have a serious underlying problem, such as hypertension.
“If you have strong risk factors, you should also consider having an exercise stress test. This will help categorise your risk into low, medium or high for getting heart disease.”
If you can control as many of the risk factors as you can — you can’t change family history or age, though — you can definitely improve your chances of leading a long and healthy life.
While it’s never too early to do this, it’s also never too late.
THE GLOBAL THREAT
HEART disease is the number one killer globally and in Malaysia. Deaths due to cardiovascular disease account for 31 per cent of all deaths worldwide and 36 per cent here.
Dr Norazlina says that despite the advances in cardiovascular medicine — novel drugs, balloons, stents, heart transplants and even artificial hearts — statistics show that heart attacks are not only the commonest single cause of death but actually increasing
in Malaysia. For example, about 8,700 people died of coronary heart disease in 2007 (24 per day) compared to 13,500 (37 per day) in 2017.
Interestingly, the average age of onset in Malaysia is 58 years, the youngest in the region, compared to 65 in Thailand and 63 in China
This is probably related to the high obesity rates in Malaysia compared to other countries in the region. In Europe, the average age for a first heart attack is at 67 years.