In recent years, there has been a globally disturbing rise in the number of sudden cardiac arrests (SCA) among the young population. India—and particularly the Union Territory of Jammu & Kashmir—is witnessing a surge in such tragic incidents, often affecting individuals in the prime of their lives, with apparently no previous history of cardiac diseases. Traditionally, such incidents have been associated with older adults and patients with pre-existing heart disease, but the changing trend in SCA is now increasingly being reported worldwide. This alarming change in disease patterns calls for deeper investigation, early screening, and stronger public health intervention.
While many of us have shifted blame to COVID-19 vaccine for this sudden rise, the reality is far more complex. Countries where the same vaccine was not administered to the population —such as Sweden, Pakistan, and Norway—have also reported similar cases of sudden cardiac collapse. This clearly suggests that our understanding must extend beyond surface-level assumptions. It is time to widen our perspective and dig deeper into the underlying causes of these silent fatalities.
Global Insights: How the World is Responding
Several countries have already recognized the urgency of this issue and adopted proactive strategies to address it:
Japan: Since the early 2000s, Japan has implemented mandatory ECG screening for schoolchildren aged 6 to 18 years, under the direction of the Tokyo Metropolitan Board of Education. A 2021 report showed that out of more than 1.2 million students screened, approximately 0.3–0.5% were found to have potentially life-threatening cardiac abnormalities, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and congenital structural defects. This early intervention has enabled risk stratification and timely management.
Italy: Since the 1980s, Italy has enforced mandatory cardiac screening (including ECG) for all young competitive athletes starting at age 12. A landmark study in the Veneto region demonstrated a 90% reduction in sudden cardiac deaths among athletes following the implementation of this protocol (Corrado et al., Eur Heart J). This screening is not limited to symptoms or family history, making it one of the most aggressive yet effective national models.
United States: While not federally mandated, several U.S. states and private institutions promote voluntary heart screening programs, especially for high school and college athletes (typically ages 14–22). The American Heart Association recommends a 14-point preparticipation screening, including family history, symptoms, physical examination, and in some programs, ECG and echocardiogram. Initiatives like “Who We Play For” have helped screen tens of thousands of teens in Florida and beyond.
These models underscore the global recognition that early cardiac screening — even in asymptomatic children and teenagers — can save lives.
India Needs a Similar Strategy
Despite being a country with a large young population, India lacks widespread school- or college-level cardiac screening programs. However, encouraging policy changes are beginning to emerge. In a significant move, the state of Karnataka has made it mandatory to report all sudden deaths, particularly in individuals under 40 years of age as a notifiable event and has mandated post -mortem examination in such cases. Such initiative creates a much-needed system of accountability and investigation, laying the groundwork for early identification and prevention in affected families through genetic counselling and cascade screening. If adopted by other States and institutionalised at the national level, such guidelines could become cornerstone in combating sudden cardiac deaths in young.
To build on this progress, India must:
Introducing mandatory heart health screening (ECG, echocardiogram) in schools and colleges
Training physicians and primary health workers to recognize early signs
Raising awareness among families about hereditary and spontaneous heart conditions
Encourage pre-marriage cardiac screening, especially in high-risk areas and families with a history of SCD
Hypertrophic Cardiomyopathy (HCM): The Hidden Danger
One of the leading causes of sudden cardiac death in the young is Hypertrophic Cardiomyopathy (HCM)—a condition where the heart muscle becomes abnormally thick, making it harder for the heart to pump blood.
In many cases, HCM is genetic, inherited from one or both parents.
However, de novo mutations (not present previously in family) can also occur.
It often goes undiagnosed as individuals may remain asymptomatic until a sudden, fatal event.
A particularly dangerous variant of this is Hypertrophic Obstructive Cardiomyopathy (HOCM), where the thickened heart muscle obstructs blood flow from the left ventricle to the aorta, further increasing the risk of arrhythmias(irregular heartbeats) and sudden cardiac arrest—especially during physical exertion or stress.
Detecting these conditions early through echocardiography and cardiac MRI can dramatically reduce fatal outcomes. For families with known or suspected cases, genetic counseling and cascade family screening should become standard medical advice.
The Role of Post-Mortem Examination: Knowing the Root Cause
To truly combat sudden cardiac deaths, we must normalize post-mortem cardiac evaluations in young, unexplained deaths. Many families decline autopsies due to social stigma or emotional distress, but these examinations are crucial in:
Identifying underlying inherited cardiac diseases like HCM or arrhythmogenic right ventricular cardiomyopathy (ARVC)
Guiding preventive screening for surviving family members
Enabling early lifestyle modifications and medical interventions in at-risk individuals
Supporting genetic testing in cases of unexplained cardiac death, even when there’s no apparent history
Post-mortem findings can serve as a diagnostic anchor, shaping both personal and public health strategies for the future.
Real-Life Cases from Kashmir: The Warning Signs
Recent events in Jammu & Kashmir underscore the gravity of this crisis: citing the example of the few cases:
Just days ago, two young officers reportedly succumbed to sudden heart attacks.
In northern Kashmir, two young brothers tragically died within a year of each other under eerily similar cardiac circumstances.
Several years ago, one of the region’s well-known business tycoons collapsed and died , another case of presumed cardiac arrest in a previously healthy individual.
These incidents, which are sadly becoming frequent, demand detailed forensic and clinical investigations to determine the actual cause. Without a structured framework to collect data, evaluate trends, and respond to these cases, we risk losing more lives to the unknown.
It is not enough to grieve after each news report of a young life lost to sudden cardiac arrest. We must move from reaction to prevention.
This is a call to India’s public health planners, educators, and clinicians:
Let us implement robust, structured cardiac screening programs in schools, colleges, and sports academies. Let us normalize conversations around heart health in the young. Let us promote post-mortem evaluations to guide future prevention. Let us integrate family screening, lifestyle changes, and genetic counseling as part of holistic heart care.
Author is Infectious Disease Physician, Clinical Microbiologist and Researcher at Vishnu Dental College
