Healthy young Indians collapsing at gyms, weddings, or workplaces, autopsies were already telling a quieter, grimmer story:
something was changing inside young Indian hearts.
Its cardiovascular pathology laboratory was largely studying rheumatic heart disease. By the mid-2000s, seeing fatty blockages in coronary arteries of much younger people during post-mortems, not patients in their 50s or 60s, but in their 40s. Since KEM is one of the largest public hospitals in India, we receive a very high number of medico-legal autopsies. This gave us a long-term view of what’s happening inside young Indian hearts. Long before social media began reporting collapses on dance floors or sports grounds and before the Covid pandemic, seeing a shift in t he age profile of heart disease on my dissection table.
It has consistently found that coronary artery disease (CAD) — fatty deposits narrowing arteries — is the single largest cause of sudden deaths. Earlier, CAD was thought of as a disease of middle age and beyond. Today, autopsies show significant blockages, clot formation, and even healed scars from the earlier heart attacks in people in their 20s and 30s. This shows some of them had already suffered one or more heart attacks, but no one knew as the symptoms were too mild or vague. Often, they also had asymptomatic hypertension or diabetes mellitus. It’s clear that fat deposits are silently building up in young Indians long before anyone expects it. There may be no chest pain warning, no prior diagnosis. The first sign may be sudden collapse and death. That’s the frightening part.
Inside these hearts is the same pattern I found before the pandemic. The culprit is still atherosclerotic plaque in the arteries — the same fibrous and fatty build-up always known to trigger sudden heart attacks.
Myocarditis (Inflammation of the heart muscle due to viral infection) in any significant number, or clots, associated with Covid-related coagulopathy (bleeding disorder). Young people were already dying of sudden heart attacks before the pandemic — Covid or vaccines did not create this trend. The drivers remained the same: lifestyle, diet, obesity, smoking, diabetes, hypertension, lack of early screening. The latest are gym activities, protein supplements and anabolic steroids thrown in, and stress, of course.
The warning signs are often subtle and easy to miss. Families recall that the young men or women sometimes complained of unexplained fatigue, indigestion, gaseous distension or disturbed sleep. These are rarely recognized as heart-related and usually dismissed as stress, acidity, or overwork. Many of them had active jobs, some were regular gym-goers. The assumption was, “He is young, he works out so his heart must be fine.” But the outward appearance of fitness does not always match with what’s happening inside the coronary arteries.
Prevention has to begin much earlier. For people over 30, and anyone over 25, with a family history of heart disease, I recommend a lipid profile, fasting blood sugar, HbA1c (which measures 2-3 month blood sugar average), and ECG. Smokers, those with obesity or high blood pressure should also undergo echocardiography (Echo) and coronary calcium scoring. Those into sports need an Echo as well to pick up subtle congenital anomalies or non-ischemic disorders. Healthy folk can repeat tests every 3-5 years but high-risk ones should do them annually.
HOW EARLY TO START SCREENINGS?:
Have found fatty streaks (earliest stage of artery disease) in obese teenagers as young as 17 years. For overweight teens with a family history of diabetes or heart disease, I would recommend blood sugar checks in the late teenage years. Early detection, regular monitoring, and lifestyle change can save lives.
