Karachi: An alarming number of young men in Pakistan are developing permanent heart failure because as often their first heart attack goes unnoticed, and by the time they reach a hospital, irreversible damage has already been done to the heart muscles, senior cardiologists warned.
They said almost every patient who ends up in heart failure had at least one poorly managed risk factor such as uncontrolled blood pressure, high cholesterol, smoking, diabetes or viral damage to the heart. More than 93 percent of young patients had two or more risk factors silently brewing before their first cardiac event, while millions live with undiagnosed risks without screening or counselling.
“We are reacting after the damage is done instead of preventing it. Nobody checks cholesterol or blood pressure until a patient collapses,” said Prof. Khawar Kazmi of the National Institute of Cardiovascular Diseases (NICVD) Karachi. He said when a heart attack goes unnoticed, the heart is deprived of oxygenated blood and large portions of muscle die permanently, leaving patients dependent on medication with no chance of recovery.
Pakistan is witnessing a rise in silent and early-age heart attacks, especially among men under 45, but a majority ignore symptoms or arrive too late at hospitals. “The golden hour, the first 60 minutes after a heart attack, is critical. This is when a patient must reach a facility that can perform primary PCI or emergency angioplasty to reopen the blocked artery,” said Prof. Kazmi, who heads preventive cardiology at NICVD.
He said an emergency angioplasty within the first hour can prevent heart muscle death, but in most cases, patients reach after two to four hours. “By then, a large portion of the heart has already died due to oxygen deprivation. That damage is permanent. These patients are then labelled as heart failure cases and put on medicines with no possibility of full recovery,” he added.
In Islamabad, only one government-run centre offers primary PCI services but shuts after sunset, while most heart attacks occur late in the evening. “Patients are then forced to go to expensive private hospitals where emergency angioplasty costs hundreds of thousands of rupees, making survival dependent on affordability,” cardiologists said. In smaller towns and rural districts, no primary PCI facility exists, and many patients either die on the way or survive with irreversible heart damage.
Experts said uncontrolled hypertension is a major driver of heart failure in young Pakistanis. Despite millions of prescriptions written daily, only 11 percent of Pakistanis have controlled blood pressure, while over 32.2 million live with undiagnosed or uncontrolled hypertension according to WHO estimates. High blood pressure silently weakens the heart over time and increases the risk of sudden failure.
Another cause of heart muscle damage is viral infection. Cardiologists said COVID-19 was one example of a virus that inflamed and damaged heart tissue. “We know coxsackie virus and several other viral infections directly harm heart muscles. The problem is we don’t even have surveillance or diagnostic capacity to assess how many hearts are being damaged due to viral myocarditis,” Prof. Kazmi said.
Pakistan does not have an active heart transplant programme, while left ventricular assist devices (LVAD) and advanced therapies remain out of reach for almost all patients. “There are hundreds of young men living with severely damaged hearts. They cannot walk properly, they cannot work, and they are told to keep taking medicines and wait for the end. This is happening because their first heart attack was either ignored or treated too late,” experts said.
Once a patient enters end-stage heart failure, treatment becomes limited to managing symptoms rather than reversing the condition. Most public hospitals do not have dedicated heart failure clinics, and diagnosis is expensive due to imaging and specialised tests.
Millions remain at risk because they do not recognise the symptoms of a heart attack. “Patients wait at home, thinking it is gas or muscular pain. Families give painkillers or antacids instead of calling an ambulance. By the time they rush to a hospital, the window for saving the heart has closed,” Prof. Kazmi said.
Experts called for a national awareness drive on recognising heart attack symptoms and seeking immediate medical care. “If people can identify stroke symptoms through FAST guidelines, we can do the same for heart attacks. Every minute after a heart attack kills a portion of the heart. A dead heart does not recover,” they added.
With private sector dominating cardiac emergency care and public facilities failing to offer round-the-clock angioplasty, cardiologists fear hundreds more young men will be pushed into lifelong disability. “Heart transplant is a dream in Pakistan. Primary PCI in time is the only real hope these patients have — and right now, most of them miss that chance,” they warned.
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