The main cause of death globally is still heart disease. Heart attacks may occur suddenly without any warning signs. However, in the film industry, intense chest pain would be portrayed for a heart attack. In actuality, many patients have slight symptoms that go unnoticed until the time of their heart attack days or even weeks prior to that.

Heart attacks do not always announce themselves with dramatic chest pain. Often, they manifest in subtle, easy-to-dismiss ways. Recognizing these overlooked warning signs and taking proactive steps toward cardiovascular health can save lives. If you or someone you know experiences any of these symptoms, seeking immediate medical care is crucial. Prioritizing heart health today can help prevent life-threatening complications in the future.

Warning Sings of A Heart Attack

1. Discomfort Pressure in the Chest

One of the earliest and most common warning signs of an impending heart attack is pressure, tightness, or fullness in the chest. This pain is not typically sharp and sudden, like most people associate with a heart attack, but it can be intermittent, coming in waves, and lasting for several minutes before fading away. According to the American Heart Association, this is one of the red flags when accompanied by exertion. If you have persistent chest pressure, you should call emergency services immediately.

2. Pain Radiating to Other Parts of the Body

The well-known symptom of chest pain can also manifest discomfort related to a heart attack as pain radiating to other parts of the body. It is not unusual for people experiencing this kind of heart attack to report feeling pain in the shoulders, arms, back, neck, and even jaw. The vagus nerve is one that connects the heart to the brain, abdomen, and neck. The pain may be referred to these regions. In case you experience a sudden, unexplained pain in these regions, especially when exercising, seek a doctor's opinion.

3. Dizziness and Lightheadedness

Feeling dizziness upon standing up quickly or missing a meal is common, but unexplained dizziness often with chest pain or shortness of breath is the first sign of heart attack. Sudden hypotension can seriously decrease the blood supply to the brain and cause dizziness. Dizziness that does not go away on its own should not be ignored.

4. Unexplained Fatigue

It often happens that excessive tiredness, particularly in a busy lifestyle, is considered trivial, but ongoing fatigue, mostly in women, is a predictor of heart failure. According to some studies, extreme fatigue often starts a month before a heart attack, primarily in women. This is simply because the heart cannot pump well enough, leaving insufficient oxygen available to muscles and organs. Consult a healthcare professional if you become increasingly tired over time, yet are getting all the rest in the world.

5. Nausea, Indigestion, or Stomach Pain

Digestive problems like nausea, vomiting, or indigestion are often mistaken for acid reflux or food poisoning. However, these symptoms can also indicate reduced blood flow to the digestive tract, a common precursor to heart attacks. If you experience gastrointestinal distress alongside other symptoms like dizziness or chest discomfort, it's important to seek medical advice immediately.

6. Cold Sweats and Excessive Perspiration

Without apparent reason, a heart attack might be signaled by sudden sweating without any exercise or hot weather conditions. The heart's inability to function properly creates the body's "fight or flight" reaction, which means excessive sweating will occur. Be aware of your body and never ignore a cold sweat, particularly if it coincides with other symptoms.

7. Heart palpitations or irregular heartbeat

A racing or irregular heartbeat can be a normal reaction to stress or caffeine consumption. However, regular or unprovoked heart palpitations may indicate that the heart is under duress. If the heart is not getting enough oxygen-rich blood, it can start to beat irregularly. If you experience palpitations along with dizziness, chest pain, or shortness of breath, you should see a doctor right away.

8. Shortness of Breath

If suddenly climbing stairs or performing other everyday activities becomes a problem, then there may be a heart issue. Shortness of breath usually occurs with heart conditions because the circulation is not adequate and less oxygen is provided to the lungs. This symptom can occur either with or without chest pain and is an important indicator of the presence of underlying heart disease. If you find yourself experiencing sudden unexplained breathlessness, then seek a healthcare provider as soon as possible.

When to Seek Medical Attention

Early detection of these symptoms and early intervention can help avoid a life-threatening heart attack. You should visit a doctor if you feel the following symptoms:

• Symptoms induced by exertion and relieved by rest
• The simultaneous onset of several warning signs, including weakness, dizziness, and nausea
• Personal or family history of heart disease, hypertension, diabetes, or smoking

Preventing Heart Attacks: Proactive Steps for Heart Health

Although heart attacks may come out of nowhere, lifestyle plays an important role in reducing a patient's risk; here are some heart-healthy habits to consider:

Take on a Heart-Healthy Diet: Focus on consuming whole foods, lean proteins, healthy fats, and fiber-rich fruits and vegetables. Try to limit processed foods, saturated fats, and added sugars.

Stay Active: Engage in at least 30 minutes of moderate physical activity most days of the week to strengthen your heart and improve blood circulation.

Smoking. Smoking is probably the single largest risk factor for heart disease. If you are a smoker, quitting can easily be the single best thing you can do to improve your heart health.

Deal with Stress: Chronic stress leads to heart disease. Relaxed people through various relaxation techniques including yoga, meditation, and even deep breathing, have lesser stresses.

Regular health checks Monitor blood pressure, cholesterol levels, and blood sugar on a regular basis. The risk factors' early detection can help avoid serious complications.

Sickle cell disease (SCD) is one of India’s most pressing inherited blood disorders, with an estimated 1 in 86 births among tribal and disadvantaged groups affected.

Despite advances in diagnostics and treatment, families continue to face uncertainty, stigma, and limited awareness.

Why Genetic Counselling Matters

A crucial distinction often overlooked is between sickle cell trait (SCT) and sickle cell disease. Carriers with one gene are usually healthy but can pass the trait to their children, while those with two defective genes live with lifelong complications.

When both parents carry SCT, each child has a 50% chance of inheriting the trait and a 25% chance of developing the disease. This is why genetic counselling must be recognized as an integral part of the care continuum.

Genetic counselling provides clarity on inheritance patterns, transmission risks, and reproductive choices. In high-prevalence communities, it serves as a preventive strategy. Counselling is equally vital after diagnosis, guiding parents on managing complications, navigating education and employment, and preparing adolescents to understand their carrier status before marriage.

Also read: Sickle Cell Disease: Why India Must Add Curative Treatment to Meet Its 2047 Elimination Goal

The Role of National Sickle Cell Anemia Elimination Mission

India’s National Sickle Cell Anaemia Elimination Mission (2023) prioritizes screening in high-burden states, with clear objectives:

• to provide affordable, accessible, and quality care to all SCD patients;
• reduce prevalence through awareness campaigns and premarital genetic counselling;
• conduct targeted screening and early detection using validated Point-of-Care Testing (POCT) kits;
• ensure holistic management through primary, secondary, and tertiary healthcare facilities;
• enable community involvement by linking patients with social security schemes.

Embedding counselling into primary healthcare ensures every positive test is followed by culturally sensitive, professional support.

Sickle Cell Disease: Tackling Stigma and Misconceptions

SCD is often misinterpreted as a curse or lifestyle issue, leading to stigma and blame. Such misconceptions not only deepen emotional distress but also delay timely medical intervention. Genetic counselling reframes the condition as a scientifically understood, inherited disorder, shifting the narrative from superstition to evidence-based care.

By normalizing dialogue, it drives empathy-centered healthcare conversations and strengthens community resilience.

SCD is also often misinterpreted as a curse or lifestyle issue, leading to stigma and often blame. Such misconceptions not only deepen emotional distress but also delay timely medical intervention.

Genetic counselling reframes the condition as a scientifically understood, inherited disorder, shifting the narrative from superstition to evidence-based care. By normalizing dialogue, it encourages empathy-driven healthcare conversations and strengthens community resilience.

Sickle Cell Disease: Why Genetic Counseling Is Important

Sickle cell care cannot stop at diagnosis; counselling must accompany patients across every life stage from childhood through adolescence, marriage, pregnancy, and adulthood. This continuity transforms care from reactive to proactive, ensuring families are never left alone in their journey.

At the same time, awareness, education, and collaboration among clinicians, policymakers, patient groups, and communities are essential. Genetic counselling serves as the bridge between science and lived experience, enabling informed choices, reducing stigma, and promoting compassionate care that strengthens both families and the wider community.

(The author is Dr Manisha Madkaikar, Director - ICMR-National Institute for Research on Blood and Immune Disorders – Mumbai).

In today's busy routines, acidity is a common complaint — almost one in five people take an acidity tablet. Most of us don't think twice before reaching for one.

A little heartburn after dinner, some burning in the chest, a feeling of heaviness - one pantoprazole tablet and the problem seems solved. And for many people, it quietly becomes a habit that they continue taking for weeks and sometimes even months.

Why This Matters for Cancer Patients

In limited doses and under medical guidance, an acidity tablet is largely considered safe. But this is not true for everyone. For patients undergoing immunotherapy for kidney cancer, that small tablet may be doing more than just controlling acidity.

A patient comes in for follow-up. The scans look encouraging. Treatment is going as planned. And then, almost casually, they mention that they have been taking pantoprazole every morning for acidity for several years without proper medical advice. Most patients genuinely don't think it's important enough to mention. But newer research suggests it might be.

The Gut Microbiome Connection

It is because the digestive system holds trillions of bacteria collectively called the gut microbiome. Once thought to help only with digestion, they are now known to be deeply connected to the immune system.

Our gut bacteria are a training ground for our immune army. If that ecosystem is disturbed, the immune response may not be as effective as we want it to be.

This is where these proton pump inhibitor medicines, such as pantoprazole, omeprazole, and rabeprazole, can also alter the balance of gut bacteria by suppressing acid production in the stomach. This seemingly minor change may have a stronger effect.

What Does Research Show

A study published in the Journal of Cancer Research and Clinical Oncology looked at patients with advanced kidney cancer receiving immunotherapy, comparing those who regularly used PPIs with those who did not.

The difference surprised many oncologists. Patients who were not taking daily PPIs had a progression-free survival of around 9.7 months, and for regular PPI users, it was around 6.4 months. When overall survival was measured, the gap was even wider — about 14.6 months for daily PPI users compared with roughly 30 months for non-users.

And this is not a one-off finding. When researchers pooled fourteen studies covering 6,716 cancer patients on immunotherapy, PPI users still carried roughly a 39 percent higher relative risk of death and a 29 percent higher risk of the cancer progressing. A larger 343-patient kidney cancer study echoed the very same direction. Although not every analysis agrees on how big the effect is — some of the most recent data suggest it may be more modest — but the arrow keeps pointing the same way.

An Important Caveat

One important caveat runs through all of it: these are observational studies, not controlled trials. PPI users are often older and have more illnesses, which can independently worsen outcomes, so the pill cannot yet be said to cause the difference.

A finding this consistent cannot simply be ignored. It deserves to be part of the discussion before treatment starts. He added that PPIs are also recognized, quite separately, as an occasional cause of kidney injury — one more reason their use is worth reviewing rather than continuing on autopilot.

Don't Stop Your Medication Suddenly

At the same time, stopping acidity medicines overnight is not the solution. When patients suddenly stop PPIs, they can experience severe rebound acidity. That's why any change should happen only after discussing it with the treating doctor.

Simple Steps Patients Can Take

A practical piece of advice would be to carry a complete list of medicines to every oncology appointment — not just cancer medicines, but everything.

Prescription drugs, over-the-counter tablets, supplements, and even home remedies. Sometimes alternatives are available. Sometimes simple dietary changes help — smaller meals, less spicy food, avoiding late-night eating. Simple measures, but often effective.

Remember, cancer treatment is not only about the drug. It is also about everything happening around the drug. The food people eat. The medicines they take. Their daily habits. Small things can sometimes influence big outcomes.

(Dr Veenoo Agarwal, Head of Medical Oncology at Shalby International Hospital, Gurugram)

Even though Sickle Cell Disease (SCD) affects thousands of families across the country, it continues to remain one of India's most under-recognized health challenges.

The National Sickle Cell Elimination Mission, launched in 2023, has brought renewed focus to the disease, with the goal of reducing the incidence of new sickle cell disease cases to zero by 2047.

The mission has largely focused on prevention and supportive care, but a comprehensive 360-degree approach is still missing, Dr. Gaurav Kharya, Clinical Lead, Centre for Bone Marrow Transplant & Cellular Therapy, Senior Consultant, Pediatric Hematology, Oncology and Immunology, Indraprastha Apollo Hospitals, New Delhi, told HealthandMe.

“The current framework does not adequately address patients who continue to suffer from severe sickle cell disease despite receiving optimal supportive care,” Dr. Gaurav said.

“Such patients may be candidates for curative approaches such as bone marrow transplantation and, in the future, gene therapy. At present, bone marrow transplantation remains the available curative option,” he added.

Dr. Gaurav noted that for decades, treatment focused primarily on controlling symptoms and managing complications. The mission led to free genetic screening cards, lifestyle counseling, and access to symptom-managing medication.

"While these measures remain important, advances in stem cell and bone marrow transplantation have changed the treatment landscape for selected patients”.

The Sickle Cell Mission does not currently address transplant support or provide specific directives to state governments regarding curative treatment.

“The impact of these interventions can be life-changing. Children who once depended on repeated hospital visits, blood transfusions and constant medical care may be able to look forward to healthier and more independent lives after successful treatment,” Dr Gaurav said.

The expert called for “incorporating support for curative therapies and allocating dedicated funding could strengthen the program and create a truly comprehensive approach that focuses equally on prevention, supportive care and curative treatment”.

Achievements of Sickle Cell Mission

Also read: Your Kidneys Could Be Silently At Risk From Work Stress And Unhealthy Habits, Experts Warn

India contributes a significant proportion of global sickle cell births every year, making it a major public health concern.

The disease is particularly prevalent in several regions of India, especially among tribal and underserved populations in states such as Madhya Pradesh, Maharashtra, Chhattisgarh, Gujarat, Odisha and Rajasthan.

One of the major achievements of the Sickle Cell Elimination mission has been bringing attention to a disease that had long remained neglected. Previously, policy-making, implementation, and fund allocation for sickle cell disease in high-burden states were limited.

The mission has brought a strong focus on sickle cell disease, prompting states with a high disease burden, including Madhya Pradesh, Chhattisgarh, Odisha, Gujarat and Maharashtra, to actively work on policy-making and implementation.

The primary objective of the mission has been prevention. Dr. Gaurav told HealthandMe that prevention can only happen when individuals know their sickle cell status and whether they carry the gene responsible for the disease.

“Once identified, individuals can receive counselling on how the disease can be prevented. Proper genetic counselling can help families understand the risks associated with passing the condition to future generations,” he said.

Following the implementation of the mission, large-scale screening programs have been conducted, particularly in high-burden states. These efforts have led to the identification of significant numbers of people with sickle cell trait as well as individuals with homozygous sickle cell disease.

Another key objective of the mission is to provide optimal supportive care to patients. Many patients have been linked to nearby Primary Health Centers (PHCs) and Community Health Centers (CHCs) to ensure access to regular medicines and supportive treatments such as hydroxyurea. Associated genetic counselling has also been initiated as part of these efforts.

To help reduce the number of children born with severe disease, Dr Gaurav urged for further boosting

• awareness of carrier status,
• access to genetic counseling
• wider implementation of screening programs.

What Is Sickle Cell Disease?

Sickle Cell Disease is an inherited blood disorder that affects the shape and function of red blood cells. Instead of being round and flexible, the red blood cells become sickle or crescent-shaped, making it difficult for them to move smoothly through blood vessels.

This can lead to severe anemia, recurrent episodes of pain, infections, organ damage and, in some cases, life-threatening complications such as stroke or acute chest syndrome.

The impact of Sickle Cell Disease extends far beyond physical symptoms, Dr Gaurav said. Children living with the condition often experience repeated hospital visits, missed school days and limitations in daily activities.

Parents frequently face emotional distress, financial strain and the challenge of managing a lifelong medical condition.

Why Early Diagnosis Matters

Dr Gaurav said that one of the biggest challenges is that many children are diagnosed only after symptoms begin to appear. Early screening can help identify affected infants before serious complications develop, allowing doctors to initiate preventive care and monitor the disease more effectively.

Newborn screening programs, regular follow-ups, and access to specialized care can significantly improve the quality of life and reduce the risk of long-term complications, the expert told HealthandMe.