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Heart attacks were once considered a concern mainly for older adults. Today, that's no longer true. In this episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, host Jitendra Hariyan sits down with Padma Bhushan Dr. Ashwin Mehta, a legendary figure in cardiology who has performed over 1 lakh angiographies and 2,000 angioplasties, to understand why heart attacks are increasingly affecting people between the ages of 30 and 45 and what can be done about it.
Watch the full conversation here: Heart Attack in Youngsters Explained by Dr. Ashwin Mehta – Jaslok Hospital
Every part of the body depends on a continuous blood supply, and the heart — which works non-stop from birth to death without a moment's rest — needs this supply more than any other organ. Blood reaches the heart through coronary arteries and their smaller branches. When this blood flow is suddenly interrupted, the affected part of the heart is deprived of oxygen and stops functioning properly. This sudden and complete blockage of blood supply is what constitutes a heart attack.
Dr. Mehta explains that blood flow reduction typically happens gradually, as cholesterol builds up along the inner lining of the arteries. The body's natural defense mechanisms often mask this decline until the blockage reaches 60–70%, which is why many people have no warning signs even as the disease progresses silently.
The real danger, however, often comes from "soft plaques" — cholesterol deposits that are not yet large enough to cause symptoms but can rupture unexpectedly, especially during intense physical exertion. When a person suddenly engages in vigorous exercise, both blood pressure and pulse rate spike sharply. This combined stress can cause a soft plaque to rupture, triggering a blood clotting response that can turn a 30% blockage into a complete 100% blockage within two hours — often too quickly for the person to notice any warning symptoms. This is what leads to sudden cardiac events even in seemingly healthy, active individuals.
According to Dr. Mehta, heart attack risk factors fall into two categories:
Non-treatable factors:
Treatable/controllable factors:
He emphasizes that heart disease prevention should ideally begin from school age, not after 40 or 45. Children today often spend two to three hours in front of screens instead of being physically active — and in some studies, as many as 16% of school-going children were found to have cholesterol levels above 300, often going undetected simply because no one thinks to test young people.
Conditions like diabetes and high blood pressure can exist silently for years without symptoms, quietly damaging blood vessels the entire time. Dr. Mehta strongly recommends at least one comprehensive health check-up every year — the same way people routinely service their vehicles but often neglect their own bodies.
Dr. Mehta shares his personal treatment philosophy on LDL (bad) cholesterol targets:
One of the biggest challenges in early treatment, Dr. Mehta explains, is that patients often delay seeking help because they misinterpret their symptoms as acidity, gas, or indigestion — especially when symptoms appear suddenly at night. This tendency toward denial can be dangerous.
Key symptoms that should never be ignored include:
Contrary to popular belief shaped by dramatic movie portrayals, real heart attack pain is often mild rather than the severe, crushing chest pain shown on screen. Recognizing these subtler early symptoms and seeking immediate medical attention can make a life-saving difference.
Most smokers pick up their first cigarette between the ages of 18 and 25, often due to peer pressure or as a "style factor." Nicotine increases adrenaline levels in the body, which raises heart rate, pumping intensity, and blood pressure — all of which directly stress the cardiovascular system over time. Any form of tobacco — cigarettes, cigars, or hookah — carries similar cardiovascular risks.
Dr. Mehta recalls the sudden loss of a healthy, active colleague — a cardiology professor — after a gym session, underscoring a hard truth: intense, sudden exertion causes a sharp spike in both blood pressure and pulse rate, which can rupture a pre-existing soft plaque. Alarmingly, he notes that 50% of people who suffer a heart attack never reach the hospital — meaning hospitals typically only treat the milder half of cases that survive long enough to seek help.
The golden hour refers to the critical window immediately after a heart attack begins, during which restoring blood supply can prevent lasting heart damage entirely. Dr. Mehta compares it to a fish taken out of water — if returned within a couple of minutes, it survives; after two hours, it's too late. Patients treated within the golden hour have a 98% chance of showing virtually no lasting signs of the heart attack after three months.
He also explains two critical treatment timelines hospitals track:
For those with diabetes or high blood pressure, Dr. Mehta recommends a highly regularized lifestyle, periodic blood pressure checks (every six months to a year), and consistent blood sugar monitoring. He shares the example of a patient who lived an active, fully engaged life — running a business and travelling internationally — until the age of 85, simply by keeping diabetes under control.
Patients who have already had one heart attack face a higher risk of a second one. Dr. Mehta shares the story of treating a prominent 30-year-old businessman decades ago — after successful treatment and consistent lifestyle discipline, the patient lived an active, productive life until the age of 85.
A common pattern Dr. Mehta describes: an active individual who previously completed several rounds of a walk or run with ease suddenly finds themselves stopping due to chest heaviness — with symptoms subsiding upon rest but progressively worsening over successive days. This pattern — discomfort linked to physical exertion and relieved by rest — is a strong indicator (around 85% likelihood) of a cardiac issue and warrants investigations like a stress test or CT angiography.
Dr. Mehta outlines the typical diagnostic pathway:
Based on the location and severity of blockages, treatment may involve medical management, angioplasty, or bypass surgery.
When blockage exceeds 70?ross multiple arteries, medical management alone is often insufficient. The choice between angioplasty and bypass depends on several factors:
During the pandemic, some patients with a prior cardiac history presented with symptoms strikingly similar to heart attacks, requiring angiography to distinguish between COVID-related symptoms and an actual cardiac event. While treatment protocols for the two conditions differ significantly, COVID-related symptoms typically resolved once the infection cleared, unlike underlying heart disease.
Dr. Mehta shares one of his most memorable cases — a six-year-old girl who complained of chest pain during play. An alert doctor performed an ECG, which revealed a dangerously abnormal cardiogram. Angiography showed a 90% blockage in the main artery supplying 70% of her heart's blood — caused by an inherited condition that had pushed her cholesterol above 900. After careful multidisciplinary consultation, Dr. Mehta successfully performed a fabricated (adapted) angioplasty using adult equipment modified for a child — potentially among the youngest such procedures performed in the world. The child was back on the playground the very next day.
Reflecting on decades of practice, Dr. Mehta highlights how far cardiology has advanced — from a full month of complete bed rest as heart attack treatment when he was a medical student, to patients today listening to music during minimally invasive artery procedures. He believes future advancements, including robotic-assisted remote surgery and breakthroughs in reversing atherosclerosis (the underlying process behind blockages, strokes, and kidney failure), hold enormous promise.
His advice to young people echoes a timeless philosophy: focus on consistent effort and discipline rather than being consumed by the anxiety of unmet ambitions — do the work, and don't over-attach to the outcome.
This article is based on an episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, featuring Padma Bhushan Dr. Ashwin Mehta, senior cardiologist. Watch the full video interview here: Heart Attack in Youngsters – Dr. Ashwin Mehta
For consultation regarding heart health, cardiac risk assessment, or treatment, please reach out to Jaslok Hospital's Department of Cardiology.