Ace comedian and actor Raju Srivastava had a heart attack while exercising in a gym. But his is not the first news of its kind. There have been many cases of deaths on treadmills or even soccer players who crumbled into a pile while playing.
“Recently there have been reports of apparently fit individuals having a sudden heart attack while… workout on a treadmill or performing some other form of vigorous exercise. This sounds counterintuitive, as exercise is known to improve the condition of the heart and prevent heart attacks. While the specific circumstances of the prior health status and the intensity of exercise undertaken are likely to vary in such cases, there are some general facts that will help explain this apparent paradox,” said Prof. K. Srinath Reddy, a cardiologist, epidemiologist and President, Public Health Foundation of India (PHFI).
dr. Reddy explains these sudden episodes: “Heart attacks are caused when there is a sudden blockage of the blood supply in one of the coronary arteries that supply blood to the heart muscle. Chronic obstruction of 70 percent or more in a coronary artery causes angina or chest pain in exercise, because the available blood supply does not meet the increased oxygen demand of the training body and the overloaded heart.However, a heart attack (acute myocardial infarction) can occur when soft plaques that form in the coronary arteries rupture and cause a large clot. with no prior warning symptoms. Even 30 percent plaques can rupture and cause the formation of a large obstructive clot.”
So how are plaques formed? “Plaques form in the coronary arteries as a result of injury caused to the blood vessel lining, by factors that cause inflammation. High blood pressure, smoking, diabetes, unhealthy diet, stress, insufficient sleep or recent infection do so. Fat in the circulating blood then settles at the site of the injury to allow the plaque to grow.Any of these chronic causes of inflammation can also cause acute plaque rupture leading to a heart attack, if there is a sudden or severe rise in one or more of those factors. strenuous exercise can cause plaque ruptures or cause electrical disturbances in the heart, which can lead to cardiac arrest,” adds Dr. Reddy.
Most of these episodes take place in the early morning. “Usually in the early morning there is a rise in blood pressure, which is part of our evolutionary biology. The tendency for blood clotting is also higher at that time. If a person with underlying coronary risk factors has not slept well, is dehydrated, and gets up to vigorous exercise, plaque instability can lead to rupture and the formation of large clots,” explains Dr. Reddy.
EXERCISE IS NOT BAD
This does not mean that exercise is bad for the heart. “It is essential to detect and manage the risk factors that build and rupture plaques in the coronary arteries. Caution and caution are all the more necessary in Indians who have an ethnic susceptibility to heart attack at a younger age than other populations, for a variety of reasons” , says Dr. Reddy.
Sudden cardiac death during strenuous exercise, such as a vigorous treadmill or snow shovel, occurs against the background of known heart blocks or more often occult coronary artery disease or blockage of heart arteries that have not yet been diagnosed. If a patient is revived in such a situation, he has a better outcome compared to a sudden arrest at rest where the heart is usually weak (heart failure),” says Dr. Suman Bhandari Visiting Consultant, Interventional Cardiology, Fortis Escorts Heart Institute
“When the treadmill is operated at a very high speed and/or incline, there is a double impact, namely the heart rate and blood pressure, which determine the oxygen demand in the heart. High metabolic values (metabolic equivalent) at higher rates and for longer periods of time can place undue stress on a compromised cardiac circulation in a setting of heart blocks. They cause sudden arrhythmias, unnecessarily low blood pressure or a heart attack. Such people should be urgently evaluated with coronary angiography and undergo appropriate revascularization, for example, a stenting procedure according to current guidelines,” adds Dr. Bhandari.