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Why seemingly healthy individuals may die of a heart attack
Mourning: Singer Bunga Citra Lestari (right), the wife of actor Ashraf Daniel Mohammed Sinclair, hugs her son Noah Sinclair during the Malaysian artist’s funeral at San Diego Hills Memorial Park in Karawang, West Java, on Feb
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ourning: Singer Bunga Citra Lestari (right), the wife of actor Ashraf Daniel Mohammed Sinclair, hugs her son Noah Sinclair during the Malaysian artist’s funeral at San Diego Hills Memorial Park in Karawang, West Java, on Feb. 18. Ashraf is suspected to have died of a heart attack. (Antara/M Ibnu Chazar)
The sudden death of actor Ashraf Sinclair, 40, has shocked many in Indonesia and Malaysia, his home country. Prior to his death, the husband of singer Bunga Citra Lestari was known to have a healthy lifestyle with an ideal physical appearance and no significant history of heart or any other disease. Those attributes would easily confuse many people, considering he reportedly died of a heart attack, which classically targets older people with unhealthy lifestyles or with obvious histories of heart disease.
In 2011, another young actor and politician, Adjie Massaid, also died of heart attack at the age of 43 after playing futsal. A famous singer, Mike Mohede, is also known to have died of a heart attack at the even younger age of 32 despite his apparent health. Those three cases are clear examples that younger individuals without a prevalent history of any particular disease are not safe from heart attacks.
Heart attacks are more commonly found in males because of the heart-protective attributes of the estrogen hormone in females. Estrogen helps the metabolism of fat, which lowers the risk of heart disease among women. However, after menopause, the rate of heart disease, including heart attacks, among both genders becomes equal.
Most people who died of a heart attack had a known history of heart disease, particularly coronary heart disease or heart failure.
However, factors such as hereditary conditions may lead to sudden heart attacks. Such a condition, called congenital heart disease, often remains underdiagnosed and undetected for years, which then appears as a single deadly blow in adulthood.
As inherited heart disease may remain silent and without showing clear symptoms for years, people may assume they are disease-free. Heart attacks among those with congenital heart disease may also be provoked by particular precipitating environmental or modifiable factors. Thus, when the inherited or preexisting heart abnormality meets particular provoking factors, such as smoking, high cholesterol or blood sugar, excessive and vigorous physical exercise or emotional stress, the risk of a heart attack then becomes higher. This even applies to anatomically and functionally healthy hearts.
A heart with inherited ailments usually has structural and functional defects that compromise its ability to keep up with the body’s functional demands, which further exceeds its capacity during high-intensity sports and exercise. That is one possible answer why even an athlete could unexpectedly die of a sudden heart attack.
Heart attacks among younger people are also associated with genetic abnormalities, especially when the heart muscle is affected. Among those diagnosed with the rare Brugada Syndrome, the victim presents no prominent symptoms and dies during sleep or while resting. This disease was believed to be the possible cause of Mike’s death in 2016 as he was found to have died in his sleep.
So, how can we be more prepared for heart attacks?
Fortunately, the risk of sudden cardiac death can be reduced trough several approaches. Disease screening is absolutely necessary to detect asymptomatic and underdiagnosed heart diseases that may have existed since birth. Early detection of heart disease can prevent its progression as early treatment can be provided as soon as a diagnosis is established. Therefore, please undergo regular medical examinations, especially when you have symptoms such as chest pain, history of repetitive syncope (loss of consciousness) or sensations of an irregular and abnormal heartbeat.
Moreover, high awareness should be given to those with a family history of heart disease or sudden cardiac death because they face the possibility of genetic-associated heart ailments.
Indonesia’s latest Basic Health Survey of 2018 revealed that the number of smoking adolescents, alcohol consumption and physical inactivity have been persistently increasing since 2012. Hence, the risk for heart attacks among the younger population will also be reasonably higher in the future.
Given the devastating health, social and emotional impacts of heart attacks, it is our joint responsibility to reduce the risk by promoting and maintaining healthy lifestyles, such as avoiding smoking and excessive alcohol, engaging in or increasing our physical activity, consuming healthy foods, regularly monitoring our blood sugar and cholesterol levels, maintaining normal blood pressure, getting enough rest or sleep and also trying to reduce emotional stress.
Lastly, because a heart attack may occur at anytime, anywhere and affect anyone, all individuals must learn about proper basic life support to provide immediate help for the victims when necessary. Remember that in heart attacks, one second matters. Any delay in providing help will result in significant survival rate reduction.
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Physician at RSUD Lakipadada Tana Toraja General Hospital
