When 26-year-old P Janarthanan, a first-year student of the Master of Public Health in Health Administration (MPH-HA) at the Tata Institute of Social Sciences (TISS), collapsed after complaining of breathlessness during a class at the institute’s Deonar campus, the nearest hospital was only a few kilometres away. But the absence of an ambulance or a defibrillator, which resets the heart’s electrical impulse, on campus meant he was taken to hospital by car, according to those involved in his treatment.By the time Janarthanan reached Zen Multi-speciality Hospital in Chembur, about 30 minutes had passed, said Dr Roy Patankar, director of the hospital. Janarthanan subsequently died following cardiac arrest.Crucial minutes before medical helpFor Dr Patankar, the incident highlights a wider gap in emergency preparedness at educational institutions, particularly when a cardiac emergency occurs in the crucial minutes before professional medical help arrives.“The hospital is hardly 2.5 kilometres away from TISS. But by the time he came to the hospital, around half an hour had passed. That is a long time; those crucial minutes had passed,” Patankar said. He said Janarthanan was complaining of chest pain before he collapsed. “We don’t know what exactly led to cardiac arrest. Apparently, he had no medical issues. The post-mortem report will tell us categorically,” he said.The case, he said, raises a basic but important question: what might have happened in those first few minutes if people at the institution had been trained in cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED) had been immediately available?“Basic first-aid CPR training must be there, especially in larger institutions. Colleges and universities should have designated people who can give CPR or basic first aid,” he said.Patankar believes defibrillators should be available at major educational institutions in much the same way as fire extinguishers and other fire-safety equipment.Story continues below this adCardiac emergencies are not just an older person’s problemThe concern is heightened by what Patankar describes as a change in the age profile of patients presenting with serious cardiac emergencies. “We are now seeing increasing numbers of young people having heart attacks, below 30 years of age also. That is quite concerning. Some of these patients do not have the conventional risk factors doctors typically associate with heart disease. They are not known to be diabetic, they don’t have blood pressure, and they don’t smoke or consume alcohol. So, this is a worrying tendency that we are seeing,” he said.Patankar said he had observed what he described as a “big trend reversal” in the age profile of patients presenting with cardiac emergencies over the past five years. One recent case involved a 30-year-old man who suddenly collapsed while paying his property tax at an M-Ward office. He had no known diabetes or hypertension, did not smoke or drink and had no previous cardiac history.“He was active, working in an office and doing all his routine activities. There was no previous chest pain. The man was brought to the hospital within minutes and was revived with a defibrillation shock. An angiography showed a 100% blockage in the left main coronary artery, following which he underwent emergency angioplasty. Again, no blood pressure, diabetes, no smoking, no drinking, no previous history. But there could have been an underlying condition or a soft plaque could have given way,” Patankar said.Story continues below this adThe distinction between a heart attack and cardiac arrest is important. A heart attack occurs when blood flow to part of the heart is blocked, while cardiac arrest occurs when the heart suddenly stops pumping effectively. A heart attack can trigger cardiac arrest, but the two conditions are not synonymous. In either situation, however, recognising the emergency quickly and initiating appropriate treatment can be critical.What raises cardiac risk in the 20s?Being in one’s 20s does not eliminate cardiovascular risk. While age is a major risk factor for coronary artery disease, younger adults can have risk factors that begin affecting cardiovascular health much earlier.These include smoking and tobacco use, high blood pressure, elevated LDL cholesterol, diabetes or insulin resistance, obesity, physical inactivity, poor diet, inadequate sleep and a strong family history of premature heart disease.An inherited condition such as familial hypercholesterolaemia can result in very high cholesterol from a young age and increase the risk of premature coronary artery disease. Young people can also have structural heart conditions or inherited electrical disorders that may cause dangerous arrhythmias and sudden cardiac arrest even without conventional coronary risk factors.Story continues below this adOther factors may contribute in some individuals, including heavy alcohol use, stimulant or recreational drug use, certain medications and chronic inflammatory conditions.“The genetics have been there before also. Now it’s environmental. The increasingly sedentary lifestyles of young adults, poor diets and inadequate sleep. Many young people sleep only around six to six-and-a-half hours a night. Stress, too, needs attention, particularly as people remain connected to work well after office hours. You never completely disconnect from work. Commuting from home to workplace and the cumulative stresses of daily life can also affect health,” Dr Patankar said.Colleges need a cardiac emergency protocolPatankar’s hospital is seeking to provide CPR training to traffic police, fire brigade personnel and BMC officials as part of a CSR initiative, and he believes students and educational staff should also be included.“We will reach out to the institute and discuss if we can support including CPR training for all the staff and students,” he said.Story continues below this adA campus emergency-response plan, he said, should include trained first responders, readily accessible first-aid equipment, defibrillators, clear protocols for suspected cardiac arrest and a mechanism to summon an ambulance without delay. “Ideally, every school, every college, every educational institute should have a tie-up with a neighbouring hospital and a facility to call an ambulance as an emergency,” he said.For young adults, the message is not that serious heart disease is inevitable, but that age alone should not be treated as protection against it. “Don’t wait till you are 40 or 50 or till you get symptoms. Start doing health check-ups at an early age and keep track of your markers and endurance,” Patankar said.For most young adults, that means knowing their cardiovascular risk profile rather than undergoing blanket testing: checking blood pressure and, where appropriate, blood sugar and cholesterol; knowing their family history; maintaining regular physical activity and healthy sleep; avoiding tobacco; and taking symptoms such as unexplained chest pain, breathlessness, fainting or sudden palpitations seriously.