Thread by @hyderabaddoctor

Why do a few young, physically active, seemingly healthy people suffer from heart attack?
1. A person with normal body weight, doing regular running, cycling, or working out in gym, is not immune to heart attack, as a few recent reports suggest. Here are some of the reasons why:

2. Hypertrophic obstructive cardiomyopathy (HCM)
HCM accounts for 40% cases of sudden cardiac death (SCD) in young athletes. Unfortunately over 80 % of affected individuals are asymptomatic before SCD, which often occurs during exercise or in its aftermath.
#running #fitness

3. Cardiac arrhythmia
About 15-20% cases of SCD occur due to cardiac #arrhythmia (abnormal heart rhythm). In patients younger than 35, the most common cause of SCD is a fatal arrhythmia, usually in the context of a structurally normal #Heart.

3a. While rare, sudden cardiac death is the leading cause of nontraumatic cause of death among young athletes. Sports-related sudden deaths are higher among elite athletes.

4. Covid 19 infection
MRI in Covid-recovered people revealed cardiac involvement in 78% patients and ongoing myocardial inflammation in 60%, which was independent of preexisting conditions. Covid19 increases risk of heart attack. It could take several weeks for heart to recover

5.Recent flu infection
One in 8 patients hospitalized for flu had acute cardiovascular events such as heart attack or other sudden heart disease as per a 2020 study.
A 2018 study found that people were six times more likely to have a heart attack within a week of having flu.

6. Covid vaccine
Myocarditis from COVID-19 booster is rare, but the risk is highest among teen boys & young men.
However, a recent JAMA study found that full #vaccination against COVID-19 was associated with a reduced risk of heart attacks and ischemic stroke after COVID-19.

7. Mild #hypertension

The lowest risk of heart attack is for systolic BP 120-130 mmHg and diastolic BP 80-90 mmHg.
SBP>130 mmHg and DBP>90 mmHg increases the risk of heart attacks.
People with BP>130/90 mmHg are at a higher risk of heart attacks.

8. Pre-diabetes
It is not only #diabetes but #prediabetes also increases the risk of myocardial infarction (MI). In a Nov 2022 study, prediabetes was associated with 25% increased odds of MI, 45% increased odds of percutaneous intervention (PCI) and 95% increased odds of CABG

9. High #cholesterol
One need not have very high cholesterol levels to get heart attack. Even, mild elevation in lipid levels can significantly increase the risk of MI in people aged 20-39 years.

9a. In a 2020 study, MI risk was significantly elevated among people with total cholesterol ≥223.4 mg/dL, LDL-C ≥139.5 mg/dL, HDL-C ≤41.8 mg/dL, and triglycerides ≥200.1 mg/dL.

10. #sleep disturbances
In a study, people sleeping less than 6 hours had a 20% higher risk of suffering from heart attack. Difficulties initiating and maintaining sleep and having a feeling of nonrestorative sleep are associated with a moderate increase in MI risk.

10a. The risk of MI is 45% higher for people with difficulties initiating sleep almost every night, 30% higher for those with difficulties maintaining sleep almost every night, and 27% higher for those with a feeling of nonrestorative sleep more than once a week.

11. Stress
Work-related and financial #stress can significantly increase the risk of MI. A Japanese study reported that MI patients worked significantly longer hours per week prior to their disease in comparison to healthy workers.

11a. In another study, a change in working hours (prolonged-working hours and modification of working-hours schedule) and a change in working conditions (new boss, new department, reorganization of work activities) had the largest impact on the occurrence of MI.

12. Suggestions to reduce the risk of heart attack
*Get ECG and Echocardiogram done- Cardiology opinion, if any abnormality is detected
*People with history of recent Covid 19 or flu infection need to be cautious while resuming exercising
*Aim for BP between 120-130/80-90 mmHg

12a
*Pre-diabetes is risky and needs intervention (mostly diet and exercise)
*Mild elevation in cholesterol is also risky and needs to be lowered.
*Ensure adequate good quality sleep at nights
*Try to reduce stress related to work, finances and personal life.
#healthylifestyle