In Kashmir, dying young hearts leave trail of questions

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Javaid Ahmad Malla fell unconscious when he was travelling in a passenger bus from his home in Watergam village of north Kashmir to his Srinagar office.

Malla, a 29-year-old journalist, was immediately rushed in the same bus to the nearby Sub District Hospital in Pattan. He was declared brought dead by the doctors. 

At his office in Srinagar, Malla’s colleagues were waiting for him in the afternoon of 1 October last year when the news about his death along with his picture started circulating on different WhatsApp groups, said Mansoor Peer, Malla’s colleague, and a close friend. “I immediately called a doctor at the hospital and I came to know that he had suffered a massive heart attack and was admitted in a hospital in Pattan,” said Peer. 

Earlier that morning Peer had spoken with Malla on the phone regarding that day’s meeting. “Like every other day, Javid said he would keep his bike at Sopore, then board a passenger vehicle to Srinagar,” he said. “Who knew this would happen?”

While working together Malla and Peer had shared a rented room in Srinagar for three years till March 2020, when the COVID-19 lockdown was imposed and both of them went back to their hometowns. “I had seen him very closely, he didn’t have any habits like smoking or drug abuse,” said Peer.

Throughout these years Malla had never shown any signs of chest pain or other symptoms that would prompt him to go to doctor, said Peer. “He did not have any health conditions like hypertension or diabetes,” he said. 

Malla’s death was not the first case of a sudden death caused by cardiac arrest among the youth in Kashmir; it wasn’t the last also. In the past few months, many young men in Kashmir died of similar causes. 

In the first two weeks of January, more than a dozen men in the age group of the thirties died due to cardiac arrest that has raised concern and caused panic amongst the people. The dead include a 34-year-old Ph.D. scholar from Budgam, a  22-year-old woman from Baramulla, and a 38-year-old woman from Shopian. 

Tahira Nazir, 27, Malla’s younger sister, said that till the time of his death Malla showed no sign of depression or anxiety. “He would talk less but that was his nature,” she said.

However, Malla may have been worried about his work, said Nazir, since there was a lockdown and like many others, he was confined to the four walls of his room. “Other than that he was really happy; he had been married during the lockdown only,” she said. 

To this day, Malla’s family is shattered by the grief of his sudden death and is trying to understand the cause of it. “If he had died from a prolonged illness, there wouldn’t have been so many questions,” said Nazir. “This was really unexpected.”

Doctor’s speak

Irfan Ahmad Bhat, an Interventional Cardiologist at Shri Maharaja Hari Singh (SMHS) hospital, said that heart attacks were rare among people till a few years ago. 

Due to urbanization, communicable diseases have reduced but the risk of non-communicable diseases has increased, he said. “These include hypertension and diabetes, caused due to the behavioral shift among people,” said Bhat. “These two diseases are the major cause for heart attacks.”

A few years ago, said Bhat, children were more indulged in physical activities such as playing at school and at their homes. Nowadays, he said, the physical activity of children has reduced to a large extent leading to their indulgence in modern gadgets and the internet which is impacting their health. 

“There are no proper sports centers, playgrounds, or swimming pools. There is no way for them to stay engaged in activities like sports and exercises,” said Bhat. 

Due to heavy smoking, which is widespread among Kashmiri people, a disease called atherosclerosis is caused among people. The chemicals in cigarette smoke cause the arteries to thicken, making it difficult for blood vessels to move through the arteries. 

If a smoker gets a heart attack, he either dies on the spot or develops morbidity, said Bhat. “A blood clot is formed in the heart that causes a heart attack. If the treatment is done on time, we usually see that the angiography is normal. It means that the clot has been dissolved,” he said. 

Another reason, believes Bhat, is the psychosocial stress among people. Psychosocial stress is the stress of one’s social status, esteem, and acceptance within a group of people. “Our youth is forced to achieve a different lifestyle. They have become overambitious,” the doctor said. “They have to fight beyond their limits which causes extreme stress.”

Bhat said the reason for the spike in heart attacks during winters is that the vessels in the body fail to prevent the heat loss due to which the cold temperature in the body goes up. Due to this, the heart has to pump forcefully as the process gets difficult. “By pumping forcefully, the oxygen demand of the heart also increases,” he said.

Any undue exercise during winters can lead to heart attack, said Bhat, as the heart cannot cope up with the stress. 

“During snow shoveling, the demand for exercise is more than the normal supply of the heart,” he said. “If the person is not accustomed to heavy work, he can immediately get a heart attack due to the difference between demand and supply.”

Fear of stigma

Yasir Rather, in-charge of the drug de-addiction center of the Institute of Mental Health and Neuro Sciences (IMHANS), said that around 40 percent of the patients who are indulged in drug abuse often suffer from a drug overdose that often leads to heart attacks in severe cases. 

“It is a near-death experience where they become unconscious and go into a coma-like state and they need a ventilator,” said Rather. “For those who are saved, it is a narrow escape.” 

Due to the stigma attached to drug abuse, said Rather, many parents often lie about the reason for the death of their children. “When they are not able to tell the reason, they say that their child died of a heart attack,” he said. 

Rather added that the phenomenon of deaths due to heart attacks is new to society and many of these deaths are basically caused due to drug overdose, kept hidden due to stigma. 

Two days ago, one of Rather’s patients involved in drug abuse died due to a drug overdose at his home. As soon as his family found him unconscious in his room, he was rushed to the hospital where he was declared brought dead by the doctors. 

The patient was a second-year student and was involved in drug abuse for three years. “I met him just three days before he died, he had been consuming heroin and cannabis,” said his friend, requesting to be anonymous. 

The family of the patient said his friend was not aware of their son’s condition and only came to know about it as they saw him lying unconscious in his room. “There were drugs around him,” he said. “Even if they know now, how can they tell the world about it?”

Preventive measures

As the concern over recent spurt in heart attacks grows in the region, the Doctors Association Kashmir (DAK) also expressed serious concern over the rising deaths. General Secretary DAK, Dr. Owais H Dar said, “The number of patients with central obesity and fatty liver disease has drastically gone up in Kashmir after Covid-19 lockdown as it led to the sedentary lifestyles as people were not able to leave their homes and couldn’t do regular exercises thereby further aggravating the problem.”

DAK advised various measures that need to be implemented immediately starting from the establishment of dedicated cardiac care centers (CCUs) with the latest diagnostic modalities like echocardiography machines, TMT and Holter.

It urged the Financial Commissioner Health and Medical Education Department, Atal Dullo for constituting an expert committee of cardiologists and other experts for ascertaining the sudden cause of the deaths for taking preventive measures.

If a person is complaining about chest pain that is spreading toward his left arm, he should be immediately rushed to the hospital, said Bhat, the interventional cardiologist. 

While most people suffering from heart attacks do not even make it to the hospital, the person should not be allowed to walk or move. The first responders should keep aspirin 300mg available at home and people suffering from diabetes can take it if they feel pain in the chest, said Bhat.

The doctor recommended a brisk walk of thirty minutes, five times a week, as a measure to keep the heart-healthy. “They should sweat and feel tired,” he added. “Those who are into drug abuse should immediately go to a drug de-addiction center.”

Bhat said that those with hypertension or diabetes should avoid venturing out during the harsh winter condition and keep themselves warm. “When they go out in the severe cold, the heart has to work very hard to keep the body warm. Due to that pressure, a person can die,” he said.

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