What causes young people to have heart attacks? | Dr. Shriram Nene
What causes young people to have heart attacks? | Dr. Shriram Nene
Although heart attacks and cardiac arrest have remained major health concerns around the world, a growing number of cardiovascular diseases have been diagnosed and reported among the younger population in recent years.
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DISCLAIMER- this video is for creating awareness about knowledge available in the medical field and is not intended to be medical advise. Every individual should consult with their own healthcare professional before embarking on a healthcare journey. The information provided is no substitute for a thorough evaluation, exam and advice from your healthcare professional.
Content
2.8 -> hey guys welcome back to the channel i'm sure
all of us were heartbroken when we heard about
7.92 -> these youngsters less than 50 years old often
less than 40 years old dying of premature heart
14.08 -> disease when we heard about raj koshal
puneeth rajkumar and siddharth shukla
19.76 -> but the truth is heart disease according to the
who is the number one killer of people across the
25.76 -> world and it accounts for about 17.9 million
deaths a year in india alone we have about 17
32.08 -> and a half lakhs and remember india doesn't have a
reported all-cause mortality so what are the risk
37.76 -> factors for heart disease what are the symptoms
how do you treat it and how do you avoid it hey
43.28 -> guys i'm dr naenae a u.s trained cardiac thoracic
and vascular surgeon and a general surgeon as a
49.28 -> healthcare innovator and a health tech innovator
i want to empower you to your best health ever on
55.76 -> this channel we will share evidence-based medicine
from all of us to you through our experiences and
62.32 -> training about health and health care the goal is
to help you make informed decisions about your own
68.48 -> health as well as that of your loved ones we're
here for you so don't hesitate to reach out so
74.16 -> the first thing to remember is heart
disease is all about supply and demand
78.96 -> and there's these arteries on the outside of the
heart which pump blood to the heart muscle the
84.64 -> heart muscle is three different things it's a
muscle which when constricted pumps blood from
92.56 -> the two upper chambers to the lungs or to the body
and it's also an electrical conduction system and
100.16 -> it's an arterial and venous system that powers up
all of the other things and what happens in heart
105.6 -> disease is you get blockages in the main arteries
which feed to your heart or in the smaller
110.8 -> arteries that feed to your heart and when they
block up and don't have enough flow that muscle
115.84 -> becomes ischemic or has starvation for oxygen and
that results in a heart attack so let's start with
123.52 -> anyone who has looked at the risk factors for
heart disease they're fairly clear and some of
129.2 -> these are more important than others like if you
have a first degree relative with heart disease
133.84 -> your risk of heart disease goes up four to ten
fold higher than the baseline similarly if you've
138.72 -> had a previous heart attack your risk goes up
substantially for having a second heart attack
144.16 -> and in these types of patients we're talking
about primary prevention through different means
150.48 -> and different ways to change their risk factors
in addition to these risk factors which we talked
155.6 -> about there's also risk factors of smoking morbid
obesity diabetes and a host of others which we've
164.16 -> listed as always i've left the references in the
description below so you can always look at the
170.88 -> evidence-based material for yourself and decide
now let's say you have those risk factors do
176 -> you run and hide put your head in the sand no in
fact now you have to think about what you can do
181.68 -> to change that if you're morbidly obese see a
doctor go on a diet start an exercise program
187.68 -> to make your heart stronger at the same time as
reducing weight and being happier if you have
194.08 -> first degree relatives with heart disease make
sure that you go into a doctor and mention that if
200.8 -> it if they succumb to it meaning they passed
below the age of 50 the risk is even higher and
205.68 -> interestingly in india it's a very peculiar type
of heart disease in males where it's one type of
212.72 -> lipid vehicle called triglyceride rich
heart disease and it occurs 10 years younger
218.24 -> than the western counterparts so if we saw heart
disease peaking somewhere between 50 and 65 in
223.52 -> the u.s it often peaks between 40 and 50 in india
and this has been mentioned in numerous papers uh
229.92 -> where they find this and when it happens asians
are often smaller in built and they have smaller
235.28 -> arteries and as a result end up with tighter
blockages and worse blood flow so let's move on
241.52 -> now from the risk factors to what are the symptoms
of heart disease in 85 roughly of patients who
249.6 -> have heart disease they may have typical symptoms
and why i'm saying that is you'll figure it out in
255.76 -> a second but those symptoms can be chest pain
chest pressure shortness of breath chest pain
261.36 -> radiating to the left arm or back pain and it
can be associated with activity or sometimes at
268.64 -> rest the tricky part is 15 of patients will either
have no symptoms or have atypical symptoms meaning
275.76 -> symptoms of heartburn or dyspepsia which are
often construed as something else and that's
281.2 -> particularly to diabetics who often have nervous
systems nerves in particular which don't function
288.56 -> normally and in those patients and also in women
we often see the disease presenting late and hence
296.48 -> the mortality or the complications are much higher
so the idea is if you're a diabetic or in the case
302.88 -> of women we found that they often did not go
in early they said oh this is just heartburn
310.24 -> or i'm so busy i have so many things do i won't go
in and heart disease in women actually has worse
316.8 -> outcomes because they often present later
and they often have smaller arteries
320.96 -> so now you've got these symptoms or maybe atypical
symptoms and they're reproducible and they come on
326.64 -> with activity what do you do if you're at home
and you have chest pain if you're in the u.s
333.84 -> you call 9-1-1 and you go to the hospital
or you drive into the hospital immediately
339.28 -> and why that's important is time is muscle in
the u.s we used to count survival and mortality
347.2 -> risks by door to balloon time meaning the time
you got into the hospital but more importantly
352.16 -> from the time you hit the hospital to the time
you hit the cath lab and the artery was opened
356.8 -> or you went to surgery and in an ideal setting
30 to 60 minutes is the best outcomes if you
363.2 -> wait longer than six hours of the heart attack
the risks are much higher and six to 24 hours is
369.68 -> the witching period for heart surgeons operating
because you get very bad reperfusion effects often
375.52 -> leading to the heart being stunned now that's a
challenge in india because the truth is that just
381.68 -> getting to the hospital with traffic and all that
many places is tough but moreover india's not one
387.44 -> india it's 30 metro 70 rural and where resources
in many cases are sparse and so the idea is to
395.76 -> recognize this early and often and move from the
acute care mode to prevention early recognition
402.16 -> early treatment prevention of heart disease relies
on a recognizing risk factors for heart disease
408.16 -> and changing them b focusing on living a better
lifestyle and improving all of your parameters for
417.28 -> healthy living it's not always easy you can't
always change the stress at work you can't always
422 -> change your diet you can't always improve your
exercise particularly in the last two years with
426.4 -> the pandemic let's face it not all of us could get
outside and do what we needed to do i'm already
432.08 -> feeling better and i had had my pandemic pounds
for a while and now they're all gone but i can
437.28 -> tell you that you need to overcome that you need
to set the goals in front of you and look at these
442.56 -> go see a doctor track all of these things in a
later video we'll talk about different aspects
447.52 -> of this with weight loss and exercise and all
that on the channel so you can refer to those to
453.2 -> help you with some of that but heart disease is
always about prevention it's about eating right
459.52 -> watching your weight exercising if you have high
cholesterol and you have risk factors or you've
466.24 -> had an event that's primary prevention let's
talk about cholesterol for a second the original
471.52 -> studies done in framingham massachusetts suggested
that people with elevated cholesterol were at
478.08 -> risk of heart attack at a higher rate however
more recently there were some crestor studies
483.84 -> on a particular drug which reduced cholesterol
and over 12 years they weren't able to show a
489.2 -> significant decrease in mortality in most patients
there were exceptions to that in patients who had
496.64 -> secondary prevention meaning they'd already had
an event or patients with exceptionally high risks
502.64 -> family history or other factors which would push
you to using it but as a rule we're not paying
508.88 -> as much attention to cholesterol now as a primary
prevention technique whereas before that we were
514.96 -> all pushing to bring the cholesterol and the ldl
way down and why that is is because the benefits
520.32 -> did not outweigh the risks in primary prevention
in patients with low risk in patients with
525.52 -> high risk or secondary prevention it makes
sense let's move on from prevention now
532.08 -> to what you do if you're having these symptoms
the first and foremost thing is to call for help
538.4 -> don't just sit by and watch this consume you
because time is muscle as we always said and
545.52 -> the bottom line is the sooner you get in and the
sooner someone can get you assessed and evaluated
549.84 -> and treated the better off you're gonna be in the
meanwhile what can you do there's numerous studies
555.36 -> that suggest just taking a baby aspirin alone 81
milligrams is beneficial how it works is to block
561.92 -> platelet coagulation or clotting and it can help
with your heart in the hospital setting i would
569.36 -> give people supplemental oxygen i would give them
nitroglycerin while getting an ekg and doing other
574.16 -> things on the way to the cath lab in addition in
many cases we would put on blood thinners through
579.68 -> the iv you can't do that at home right your only
hope is to get into the hospital now you've been
584.4 -> admitted to a hospital you typically go through
the er they're going to do an ekg on you and
589.44 -> they're going to look at specific changes which
would indicate that parts of your heart muscle are
595.2 -> having problems with blood flow and what they'll
end up doing is temporizing you until they can get
602.32 -> a cath lab operating if perchance your ekg is not
showing it but you have symptoms the other thing
607.6 -> they often do is draw cardiac enzymes what are
cardiac enzymes when your cells die they basically
615.76 -> break down and these cardiac enzymes which are
byproducts of muscle breakdown will go into the
622.16 -> bloodstream and these can be measured
the most common ones are troponins or
627.76 -> myocardial enzymes and these things are essential
and if your troponins measured at different
633.12 -> intervals or positive then it indicates that
you have had a cardiac event that would push
640.4 -> you to potentially take someone to the cath lab
but there are a lot of criteria the second thing
646.16 -> they may do in the hospital after getting the ekg
if they're not sure is getting an echocardiogram
650.88 -> to see if one part of your heart muscle is moving
differently than another part and what will happen
655.92 -> is if there's an area which is starved for blood
meaning there's a blockage there that part of
661.44 -> the muscle will become either hypokinetic
or a kinetic hypokinetic means move less
666.88 -> and a kinetic means not move at all depending on
when you get to it you can reverse that if it's
673.2 -> within the first six hours there's a good chance
that you can get that back and if it's within
677.12 -> the first 30 minutes chances are it'll get back
completely beyond that sometimes the heart will
681.92 -> get stunned and it may take a number of hours
or days to get better so what are the options
687.12 -> once you're faced with that there's actually three
options the first is if you're in a remote area
693.92 -> and you're having a massive heart attack the one
thing they can do and if they're proving it is
697.84 -> they can lyse you with tnk which is something
which breaks down the clots there are basically
704.24 -> things which act on the clots to break them down
if they don't have a cath lab in an ideal setting
710.48 -> a cardiologist would see you they would take you
to cath lab and through access through your groin
715.28 -> through the femoral artery they would or through
your radial artery they would put a catheter up
719.76 -> and squirt some dye in to see what blockages
are there and then they'd pass a wire down
724.32 -> and get past the blockage and then either suck it
out or put a stent across it to re restore flow
730.88 -> now there's situations where you can't do that
and the absolute indications for a bypass surgery
738.24 -> would be severe three vessel disease meaning that
the three main arteries on your heart are blocked
743.92 -> and you're starving the heart muscle for blood
the second would be a left mane meaning that the
750.32 -> two arteries on the left side of your heart one
going down the front and one going down the side
754.8 -> the led and the circumflex come from one root
called the left main off the aorta and if that's
760.72 -> blocked high grade it's very risky to put a stent
across and so that would be another indication the
766.24 -> third would be multivessel disease meaning small
blockages all throughout in arteries which could
771.28 -> be bypassed in diabetics and in all of these
three cases they've shown that there's benefit
777.12 -> to operating on someone now they catheterize you
they put in a stent what can you expect usually
783.6 -> recovery from stents is fairly quick there are
some complications which can occur like having
788.72 -> bleeding from your groin you can have
pseudoaneurysm or a small collection there
794.16 -> or you can have bleeding from other areas from
the blood thinners they put you on they also put
798.32 -> you on anti-platelet agents for a number of months
and you will have to tolerate them and some of the
804.4 -> side effects can be from bleeding from your gut
from your stomach through ulcers and things like
808.96 -> that or from other areas which were not an issue
before but were revealed once they put you on the
815.52 -> antiplatelet now let's say they can't stent you
what are the other options depending on how sick
821.04 -> you are and how well they can stabilize you with
the blood thinners the oxygen the nitroglycerin
828 -> they can dictate whether you need to go to
emergency heart surgery or whether they can
833.04 -> let you stabilize a little bit and take you but
generally if they've opened up the block or bought
838.08 -> you some time and you're no longer showing your
semi-changes but you have severe heart disease
842.24 -> then the recommendation would be to do it either
electively meaning at a small time interval or
849.6 -> emergently meaning that i need to go right away
and when they take you to the operating room what
854.4 -> they'll end up doing is under general anesthesia
they'll take artery from the inside of your chest
861.12 -> veins from your legs and open your chest up and
sew the arteries onto your heart or the vein
866.72 -> onto your heart coronaries and then attach that
to the aorta in the case of the veins or attach
874 -> with the artery that comes from the inside of
your chest it already has its own blood supply
878.56 -> with that the long-term survival is exceptionally
good in patients who warrant that and remember i
884.64 -> gave you those criteria for doing it so now you've
had heart surgery what do you expect generally
889.84 -> you're in the hospital about three to seven days
afterwards it will take about three months to
895.12 -> get over it but the recovery will be full in most
cases there are risks and your doctor will explain
901.52 -> those to you but the long-term benefit from heart
surgery is very clear the artery which we put on
907.84 -> often is open 90 of the time at 10 years and the
veins can be as high as 70 percent it's a very
914.08 -> proven procedure for patients who need it the hope
would be with this and what the take home is is if
920.24 -> we can prevent early recognize and early treat and
move away from acute care we can solve this puzzle
927.6 -> let's face it worldwide and in india there aren't
enough resources to go around and heart disease is
933.84 -> such a killer predominantly because people come in
late and if they understand what the risk factors
940.4 -> are what the symptoms are what the treatment is
and also when they should go in right then the
947.52 -> hope would be that we can treat them earlier
in the diseases process and in doing that we
954.32 -> can potentially save their lives and save the
lives of their loved ones as always i've left the
959.52 -> evidence-based links in the description of this
video and you can go to my website doctornay.com
965.44 -> which has a lot of the details that you can dig
deeper on i'm here for you and you're here for
971.28 -> me and together we'll build a better world but
the idea is to start the dialogue now and so
976.8 -> leave comments below don't forget to subscribe
like and share and always always think of your
983.52 -> health because it's something which can slip by
very quickly and it's something that if you spend
988 -> time on can be amazing here's to your health and
here's to your happiness thanks for joining us
1002.6 -> [Music]
1003.6 -> you
Source: https://www.youtube.com/watch?v=vEaCshtSBMs