Thread by @GastroOneIndia

#cardiacarrest
Sudden deaths and the fear among doctors

I was forced to post this write up for some of my students who wanted me to comment on sudden death of a few of the young and energetic people, including doctors, due to massive myocardial infarction- obviously everyone is upset about this issue now.

It is frightening, especially when we hear that at least a few of them were fitness freaks too- that further heightened the fear psychosis to newer levels in the Covid scenario.

My sincere advice is -please don’t be afraid, do not live in fear, live your life courageously, but do everything possible to look after your health and the health of people you come in contact with.

I too was deeply saddened by the sudden deaths, but we need to accept that, just because death is as certain as birth is- doctors are here not to stop death altogether, but we are here to promote health and wellness and prevent premature deaths; But when an illness strikes, we…

…may or may not succeed in lifting all the dying patients- it is like trying to save a drowning person, we have to give up at some point. Let us focus on preventing such events in future.

The reasons for an event like myocardial infarction itself are different in different persons Sudden death due to myocardial infarction raise several issues- especially when the person is a fitness freak.

Fitness externally never means fitness internally always, internal fitness is decided by several factors, that too can change due to some transient phenomena like a recent viral infection, or changed diet and lifestyle, including heightened anxiety, not sleeping not taking…

…enough water etc. Some may attribute the death to covid, making it post Covid or long Covid – that is simple lack of common sense, it can happen after any infection in some individuals- such sudden deaths used to happen even before, during and would occur even after Covid.

Those who opposed the vaccination strategy for Covid 19 would say it was due to the vaccine- that too is lack of common sense. It is lack of common sense that makes people unnecessarily associate one event with the other.

We need to individualise every conclusion in medical parlance, every person is different, each symptom in a person has multiple contributory factors, each known disease has multiple contributory causes in each person, the combinations of problems happening in one person are…

…different from those occurring in another, hence we should not be comparing two individuals with one symptom or one disease and build generalisations.

Instead, we need to find out the combination of factors that contributed to the development of the problem in each person separately.

Sudden deaths during exercise could be due to underlying clinical or subclinical issues or multiple minor and overlooked correctable issues coming together, incidentally or accidentally. It is truly an accident, but it could have been avoided too, if we take some precautions.

All these factors could be identified or predicted by studying the diet and lifestyle in detail, then a proper physical examination, combined with very few investigations like complete hemogram, liver enzymes, blood sugar and serum protein, in the vast majority of persons.

Very rarely only we may have to do any other investigation to predict risk of getting any disease.
During exercise the heart rate can go up to 140 or more without causing any untoward events if everything is fine at that moment.

If exercise is done after an illness, the situation is slightly different. We need to always start low and go slow- never try to do at the same pace as we used to do before, any way never try to overdo.

This is also true for all those who resume exercise after stopping it for some time for any reason, don’t be aggressive while resuming exercise.

Resume gradually only, over a week or two, do incremental levels of exercise and bring it to the previous level, let us give some time to make the body adapt to the previous level of exercise.

Take care to do only aerobic exercise (isotonic) only after an illness and even for fitness, never do any isometric exercise all on a sudden.

Make sure of taking a proper diet in moderation (with plenty of vegetables, adequate fruits and one source of protein in required amounts) every day, every time.

Never forget to take enough water -before, during and after exercise- dehydration alone is enough to tilt the balance to the opposite side sometimes.

Similarly exercise beyond an accustomed limit, all on a sudden, is enough to trigger problems in people who were otherwise waiting to develop a plaque rupture.

Sudden unexpected increase in heart rate beyond a limit can trigger an arrythmia due to the ischemia to the myocardium during the tachycardia.

The myocardial perfusion happens during diastole, with tachycardia myocardial perfusion might decrease further, and there is increased demand during exercise- ischemic heart disease is always a demand supply imbalance.

The absence of vegetables and fruits in diet leads to hypomagnesemia, hypokalaemia, and folic acid deficiency too. Folic acid deficiency and or coexisting B12 deficiency (extremely common issues) may add one more risk factor to ischemic heart disease.

The consequent hyperhomocysteinemia increasing the thrombotic risk and even plaque rupture.

Hypokalaemia, hypomagnesemia, Vit D deficiency all can weaken the myocardium, or they can act as triggers for an arrhythmia in the setting of ischemia- relative or absolute- happening either due to sudden increase in heart rate or due fixed to coronary artery narrowing or when…

…an unstable plaque ruptures during the above situations
To compound all these, viral infection or vaccination both can trigger and aggravate autoimmune disorders in some predisposed individuals.
Antiphospholipid antibodies can develop transiently due to any infection

Some lean people could have subclinical autoimmune liver problems with protein c and protein s deficiency with heightened thrombotic risk- obese overweight people have it almost always.

If we get a viral infection there could be minor issues like subclinical myocarditis which would recover with time- usually in 1- 2 weeks; therefore, post viral illness, the resumption of exercise should be gradual and step wise only

We need to study everything before any clinical problem or event to find out what went wrong in each individual to cause it.
We now have only people who go to the extremes in interpreting events and things

Everything that happened during Covid 19 was attributed to Covid, or made it post covid or long Covid- it was genuinely wrong.
Going by that kind of logic- everything that happened after the vaccine drive can be made post vaccination too.

At least that is what some people have started believing now- someone has recently mentioned my name in a video saying that I was against vaccinations. In fact, I am not against vaccinations if it is a time tested one, with established efficacy and when the disease is fatal.

But Covid was a different disease, the genuine mortality was less than 0.1% and such diseases can easily be controlled without mass vaccination of everyone- no one listened to me

The people who came with support to my difference of opinion wanted to distribute quick fix remedies, to fish in troubled waters– I stopped making comments on Covid at that point.

We now have created a situation where the majority are made to possess only blind faith, instilled in them by the marketing strategies of the industries and predatory service providers - there is no true scientific attitude now.

Scientific attitude and scientific behaviour principle centred behaviour alone is science. Science is for TRUTH, which lies somewhere in between all these..
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