WHAT IS HEART DISEASE?

Mr. Kishore Shah is a 60-year-old stockbroker who has been smoking for 30 years and has managed diabetes for the past 4 years. One night, after a heavy meal, he suddenly felt a squeezing pain in his chest that lasted for two hours. He was rushed to the hospital, where doctors discovered he had suffered a massive heart attack. Luckily, he was given medicine in time and survived.

Mr. Manish Arora was a 30-year-old executive who was very fit and played sports four times a week. He was slim and did not have any traditional risk factors for heart disease. One evening, while playing tennis, he collapsed on the court and was declared dead.

While both men suffered a "heart problem," it is important to note that the causes were very different. Mr. Arora had a cardiac arrest due to a condition called hypertrophic cardiomyopathy, in which the heart muscle becomes abnormally thick and enlarged. This is very different from the heart attack that Mr. Shah experienced. It's worth noting that while Mr. Arora's case is tragic, recent 2025 AHA/ACC cardiology guidelines now state that with proper expert screening and shared decision-making, many individuals with hypertrophic cardiomyopathy (HCM) can safely return to vigorous recreational and even competitive sports.

When we commonly refer to "heart disease," we usually mean coronary heart disease, which happens when blockages build up in the coronary arteries. These blockages are called atherosclerotic plaque, and the process by which they build up is called atherosclerosis. This is also known as coronary artery disease. These blockages may lead to a heart attack, but it is not a certainty that they will.

What is a heart attack?

A heart attack (medically known as a myocardial infarction) is the injury or death of part of the heart muscle. There are two major ways in which a heart attack can occur:

• Blockages get worse: As plaque blockages get larger, there is less blood flow to the heart muscle. At a certain point, the heart muscle can no longer get the blood and oxygen it needs. When the blood supply is severely restricted or cut off for more than 30 minutes, the heart muscle cells begin to die, and a heart attack occurs.

• The plaque cracks: Most heart attacks happen when a plaque blockage cracks or ruptures. The plaque becomes unstable, causing a blood clot to form over the rupture. This clot completely blocks the flow of blood through the artery, causing an immediate heart attack.

What is angina?

Angina is a pain or discomfort that is usually felt in the chest and can spread to other parts of the body, such as the neck, jaw, shoulders, or arms. In some people, the discomfort is only felt in these surrounding areas and not in the chest at all.

Signs of a heart attack:

• Angina (chest pain or discomfort)

• Nausea and vomiting

• Shortness of breath

• Sweating

• Anxiety

• A Note on Atypical Symptoms: While chest pain is the most common symptom, many people experience "silent heart attacks" with subtle symptoms or no pain at all. This is especially true for women, who may just feel upper back pressure, jaw pain, or severe fatigue. Furthermore, people with diabetes (like Mr. Shah) often have nerve damage that masks severe chest pain, making them twice as likely to have atypical symptoms.

The signs of a heart attack can occur in any combination. It is incredibly common to mistake these signs for gas, indigestion, or acidity. However, unless a doctor explicitly tells you otherwise, always assume severe or unusual chest discomfort is a heart attack and take immediate action.

Other forms of heart disease:

As mentioned earlier, while we commonly refer to coronary artery disease, there are other types of heart conditions as well:

• Valvular heart disease: In this condition, one or more valves of the heart are affected and do not open or close properly.

• Heart failure: In this condition, the pumping action of the heart is weakened, and adequate blood is not pumped to all parts of the body. A person with heart failure tends to experience difficulty breathing even with mild exertion.

Author: Dr. Aashish Contractor is India's pioneer in cardiac rehabilitation and the Founding Medical Director of the Mumbai Marathon. With over 25 years of experience, he has guided hundreds of heart patients to run safely.