Silent Heart Attacks, Jaw Pain: India’s Top Cardiac Surgeon on Everything You Knew (& Didn’t) About Heart Health

He watched it beat; its choreography was perfect. A delicate dance that dictated life and death. 

As a third-year medical student, Dr Ramakanta Panda, the Chairman of Mumbai’s Asian Heart Institute — a post he has held for the last decade — stood over a live beating heart. It was his first time at an open-heart surgery and he was cognisant of his luck. Getting a front row seat to a coveted surgery, as this one was rare. 

As the young Dr Ramakanta watched the surgeon handle the heart, he stood stunned, amazed, fascinated. This was the organ that orchestrated life. To hold it in one’s hands was almost like holding fate itself. That day, and in that moment, he pledged his allegiance to the human heart. “That day made me realise I didn’t want to do anything else,” he says. He’d just found his life’s leitmotif. 

Dr Ramakanta is known as ‘India’s safest heart surgeon’; over 30,000 successful cardiac surgeries colour his professional archives. But here’s a bout of trivia: his life’s trajectory would have looked very different had his uncle’s coaxing to apply for a government job worked. 

“There are only a few places in the country that perform heart surgery. What if you become a cardiac surgeon and don’t get into those places? You will lag behind your batchmates,” his uncle dissuaded him from his dream.  

But Dr Ramakanta was adamant. “I have decided. I want to be a heart surgeon. Whatever happens, we will see.” Today, uncle and nephew share a laugh about what played out all those years ago. “It’s a good thing you didn’t listen to me,” his uncle tells him. And we agree. Because that moment of defiance gave India its finest heart surgeon. 

When’s the last time you checked your heart health? 

Dr Ramakanta, who is just out of surgery, shares that he operated on a 23-year-old patient who needed six bypasses. The doctor’s concerns about an uptick in heart disease among young patients are mirrored by data released by the World Health Organisation that suggests that India is responsible for one-fifth of global cardiovascular disease-related deaths in the world. 

According to a study published in The Lancet, the CVD (cardiovascular diseases) epidemic in Indians is characterised by a higher relative risk burden, an earlier age of onset, higher case fatality and higher premature deaths. To this end, Dr Ramakanta swears by a four-fold approach to dodge the pitfalls of the hustle culture that has taken the current generation by storm. 

The first key is exercise. 

Calling it “the best medicines for any human being”, Dr Ramakanta positions it as something that isn’t just beneficial for heart health, but also for mental acumen, immunity, and to reduce the risk of cancers and stroke. Two kinds of exercise are important, he emphasises, aerobic exercise — repetitive, rhythmic activity that increases your heart rate — and weight training. The aim of aerobic exercise, he says, is to get your heart rate to around 85 percent of your target heart rate.

If you want to know your target heart rate, subtract your age from 220. This will give you your maximum heart rate (MHR). Multiply this number by a percentage (typically 50-85 percent) to find your target heart rate zone. 

But even whilst you place importance on exercise, don’t forget the warming up and cooling down phases are as important, Dr Ramakanta points out. “People who haven’t exercised shouldn’t push themselves suddenly one day. That could bring on a heart attack.” 

The second golden rule, he says, is eating right. “Go for natural things, stop everything artificial,” he says. The third golden rule is sleep — minimum eight hours. But along with the number of hours, the time of going to bed is crucial. Dr Ramakanta advises 9 pm - 10 pm.

The fourth golden rule is yoga and meditation, the doctor shares. In today’s generation, where modern habits defy conventional wisdom, the doctor urges us to retrace our steps back to the basics.   

‘Everyone believes their heart is the healthiest’

Texas, 4 April 1969 

Dr Denton A. Cooley performed the world’s first total artificial heart implant, a watershed moment in medical history. That week, the news was plastered onto every science journal cover across the world. And Dr Ramakanta (in class 9 at the time), who scrambled to read all of them, feasted his eyes on the news. That medical marvels could be created by simply daring to dream outside the confines of the ordinary fascinated him. The news left an imprint on his psyche. 

By then, the dream of becoming a doctor had already taken root in his mind. The news of the transplant only compounded it. Growing up in Odisha, Dr Ramakanta, a farmer’s son, was familiar with the responsibility that came with the profession. Dr Cooley’s experiment made him see how cool doctors could really be. But there’s only so much that doctors can fix, he realised once he became one. 

He's always amused at how people think they’re invincible. 

“The problem is that everybody thinks nothing will happen to their health. They think health problems are things that affect other people, and that they are safe,” he smiles. 

And so, when a patient walks in, with this mindset, but with their symptoms suggesting otherwise, Dr Ramakanta immediately looks for predisposing conditions. 

“These include a very strong family history of heart disease, conditions like diabetes, high blood pressure, being overweight, smoking, chewing tobacco, lack of sleep, stress and high cholesterol,” he lists them out. 

For instance, in the case of the 23-year-old patient, he shares that a history of high cholesterol was indicative of heart damage. 

But the catch is that around 50 percent of patients may not get the classic symptoms, Dr Ramakanta points out. Calling these atypical cases, he explains that, instead of pain in the chest, these people could experience pain and discomfort in other areas — the stomach, the jaw, the wrist, the fingers. This is caused by a blockage in the nerve that supplies the heart, as well as these areas. 

Your impending heart condition could just be masquerading as jaw pain or bad acidity. 

Another fallacy is that not all heart attacks occur from blockages. “Quite often, you get a heart attack from just a cholesterol deposit. The lining of the arteries works to keep them lubricated. Tobacco use, diabetes, stress, and lack of sleep render the endothelium dysfunctional. Once it starts getting damaged, soft cholesterol starts getting deposited inside it. When a person’s stress levels increase, the plaque may rupture, and a clot begins to form at the rupture site. This is why a large number of patients get a heart attack without having any critical blockage,” he explains. 

Have you heard about the silent heart attack? 

An invisible miscreant, the silent heart attack is a heart attack that occurs with little to no symptoms, or with symptoms that are easily mistaken for indigestion, stress, or fatigue, but causes significant damage to the arteries or heart. It’s more prevalent among diabetics, Dr Ramakanta shares. 

Reasoning why, he explains, “Diabetes affects the nerve endings, which is why diabetics might not feel the symptoms of the silent heart attack.” 

Research agrees. “The risk for CAD (coronary artery disease) is two to four times higher in diabetic subjects, and in Indians, CAD occurs prematurely, i.e., one to two decades earlier than in the West,” reads the findings of a study which pointed out that hyperglycemia, central body obesity, dyslipidemia, and hypertension and the interplay of these risk factors could explain the enhanced CAD risk in Indians. 

“Preventive measures such as lifestyle modification with a healthy diet, adequate physical activity, and a decrease in stress could help prevent the twin epidemics of diabetes and CAD,” it read. 

Managing stress is crucial for the current generation, Dr Ramakanta notes. 

So how do you manage your stress? 

My question takes him by surprise. While he does reveal his secrets — exercising five to six days a week, walking on a treadmill in his office, doing 30 minutes of yoga daily, a vegetarian diet including brown rice, salads, fruits and vegetables, listening to western classical music and old Hindi numbers (these also play during his surgeries) — he saves the best for last: wildlife photography. 

The wild is where Dr Ramakanta really relaxes. Away from the mental and physical toggling his job necessitates, it’s here that he can let nature dictate his pace. And nature knows the way. The tug of metaphor is not lost on Dr Ramakanta, who, when at an impasse during a surgery, lets instinct guide his decisions. Here’s where he believes that he’s learnt a lot from the wild. 

 As for whether he’s ever nervous about surgery, he leaves us with an important lesson. “Being called the safest heart surgeon in India comes with a lot of responsibility. I treat every surgery of mine as my first one. When you’re doing something for the first time, you’re extra cautious. You do it with all your heart.”  

Edited by Vidya Gowri Venkatesh, All pictures courtesy Dr Ramakanta Panda 

Sources 

'Young Indians With Fatigued Hearts': by Krish Keswani, Published on 17 October 2023.

'Cardiovascular disease in India: A 360 degree overview': by Medical Journal Armed Forces India, Published in January 2020.

'The burgeoning cardiovascular disease epidemic in Indians – perspectives on contextual factors and potential solutions': by The Lancet, Published in May 2023.