Pain in the left side of the chest and breathlessness walking are textbook signs of an impending heart attack.
Yet when Ankit Singh (name changed on request), who is studying to be a doctor at Jaipur's Mahatma Gandhi Medical College & Hospital, got them, he popped some painkillers to ease the pain and went right back to study and work.
Three days later, he collapsed in class.
"An emergency electrocardiogram (ECG) showed I'd had an acute anterior wall myocardial infarction (heart attack), which was followed by an angiogram that showed a major blockage in the left coronary artery. They propped open my artery with a stent and I was discharged in three days," says Singh, a first-year MBBS student.The reason for the misdiagnosis was simple: Rahul is an apparently healthy 18-year-old with no family history of premature heart disease.
"I've always been active, don't smoke or drink, and have no diabetes, high cholesterol or high blood pressure. I was stressed about study and work at medical school, but so was everyone else. The heart attack was like a bolt from the blue," he says.
Never too young
Psychosocial stress like Singh's can trigger heart attacks, but these cases are rare. More often, it's poor lifestyle that causes children - usually the ones who are overweight - as young as 10 years to have elevated blood pressure and cholesterol.
"Overweight children with a family history of premature heart disease (defined as a father, brother or uncle with high blood pressure, high cholesterol or high triglycerides before 40 years) should get a lipid profile to test for blood cholesterol done at the age of 10 years. I get three to four children as young as 10 years every month with elevated cholesterol," says Dr Upendra Kaul, executive director of cardiology at Fortis Escorts Heart Institute.
His advice is in keeping with the new US National Heart, Lung and Blood Institute guidelines for preventing children and adolescents, which recommends all children be screened for high cholesterol at least once between the ages of nine and 11 years, and again between ages 17 and 21 years.
The guidelines also recommend regular physical activity and a diet low in saturated fat - oils usually food in processed food like chips, instant noodles, namkeens and biscuits - starting at age one year and protection from secondhand tobacco smoke.
"A negligible number with genetic dyslipidaemia (abnormally high blood fats like cholesterol) may need cholesterol-lowering statins. But for most others, lifestyle modifications such as more physical activity and a high fibre-low salt and saturated fat diet works well," says Dr Kaul.
"Risks of heart disease and stroke in adults begin in childhood and progresses over time, so we should target working with children to lower lifetime risk and prevent more serious problems in adulthood," says cardiac surgeon Dr Ramakant Panda, director, Asian heart Institute, Mumbai.
The big five
Obesity is one of the strongest risk factors in children, with the Tulane University's Bogalusa study that 2,000 children were tracked from initial evaluation at five to 14 years to the mean age of 27 years showed that obese children grew up to be obese adults with high blood pressure and high cholesterol.
The other big four are diabetes, high cholesterol, high blood pressure and/or smoking.