‘Puneeth's sudden death a rare case, don't panic but take care of your heart’: Dr Yusuf Kumble
The sudden death of Kannada superstar Puneeth Rajkumar, who was fit as a fiddle, has once again put the spotlight on the prevalence of heart diseases among the youth, about working out in the gym and silent factors like genetic disposition to certain diseases.
Dr Yusuf Kumble, eminent interventional cardiologist and managing director of Indiana Hospital and Heart Institute, Mangaluru, provides answers to some of our most common questions and dispels myths about heart diseases. Here's a summary of what he says:
What is a sudden death?
The most common cause of a sudden death is mostly related to the heart as against accidents or other causes. From a cardiologist's perspective, a sudden or unexpected death happens within six hours of the onset of symptoms as per European standards and within 12-24 hours according to US standards.
What causes a sudden death? How does it happen?
The most common underlying cause of a sudden death is arrhythmia, or rhythm disturbance of heart. If the heart beats more than 300-400 times per minute, it's called tachycardia or ventricular fibrillation which can result in sudden death if not treated urgently.
These sudden deaths often occur due to a spontaneous rupture of plaque in the coronary artery, which supplies blood to the heart [heart attack]. This could also be due to a old heart attack which causes some scar in the heart which in future leads to ventricular arrhythmia and sudden death; some other causes include structural heart disease, a hidden family history of heart diseases, a severe brain stroke or lung issues etc.
Are there any symptoms that can be recognised by patients who had sudden deaths?
People may have some premonitory symptoms like mild chest discomfort or burning sensation within one or two days before heart attack. In most of the cases patients may not have any symptoms or may have a mild dizziness or some chest pain and discomfort, and within a few minutes patient suddenly become unconscious.
Which people are at the most risk of sudden deaths?
People who are having major conventional risk factors for heart attacks like diabetes, high blood pressure, high cholesterol, smoking and obesity are at higher chances of sudden death. Those with a family history of heart diseases or sudden cardiac death (SCD) are also at risk. Patients who had heart attack and left with reduced ejection fraction (poor pumping of heart) are having high risk of SCD. Also structural heart diseases like HOCM, SEVERE AORTIC STENOSIS, channelopathy, drug abusers and bed ridden patients are having high chances of SCD.
What tests should be done to go for regular exercise programme?
First, getting a baseline ECG is a must. Echocardiogram and treadmill are the main tests used to detect the adequacy of blood supply to cardiac muscles. A few blood tests are also recommended. After seeing these reports, the cardiologist will prescribe what needs to be done and what kind of exercise and lifestyle modification is required. Despite all preliminary investigations, including angiograms being normal, some serious issues can still happen due to hidden diseases. These won't be revealed by conventional tests and need further high-end investigations which are not practically possible unless high suspicions is there.
Are working out in the gym and doing other exercises harmful? How dangerous are they?
The incident that befell Puneeth is a rare case. Only one person in a population of one lakh can have a sudden death. It's not very common. Some studies show that one death can happen in 15,000 people with more than 40 yrs of age. It is not very alarming but since it (Puneeth's sudden death) received widespread publicity, it sends shivers down your spine.
It's prudent to get a proper health evaluation done before signing up for a rigorous gym programme. Any excessive strenuous exercise done in a short span of time is not proper. Conditioning the body before the exercise, especially the warm-up, and cooling down afterwards are a must. An evaluation of family history and physical examination before beginning the exercise regimen are vital.
Any tips for working out that will not put a strain on the heart?
Anything done in moderation is good. Overwhelmingly exhausting yourself is unnecessary. You need to consider the age factor as well. Water intake should be adequate. If you are heavily stressed, do only light exercises and take some rest in-between. Warm up before the exercise and cool down after. Never work out under humid conditions as you will tend to lose electrolytes. Sudden bursts of exercise should be avoided. If you take a long break, you need to first build up a rhythm for exercise.
Can we take Aspirin or other medicines if we anticipate a panic attack?
If a person identifies unusual symptoms or discomfort that he/she never or hardly encountered before or if he/she is not a heart patient, he/she can take Aspirin 325 mg. This pill can be kept handy at home/office or during travel. There is nothing wrong in taking chewable Aspirin tablets without the doctor’s advice even if there's no cardiac cause and no major harm was done. It is safe to take the tablet before seeking medical help.
Another easy option is to call up your doctor friend and take his/her advice. In an advanced case, if symptoms are severe and the chest pain is intolerable and the patient feels the pain radiating towards the left arm, he/she can take Clopidogrel 300mg tablets which would provide an added benefit for high-risk people and those with established cardiovascular disease(s).
What can a bystander do when someone is unconscious or has a severe chest pain?
Everyone must be trained in Basic Life Support (BLS) skills, and the government should make it mandatory for senior students to get trained in Cardiopulmonary Resuscitation (CPR) techniques. Immediate CPR can save the victims of cardiac arrest. These days, social workers have been taking interest in BLS training. It's a good sign.
When a person suddenly collapses, it causes panic. In such a situation, BLS-trained people who are around can help. The next step is to seek the help of the Emergency Medical Service, which is available on the toll-free ambulance number. An EMS manned by trained paramedics should be easily accessible to everyone. The government should ensure that.
Another way to address a cardiac emergency is to instal Automated External Defibrillators at important public places where there is a possibility of large gatherings. Many people are aware of the Cardiopulmonary Resuscitation (CPR), which is given physically, while ventricular fibrillation is handled with a medical device.
My message is to go for regular check-ups for high-risk people. Do not panic although certain deaths are unavoidable. But prevention is always better.
Dr Yusuf Kumble, cardiologist and managing director of Indiana Hospital and Heart Institute, Mangaluru
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London, Nov 22: A bomb disposal squad deployed as a “precaution” to the South Terminal of Gatwick Airport concluded an investigation into a "security incident" on Friday after making a “suspect package” safe.
The South Terminal of Gatwick Airport, the UK's second busiest airport after Heathrow, which was briefly shut owing to the incident reopened following the incident.
The Gatwick is around 45 km south of London.
Two people detained during the enquiries have since been allowed to continue their journey as the airport was opened.
“Police have concluded their investigation into a report of a suspect package at Gatwick Airport. Officers from the EOD (Explosive Ordnance Disposal) team made the package safe, and the airport has been handed back to its operator,” Sussex Police said in an updated statement.
“Two people detained while enquiries were ongoing have subsequently been allowed to continue their journeys. There will remain an increased police presence in the area to assist with passengers accessing the South Terminal for onward travel,” the statement added.
Earlier on Friday, the incident caused severe disruption at the busy airport’s South Terminal, while the North Terminal of Gatwick Airport remained unaffected.
“Police were called to the South Terminal at Gatwick Airport at 8.20 am on Friday (November 22) following the discovery of a suspected prohibited item in luggage,” a Sussex Police statement said.
“To ensure the safety of the public, staff and other airport users, a security cordon has been put in place whilst the matter is dealt with. As a precaution, an EOD (Explosive Ordnance Disposal) team is being deployed to the airport. This is causing significant disruption and some roads around the South Terminal have been closed. We’d advise the public to avoid the area where possible,” it said.
Footage on social media taken outside the airport showed crowds of frustrated travellers being moved away from the terminal building.
Gatwick said it was working hard to resolve the issue.
“A large part of the South Terminal has been evacuated as a precaution while we continue to investigate a security incident," the airport said in a social media post.
“Passengers will not be able to enter the South Terminal while this is ongoing. The safety and security of our passengers and staff remain our top priority. We are working hard to resolve the issue as quickly as possible.”
Train and bus services that serve the airport were also impacted while the police carried out their inquiries.
In an unrelated incident in south London on Friday morning, the US Embassy area in Nine Elms by the River Thames was the scene of a controlled explosion by Scotland Yard dealing with what they believe may have been a “hoax device”.
“We can confirm the 'loud bang' reported in the area a short time ago was a controlled explosion carried out by officers,” the Metropolitan Police said in a post on X.
“Initial indications are that the item was a hoax device. An investigation will now follow. Some cordons will remain in place for the time being but the majority of the police response will now be stood down,” it added.
