At least 10 people, including a boy of 13, have died from heart attacks after taking part in the traditional garba dances in India's western state of Gujarat, local media reported on Monday.
Garba is a high-energy traditional Gujarati dance performed during the nine-day Hindu festival of Navaratri to celebrate the goddess Durga.
Every year, large garba events held in parks and community halls across Gujarat, as well as other parts of the country, draw large crowds of people dressed in traditional costumes who dance in groups for hours through the evening and night.
The deaths, which occurred in the space of 24 hours, have once again raised questions about the general health of Indians and their susceptibility to cardiac problems.
The youngest fatality, 13-year-old Vaibhav Soni, reportedly fell off his cycle while returning from a garba event in Vadodara district on Saturday and was taken to hospital with minor injuries.
He was discharged after some tests, but complained of chest pain after being taken home.
His family said they sent him to bed after giving him medicine but became alarmed when he did not wake up after several hours. He was taken to hospital where doctors declared him dead from a heart attack.
Another teenage fatality was Veer Shah, 17, who reported feeling unwell and suffered a nose bleed while dancing the garba in Kheda district on Saturday night.
He was rushed to a hospital where he suffered a fatal heart attack.
Similar deaths were reported in Gujarat's Ahmedabad, Navsari and Rajkot districts.
Authorities said ambulance services received more than 500 calls related to heart problems over 24 hours in which the deaths were reported, and about 600 calls about people experiencing breathlessness during the first six days of the festival which began on October 15 this year.
The state government on Sunday asked garba organisers to ensure that ambulances were available and ordered community health centres near garba venues to be on high alert.
Cardiologist Anurag Mehrotra said the heart attacks suffered by the teenage garba dancers could be the result of a lack of exercise among Indian youth.
"If you do something that you are not accustomed to and you are exposed to that sort of exercise, these incidents occur," Dr Mehrotra, head of the cardiology department at Siddh Hospital in Uttar Pradesh state, told the NDTV news channel.
Cases of heart attacks among Indians have been increasing, says federal Health Minister Mansukh Mandaviya. In recent months, a number of videos of people collapsing while working out in gyms or dancing at weddings have surfaced on social media.
At Mr Mandiviya's request, the Indian Council of Medical Research (ICMR) launched an investigation in March into whether cases of cardiac arrest had increased after the Covid-19 pandemic but found no evidence to support this.
Heath experts say high rates of diabetes, metabolic syndrome, hypertension and smoking, as well as genetic factors, make Indians predisposed to heart attacks.
Doctors believe that these factors lead to the onset of coronary artery disease – the build-up of plaque on the walls of arteries.
The ICMR said cardiovascular disease was a factor in 28 per cent of total deaths in 2016.
