Raju Srivastava death: Is over-exertion at the gym damaging your heart? Why a TMT test is not enough?

“All you need is 150 minutes five days a week, or 30 minutes of exercise each day. It should be a healthy mix of aerobics, weight training (this strengthens your muscles, including your heart), and stretching (yoga and breathing exercises). This rotation regimen is good for both physical and mental health. Stop during exercise if you feel discomfort and get tested before adopting any high-intensity regimen,” advises Dr. Ruchit Shah, Interventional Cardiologist at Masina Hospital. mumbai.

“Regular exercise increases your heart rate, improves your heart muscles, and helps improve lung capacity. On the other hand, there is a phenomenon known as over-exercising. Continuous overexertion has been linked to an increased risk of ‘atrial fibrillation’, a form of irregular heartbeat that can be fatal if left untreated. Additionally, it can potentially increase the risk of heart abnormalities, particularly for those with hypertrophic cardiomyopathy or coronary heart disease,” says Dr. Shalin Thakore, senior interventional cardiologist at Shalby Hospitals. Ahmedabad.

What is hypertrophic obstructive cardiomyopathy?

Hypertrophic cardiomyopathy, usually caused by genes, occurs when the walls of the heart chamber (left ventricle) become thicker than normal. The thickened walls can become stiff, and this can reduce the amount of blood that enters and pumps out to the body with each heartbeat. The thickened part of the heart muscle, usually the wall (septum) between the two lower chambers (ventricles), blocks or reduces blood flow from the left ventricle to the aorta.

“This can lead to sudden cardiac arrest and a patient needs resuscitation within the first 60 seconds. In fact, we must train students in schools and universities about CPR. We all need to know how to manage this. Also, all public places should have defibrillators, schools and college students,” says Dr. Shah.

WHAT YOU SHOULD DO BEFORE THE GYM: NOT JUST A TMT TEST

Dr. RR Kasliwal, Chairman of Clinical and Preventive Cardiology at Medanta hospital, Gurgaon, advocates for a full cardiac examination for anyone who goes to the gym or does any strenuous activity. “Just one TMT (treadmill test) is not enough. These days there are CT angiograms that can even tell if there is a 40 to 50 percent blockage. Such a block would not appear in TMT because there is not much impairment in the patient’s capacity. Always know your heart before undertaking any strenuous activity. Many people who experience cardiac arrest don’t live to tell about it.”

He said the same should apply to anyone who stopped exercising during the pandemic and is now getting back into an old routine. Such checkups are particularly essential for diabetics and women, she said, because they may not experience a heart attack like typical chest pain.

Dr. Kasliwal said that the COVID-19 The condition of the patient is also very important. “If you have had COVID-19, and we now know that prolonged COVID-19 is causing sudden cardiac death, it is very important that you monitor your heart health. Those who have had Covid-19 also have a high heart rate (tachycardia) sometimes.”

Intensity and duration act as critical factors
“When the treadmill is done at very high speed and/or incline, there is a double whammy, namely heart rate and blood pressure, which is a determinant of oxygen demand on the heart. High mets (metabolic equivalent) during a higher rate and for prolonged periods can cause undue stress on a compromised cardiac circulation in an environment of heart blocks. They cause sudden arrhythmia, unduly low blood pressure, or a heart attack. These people should be urgently evaluated with coronary angiography and should undergo appropriate revascularization, such as a stenting procedure according to current guidelines,” says Suman Bhandari, MD, visiting consultant, interventional cardiology, Fortis Escorts Heart Institute. .

Vigorous activity leaves you breathless and you sweat profusely. Instead, engage in moderate-intensity exercise, which includes activities that get your heart rate up, such as casual sports, brisk walking, jogging, bicycling, and swimming. “Everyone should engage in 30 minutes of moderate-intensity physical activity daily to receive the health benefits. Avoid testing the physical and physical strength of him. Whether you’re a novice or a seasoned athlete, you shouldn’t overdo it. Also, allow plenty of time for your body to recover and repair itself. See a doctor if you have any difficulties,” adds Dr. Thakore.

How to prevent overexertion?

Exercise has both direct and indirect beneficial effects on the heart. Direct effects include helping the heart muscles to get stronger and pump more blood per beat, as well as the ability to better withstand abnormal heart rhythms. Indirect effects include beneficial effects on blood pressure, sugar, cholesterol, and body fat, all of which reduce the chances of a heart attack.

“It is important to note that sudden cardiac death rarely occurs in someone with a healthy heart. Exercise can be the trigger for a cardiac event in people who have silent or undetected heart disease. In terms of a single bout of exercise, there is no definite upper limit, and it all depends on the training level of the individual. One should avoid high levels of unaccustomed exertion, the general rule of thumb is that any exercise session should have no more than a ten percent increase compared to previous sessions. Environmental conditions should also be considered and outdoor exercise should be avoided in extreme weather conditions; as this is a scenario where even a healthy person could suffer serious consequences,” says Dr Aashish Contractor, Director, Sports Medicine and Rehabilitation, Sir HN Reliance Foundation Hospital, Mumbai.

He adds that “Another way to look at ‘too much exercise’ is the total volume of exercise accumulated over the years. In this case, research has shown that a high volume of exercise over several decades could cause some changes in the heart muscle, as well as calcium buildup in the coronary arteries. At this point, the amount of exercise has not been defined and the consequences of these changes have not been fully understood. However, it is well known that for optimal health benefits, moderate exercise is the way to go. So how do you reduce risk? In my opinion, the risk can be reduced by taking care of the following:
1. Health check prior to participation
2. Pay attention to warning signs
3. Sensible and appropriate training programs.”

Balancing your fitness routine with a healthy diet

Indians are genetically prone to heart disease 15 to 20 years earlier than their Western and Japanese counterparts. And since our genes are not modifiable, we need to look at modifiable factors like lifestyle, sleep cycles, and stress. “Now to stress is added tobacco, tobacco derivatives and alcohol. Did you know that the effect of even a single tobacco use lasts three to six months? According to rough estimates, one cigarette shortens life by five to seven minutes. Which means that a moderate smoker can easily reduce his life from three to five years. Instead of ‘no smoking’ banners, we should start a ‘why you shouldn’t start smoking’ campaign,” says Dr. Shah.

Maintaining physical and mental health requires a good diet and regular exercise. “When people do high-intensity workouts and consume less, the body uses up stores of nutrition, causing deficits. Following fad diets to lose weight promotes hunger, anemia, heart disease, stroke, poor mental health, etc. Align your diet with your exercise regimen. Choose healthy carbohydrates as they power your brain and body. Carbohydrates recharge the body after a workout. Eating quality protein after training repairs muscle micro-tears and increases blood flow. Some fats are actually healthy despite being calorically dense. Polyunsaturated fat is advantageous. You can also look for sunflower oil, soybean oil, and various nuts and seeds.
as they contain omega fatty acids. In conclusion, the benefits of exercise should not be questioned; on the contrary, they must be reinforced. However, moderate activity and a healthy diet are strongly supported for a healthy heart,” says Dr. Thakore.

Dr. Shah advocates the “Ek chamach kam (One teaspoon less)” campaign, which involves reducing the use of the three whites in our food: salt, sugar, and oil. More fruits and vegetables. Minimize pastries and junk food.”

When should you have a cardiac fitness test?

Coronary artery disease (CAD) can begin in adolescence. Plaque can form this early. “To prevent further buildup, your first blood pressure, sugar, and lipid profile test should be done at age 18, and then once every three to four years. Check your blood pressure during each clinic visit. You should have your ECG done once a year when you turn 40, and depending on your other parameters, space out the frequency as advised by your doctor. Keep an eye on your LDL levels and, for those who have not had an intervention, keep the level below 60 mg/dL and for those with cardiac intervention such as stenting, below 30 mg/dL.” , advises Dr. Shah. No test is infallible. What we need is a good level of alertness.

UNDERSTANDING PLAQUE RUPTURE

Explaining these sudden episodes, Professor K. Srinath Reddy, Cardiologist, Epidemiologist and President of the Public Health Foundation of India (PHFI), says: “Chronic obstruction of 70 percent or more in a coronary artery results in angina or chest pain with exertion as the available blood supply does not meet the increased oxygen demand of the body in exercise and the strained heart. However, a heart attack (acute myocardial infarction) can occur when soft plaques that form in the coronary arteries rupture, causing a large clot to form. This can come without any prior warning symptoms. Even 30 percent plaques can rupture and cause a large obstructive clot to form.”