Dr Sabiha Gati is a cardiologist who works for CRY (Cardiac Risk in the Young), which is a charity that raises awareness about potentially life-threatening cardiac conditions, including sudden death syndrome in young patients aged between 14-35.
Here, Dr Gati explains what it’s like to work with the younger population in comparison to adults. She shares her professional advice on the effects of substance abuse, the importance of exercise and which types work best for those living with a heart problem.
What is it like working with young people with cardiac conditions compared to adults?
A typical day’s work involves assessing patients aged between 17 and 35 years old. The vast majority of individuals admitted or investigated in heart clinics are usually in their sixth decade onwards. Most of these individuals have age-related problems such as high blood pressure, narrowing of the blood vessels supplying the heart, or, a weak heart muscle. All of these are extremely important causes of feeling unwell or even dying.
One of the main differences with working with young people affected by these diseases is that I am dealing with individuals who often believe they are invincible due to lack of symptoms and the inner energy as a result of their youth, hence they do not always appreciate the dangers of the underlying disease. The main challenge is to allow as normal a life as possible and to promote aspirations and goals without increasing the risk of potentially dangerous heart rhythms.
Many young people enjoy participating in competitive sport, which may increase the risk of sudden death. We are all aware that the exercise is one of the best therapies known to medicine and one of the challenges is to provide a safe exercise prescription which is sometimes considerably less than the young individual performed.
How common are heart-related deaths in young people?
Fortunately, deaths in young people (under the age of 35 years old) are much less common than in the older population, nevertheless, they are associated with a loss of several decades of life. Most deaths are from diseases that run in families and there are several treatments available to doctors to change the natural course of the disease and save young lives.
How might drugs and alcohol affect the heart in youngsters with cardiac conditions?
I often find myself talking to the young about the dangers of substance abuse including alcohol. There is a link between alcohol bingeing and sudden death from Brugada syndrome.
Stimulants such as Ecstacy or cocaine may provoke sudden death in individuals with long QT syndrome. Young people also frequently delve in activities associated with a surge in adrenaline that can also provoke serious rhythm disturbances in some people with long QT syndrome. In such cases, I find myself trying to provide the best advice about engaging in bungee jumping or speak rollercoaster rides.
I enjoy discussing issues with our young team and learn a lot from them about the apprehensions some of these people have that they may not feel comfortable discussing with their local cardiologists. The questions these individuals pose often leave me thinking about the best approach to managing a situation where the evidence is rather limited compared with cardiac diseases that I encounter in my day to day practice.
What advice can you give to young people who have conditions and like to exercise?
The benefits of regular exercise are irrefutable. All doctors should promote exercise. In young individuals affected by genetic diseases affecting the heart muscle or the electricity of the heart, the aim is to strike a balance between the multiple benefits of exercise such as reducing obesity, high blood pressure, diabetes and the small risk of sudden cardiac death.
A moderate amount of exercise is generally safe. The current exercise recommendation for all individuals includes at least 150 minutes of moderate-intensity exercise per week. Among individuals affected with heart diseases, I would advise exercising to a point there are no symptoms and generally not above 80% predicted for age (generally 80% of 220-age) or above 70% for those who are treated with beta-blockers. It is also important to tone the muscles and the recommendations are to push no more than 50% of the body weight with the arms and no more than 100% on the bodyweight with the legs.
All individuals should warm up well and cool down. It is not advisable to exercise in extreme climates without acclimatisation. I would discourage exercise at a temperature above 25oC. Individuals should avoid exercise if they have a fever or diarrhoea.
Certain exercises and sports should be avoided with some diseases, for example, people with long QT syndrome should not dive into cold water and people with Brugada syndrome should avoid long-lasting sports such as marathon running or triathlon where the body temperature may exceed 40oC and promote dangerous cardiac rhythm disturbances.
Dr Gati specialises in sports cardiology, cardiac screening, stress test, echocardiogram and cardiomyopathy. You can book an appointment to see her via her Top Doctor’s profile here.