‘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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Trouble ‘Miyas’ everywhere only then they will leave Assam: Himanta Biswa Sarma
Says “Himanta Biswa Sarma, BJP are openly against them, we are saying it openly
New Delhi: Assam Chief Minister Himanta Biswa Sarma on Tuesday said that four to five lakh “Miya voters” would be removed from the electoral rolls in the state once the Special Intensive Revision (SIR) of voter lists is carried out. He also made a series of controversial remarks openly targeting the Miya community, a term commonly used in Assam in a derogatory sense to refer to Bengali-speaking Muslims.
Speaking to reporters on the sidelines of an official programme in Digboi in Tinsukia district, Sarma said it was his responsibility to create difficulties for the Miya community and claimed that both he and the BJP were “directly against Miyas”.
“Four to five lakh Miya votes will have to be deleted in Assam when the SIR happens,” Sarma said, adding that such voters “should ideally not be allowed to vote in Assam, but in Bangladesh”. He asserted that the government was ensuring that they would not be able to vote in the state.
The chief minister was responding to questions about notices issued to thousands of Bengali-speaking Muslims during the claims and objections phase of the ongoing Special Revision (SR) of electoral rolls in Assam. While the Election Commission is conducting SIR exercises in 12 states and Union Territories, Assam is currently undergoing an SR, which is usually meant for routine updates.
Calling the current SR “preliminary”, Sarma said that a full-fledged SIR in Assam would lead to large-scale deletion of Miya voters. He said he was unconcerned about criticism from opposition parties over the issue.
“Let the Congress abuse me as much as they want. My job is to make the Miya people suffer,” Sarma said. He claimed that complaints filed against members of the community were done on his instructions and that he had encouraged BJP workers to keep filing complaints.
“I have told people wherever possible they should fill Form 7 so that they have to run around a little and are troubled,” he said, adding that such actions were meant to send a message that “the Assamese people are still living”.
In remarks that drew further outrage, Sarma urged people to trouble members of the Miya community in everyday life, claiming that “only if they face troubles will they leave Assam”. He also accused the media of sympathising with the community and warned journalists against such coverage.
“So you all should also trouble, and you should not do news that sympathise with them. There will be love jihad in your own house.” He said.
The comments triggered reactions from opposition leaders. Raijor Dal president and MLA Akhil Gogoi said the people of Assam had not elected Sarma to keep one community under constant pressure. Congress leader Aman Wadud accused the chief minister of rendering the Constitution meaningless in the state, saying his remarks showed a complete disregard for constitutional values.
According to the draft electoral rolls published on December 27, Assam currently has 2.51 crore voters. Election officials said 4.78 lakh names were marked as deceased, 5.23 lakh as having shifted, and 53,619 duplicate entries were removed during the revision process. Authorities also claimed that verification had been completed for over 61 lakh households.
On January 25, six opposition parties the Congress, Raijor Dal, Assam Jatiya Parishad, CPI, CPI(M) and CPI(M-L) submitted a memorandum to the state’s chief electoral officer. They alleged widespread legal violations, political interference and selective targeting of genuine voters during the SR exercise, describing it as arbitrary, unlawful and unconstitutional.
