Young_Heart_Attacks_Master_AllInOne.pptx

cardiac arrest in young

1. Cardiac Arrest & Young Heart Attacks – India’s Emerging Crisis Epidemiology, Pathophysiology, Risk Factors, and New Frontiers

2. Tobacco & Premature CAD YOUTH Registry: ~50% young MI patients use tobacco INTERHEART South Asia: smoking = 36% of MI risk in <40y Smokeless tobacco (gutkha, khaini): 7–10% prevalence

3. Smoking-attributable MI (<40y)

4. Alcohol & Heart Risk Binge drinking → arrhythmias (Holiday Heart Syndrome) Urban Indian youth: 25–30% males, 10–15% females binge Kerala cohort: heavy alcohol → 2.3× CAD risk

5. Gender Distribution 80–95% of young MI cases are male Protective estrogen effect in premenopausal women Female risk rises with smoking, diabetes

6. Other Addictions Cocaine/Amphetamines: potent vasospasm triggers Energy drinks: arrhythmias, hypertension Digital addiction → sedentary lifestyle

7. Urban vs Rural Lifestyle Urban youth: obesity, diabetes, stress Rural youth: tobacco use, limited healthcare IT/Finance: 3× higher metabolic syndrome

8. Obesity Phenotype Thin-Fat Indian: visceral adiposity at normal BMI Waist-to-hip ratio better than BMI Punjab: 71.8% obese/overweight among young hypertensives

9. Central vs Peripheral Obesity Risk

10. Dietary Risks Refined carbs, fried foods, ghee → ↑ MI risk Low fruit/veg intake → 1.6× higher MI risk Mediterranean/DASH diets protective

11. Stress & Psychosocial Factors INTERHEART: stress = 32% of MI risk in South Asians >50% of Indian IT workers report chronic stress Mechanism: sympathetic overdrive → plaque instability

12. Type A Personality & Competition Hostility, competitiveness, urgency → 2× CAD risk Academic/work pressures in India accelerate disease

13. Pathophysiology of Young CAD Endothelial dysfunction → fatty streaks Plaque formation, rupture vs erosion Arrhythmias: HCM, ARVC, Brugada, CPVT, LQTS

14. Plaque Progression Timeline

15. COVID/Post-COVID Impact Delhi/Kerala: rise in STEMI <40 post-pandemic Mechanisms: inflammation, hypercoagulability, myocarditis Lifestyle changes: weight gain, inactivity, stress

16. Emergency Response in India Bystander CPR: <10% in India vs 60% global target AEDs scarce in public spaces Hospital care: TTM, immediate PCI access

17. Bystander CPR Gap

18. Chain of Survival 1. Early recognition & call 2. CPR 3. AED defibrillation 4. Advanced care 5. Post-arrest care

19. Interventional Advances PCI: cornerstone of STEMI management BRS: MeRes100, DREAMS 3G, ABSORB (mixed results) Calcium modification: IVL, Rotablation, Orbital Imaging: IVUS, OCT essential in young PCI

20. New Pharmacology PCSK9 inhibitors (FOURIER, ODYSSEY) → ↓ LDL Inclisiran (ORION): siRNA approach Icosapent Ethyl (REDUCE-IT): ↓ CV events GLP-1/GIP agonists (SELECT, SURPASS): obesity + CV benefit

21. Genetics & Screening Familial hypercholesterolemia (FH), Lp(a) Cascade lipid screening critical in families Channelopathies: Brugada, LQTS, CPVT CMs: HCM, ARVC

22. Case: Smoker STEMI 28yo male, anterior STEMI PCI vs BRS debate Outcome: PCI with DES, risk factor modification

23. Case: Athlete Syncope 19yo male, syncope during sport Echo → HCM Management: family screening, activity restriction

24. Case: Post-COVID NSTEMI 35yo, obesity + metabolic syndrome NSTEMI with TG elevation Management: PCI + anti-obesity drugs

25. Prevention Roadmap Campus/gym checks: BP, BMI, lipids, ECG Workplace: smoke-free, healthy canteen, stress mgmt City: AEDs in malls, mass CPR training Clinicians: early statins, GLP-1, smoking cessation

26. Algorithm: Young MI Evaluation 1. Clinical history & risk factors 2. ECG, Echo, labs 3. Coronary angiography ± IVUS/OCT 4. Screen for FH, Lp(a), secondary causes

27. Algorithm: Syncope in Young 1. History & family history 2. ECG, Echo 3. CMR ± EP studies 4. Consider channelopathies

28. Take-home Messages Premature CAD is rising in India Risk factors cluster: tobacco, obesity, stress CPR/AED essential to save lives BRS promising but selective Genetics & lifestyle interventions key

29. References ICMR, YOUTH, NORIN-STEMI, ACS-QUIK, INTERHEART FOURIER, ODYSSEY, ORION, REDUCE-IT, SELECT, SURPASS trials BJMC autopsy data, Punjab screening studies International CPR consensus, BRS trial data