Understanding the Early Warning Signs of Chronic Heart Disease

Exertional dyspnoea, fatigue disproportionate to activity, mild retrosternal discomfort with exertion, and unexplained drop in exercise tolerance. Indian patients also frequently attribute early angina to 'gastric' pain. Screen with resting ECG plus ETT if symptoms are exertional; add echo if any exam findings.

ICMR and CSI guidance: baseline at age 20, repeat every 5 years if normal, annually after 40 or earlier with family history of premature CAD, diabetes, hypertension, or South Asian ancestry (higher baseline risk at lower BMI cutoffs).

Smoking cessation (RRR ~50%), Mediterranean-style diet (PREDIMED RRR ~30% for major CV events), 150 min/week moderate activity, and BP control to <130/80. Statin therapy per ASCVD risk calculator when 10-year risk ≥7.5% and lifestyle alone insufficient.