Pathologist dies of heart attack: What does Dr Gaurav Gandhi's death tell us?

His ECG reading was normal. In about 20-30 percent of cases, the first ECG may appear normal even after a heart attack. Hence we need to conduct serial ECG and test cardiac enzymes (which are biomarkers, such as troponin and creatinine, and indicate heart damage) in 12 to 24 hours Dr. Saugata Chatterjee, Guru Gobind Singh (GG) Says Assistant Medical Superintendent of General Hospital, Jamnagar

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Dr. Gaurav Gandhi, a 41-year-old renowned cardiologist from Jamnagar, died on the morning of June 6 due to cardiac arrest. His death has once again raised concerns about heart attacks among young Indians as he had no symptoms or traditional triggers and was completely uncommon. His colleague, Dr Saugata Chatterjee, assistant medical superintendent of Guru Gobind Singh (GG) General Hospital in Jamnagar city and professor of medicine at the MP Shah Government Medical College, says, “He was young, very physically active, around 14 hours Used to work one day, a non-smoker and a drinker. There was no medical history to indicate that he may be predisposed to a cardiac event. Nor did he have any recent history of infection or COVID-19.

Dr Gandhi was a contractual assistant professor at MP Shah Government Medical College for the past one year, teaching cardiology and attending to both OPD and critical patients at the hospital. Additionally, he was working at the private Sharda Hospital in Jamnagar.

Dr. Nandini Desai, Medical Superintendent of GG General Hospital, says that being a cardiologist, Dr. Gandhi's response was absolutely correct. “He felt chest discomfort on June 6 at around 2 am, went to Sharda Hospital and got an ECG done. However, the cardiogram was normal. So he thought it was acidity and took an injection for the same. He stayed in the hospital for half an hour to check for any abnormalities and then went home. Around 6 a.m., his wife found him lying face down on their bathroom floor. The relatives immediately brought him to the emergency ward of GG Hospital. We put him on a ventilator and a cardiogram was done, which showed that his heart was very underactive. So we tried CPR for about 45 minutes but could not revive him. medically, It is suspected to be cardiac arrest. We went for postmortem but there was no change in his heart to indicate cardiac arrest. But the window between the onset of symptoms and his death is very narrow and scientifically, the heart will not show changes in such a short period of time. They usually appear in seven hours. Dr Gandhi's death raises several questions:

Is it possible to have a heart attack despite normal ECG readings?

Yes, it is possible to have a heart attack despite a normal ECG reading as it may not show blockages in your arteries without symptoms which may put you at risk of future heart attacks. Dr Chatterjee explains, “In about 20-30 per cent of cases, the first ECG may appear normal even though someone is having a heart attack. This is also documented in the medical literature. In such cases there is a high index of suspicion , we keep patients under observation for 12 to 24 hours, testing serial ECGs and cardiac enzymes (which are biomarkers, such as troponin and creatinine, and indicate heart damage). Dr. Gandhi's case, however, was an unusual one. matter.

Are we taking high blood pressure and stress lightly?

Did the long working hours and stress affect Dr. Gandhi? Dr Chatterjee doesn't speculate, but says anecdotally, "The incidence of patients reporting cardiac arrest in the 25-30 year age group has increased compared to what we used to see a few years back."

Dr Raghav Sharma, Interventional Cardiologist, Meditrina Hospital, Ambala says, “In India, hypertension tends to start in the early 40s as compared to western populations, where the condition sets in between the 60s and 70s. If we look at the malaise in people above 40, about 60 percent of the population suffers from hypertension. And if you even have a systolic reading above 120 and a diastolic marker above 85, according to recent medical guidelines, that indicates that more than 60 percent of the population is hypertensive. An estimated 57 percent and 24 percent of deaths related to stroke and coronary artery disease, respectively, are related to high blood pressure.

The young population pursues a hectic and competitive professional life which disturbs the work-life balance. Working long hours can mean eating junk food, which is high in sodium, chemical preservatives or flavor enhancers. There is little time for exercise and sleep. Young people also smoke excessively, which leads to high BP. If these habits are not stopped properly on time, then sooner or later high blood pressure will take them under its control. “Always remember that retention of stress is high blood pressure. High level of stress and tension elevates the BP which in turn stimulates the energy drive along with releasing lots of stress related hormones in the body. We need to reduce BP with medication needs to be controlled, but if the condition worsens, it may lead to stroke or heart failure and the patient may need to be hospitalized,

Should we be probing beyond traditional risk factors?

By now, most Indians are aware of cardiac profile tests to track their BP, cholesterol, lipids and blood sugar. But there are other triggers that we need to pay attention to and neutralize as soon as possible

(1) Get BP checked early: Start at the age of 25. Symptoms of high blood pressure manifest as frequent headaches, shortness of breath while walking short distances or even during routine work. This is when one should check their BP level and immediately go for medication and monitoring before the onset of hypertension. Reduce salt intake, reduce weight and maintain regular exercise routine, all these can reduce BP by 5-6 mm to lead a stress free life. If overweight, reduce fat and eat a high fiber, good fat and high protein diet and fruits, which are rich in potassium

( 2) Check for a genetic disorder called familial hypercholesterolemia (FH):An inherited condition, such people have elevated levels of LDL cholesterol, which not only makes them prone to developing heart disease at a young age but also puts them at a higher risk of mortality. Dr K Srinath Reddy, Cardiologist, Epidemiologist and Distinguished Professor, Public Health Foundation of India (PHFI) says, “This disorder is such that it causes a build-up of cholesterol regardless of your weight, diet, habits and exercise. allows. Not only does total blood cholesterol matter but also subfractions of cholesterol and other blood lipids contribute to the assessment of risk. LDL cholesterol and non-HDL cholesterol levels predict risk better than total cholesterol. 'Large buoyant' of 'small dense' LDL fraction, even within LDL cholesterol Fraction is important (smaller closely packed particles are more damaging to blood vessel walls). Since 'small dense LDL' is difficult to measure, the ratio of serum triglycerides to HDL cholesterol is a good surrogate measure. The apolipoprotein B to apolipoprotein AI ratio, which profiles the 'good' to 'bad' cholesterol balance, is another good risk marker. It is not unusual to find individuals with 'normal' total cholesterol levels having a heart attack because the subfractions are erratic. Another good risk marker is. It is not unusual to find individuals with 'normal' total cholesterol levels having a heart attack because the subfractions are erratic. Another good risk marker is. It is not unusual to find individuals with 'normal' total cholesterol levels having a heart attack because the subfractions are erratic.

(3) Keep your LDL levels really low:  The most common mistake people make is to consider the total cholesterol count. “But you have to look at the LDL (bad cholesterol) count, HDL (good cholesterol) ratio and HDL:LDL ratio. Indians have low HDL levels anyway. They say 50mg/dL is ideal to neutralize LDL But in Indians this level never crosses 45 mg/dL. So we have to work aggressively on LDL levels and bring them down. So, if you are an Indian, who is anyway compared to western population If you are at high cardiac risk, the preferred LDL range is less than 50 mg/dL. For those with a family history, it should ideally be 30mg/dL or less," says Nanavati Max Super Specialty Hospital, Mumbai. Says Dr Rajeev B Bhagwat, Interventional Cardiologist. Then there are triglycerides. , Triglycerides are fats in the blood that, when combined with cholesterol, cause plaque build-up. Hence, both triglycerides and LDL levels need to be brought down significantly,” says Dr. Bhagwat. "We need to introduce lipid-lowering drug treatments such as statins in addition to addressing modifiable risks."

(4) Beware of sudden cardiac arrest:Sudden cardiac arrest is described as a condition where the heart stops and loses all its activity due to an irregular heart rhythm. As a result of these irregular electrical impulses, the heart is unable to pump the oxygen-rich blood that your body needs. Within the first few minutes, blood flow to the brain is impaired, causing the patient to faint. And within eight minutes, all major organs shut down due to lack of blood flow. Sudden cardiac arrest is not caused by a blockage. However, if a heart attack can alter the electrical impulses of the heart, it can become a trigger for sudden cardiac arrest. "Typically, it's a prevalent history of heart blockages, Which can trigger serious arrhythmias. Sometimes this is due to low heart pumping efficiency or genetic conditions such as cardiomyopathy. Which compromises the heart muscles. Sometimes, it can be triggered due to changes in the structure of your heart due to excessive blood loss due to illness or infection or due to some other injury. But what is worrying is that this happens to a lot of asymptomatic people, which makes them a high risk group,” Dr. says Balbir Singh, Chairman, Cardiac Sciences, Cardiology, Cardiac, Electrophysiology-Pacemaker, Max Hospital.

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(5) Take a calcium score test after 45: " This test involves a simple CT scan and doesn't require an invasive procedure with dyes. It measures the amount of calcified plaque in your arteries, which in turn affects your heart's function." leads to seizures and strokes. A high score puts you in the risk category but it does not mean that you will have a heart attack the very next moment. It indicates a possibility so that such an event can be prevented. Medical intervention with medications and lifestyle modifications can be started early," says Dr. Singh.