As many as 15% of seemingly healthy Mumbaikars visiting city doctors end up discovering their hearts are functioning at just 50 % capacity
A kilometre away from his 21-km goal, 37-year-old Amit Kasat collapsed on the race track. The doctors treating the banker, who was participating in the Mumbai Marathon, say he suffered a heart attack — when a blocked artery prevents oxygen-rich blood from reaching a section of the heart — which was followed by a sudden cardiac arrest — an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia), causing loss of blood supply to the brain, lungs and other organs putting the patient at risk of loss of consciousness, and even death.
Along with Kasat, photographer Viraj Kovale (39), a non-participant, was also admitted to the ICU after suffering a cardiac arrest. Kovale was taking photographs of the event and had walked the entire route.
On the surface both men were healthy. Kasat had been actively preparing for the January 19 run, clocking 15 km every day. But, Dr Ramakanta Panda, senior cardiac surgeon and director of BKC's Asian Heart Institute, warns that race day is a different ball game altogether. "Runners should start training six months before the event. But, they think the adrenaline rush will see them past the finish line. When they push themselves, they put their body under more stress than it can handle," he says. Dr B K Goyal, director of cardiology at Bombay Hospital (where the two are admitted) agrees. "Runners must train for the entire distance of the race. A heart that is not used to that level of stress will not be able to cope up," he says.
Hidden dangers
That Indians are prone to a weak heart is no secret. A study that was published in 2013 put 70 per cent of urban Indians at the risk of cardiovascular disease — blaming poor dietary habits, smoking and high alcohol consumption along with a sedentary life. Fifty-one per cent of Mumbaikars, the three-year study conducted in 12 cities said, were found to have low levels of the heartprotecting high-density lipoprotein (HDL, also known as good cholesterol). "Throw in a genetic disposition to cardiovascular disease and we are already fighting an uphill battle," says Dr Goyal.
He adds that of the 500 patients he sees every month, at least 15 per cent have between 40-50 per cent of blockage. These, he says, come to follow up on the occasional heart trouble. "An electrocardiography (ECG) or a stress test — where a patient is made to run on a treadmill for 15-20 minutes while his heart rate is monitored — won't show any anomalies," Dr Goyal says.
Dr Ashwin Mehta, director of cardiology at Jaslok Hospital & Research Centre, says more than 85 per cent heart attacks occur without warning. "Plaques cause 30-50 per cent narrowing of blood vessels. Fifty per cent of blood flow is sufficient for individuals to remain free of symptoms even under daily stress. Under heavy stress, the plaque ruptures, leading to blood clots which make a partially blocked artery, 100 per cent blocked. This is why apparently healthy people occasionally end up with massive heart attacks during marathons," he adds.
Right test
A stress test, the doctors say, will only help discover blockages of over 70 per cent. "Every one over the age of 30, should undergo a Computed Tomography Angiography (CTA), a non-invasive procedure that locates minor blockages," says Dr Goyal, adding that it's ideal for long-distance runners and those with a family history of hypertension.
Dr Mehta says that those who plan to participate in marathons, should undergo a complete body check-up, along with an ECG, a 2Dimensional echocardiogram (2D Echo) and a high level Exercise Stress Test. This should be done a week before the final day," he says.
