When Rashi Ramlal had his first heart attack at age 34 , he had no idea what was happening to him. All he wanted was some relief for what he thought was indigestion.

He was working as a promoter in Miami Beach’s nightclub scene on a busy Halloween weekend in 2010, but decided to call it an early night. By morning, he had gone through two packages of Tums. He called 911 and was taken by ambulance to Jackson Memorial Hospital, where doctors placed tube-like coronary stents to open up two clogged arteries.

“It was a very scary wake-up call,” said Ramlal, 36, a father of two teens. “I have never broken a bone, or even had a serious cough.”

Ramlal, who has been in the club promotion business for about 10 years, said he has made some lifestyle changes. He quit drinking (he used to drink a bottle of Hennessy Cognac a night), and started eating healthier meals (he used to grab a pizza after leaving the club at 5 a.m., then go home to sleep.)

He still smokes, however.

Last year, during another Halloween weekend, he suffered a second heart attack. This time he took a taxi to Mount Sinai Medical Center in Miami Beach. That second trip to the hospital was bleaker.

“The first time around I thought it was indigestion. This time, I wasn’t playing because I had the awareness that I have a heart problem,” he said.

Doctors at Mount Sinai inserted a third stent and adjusted one of the other two already in place.

“Any delay between the time of heart attack and when we get the artery open means a bigger heart attack and more complications after,” said Dr. Gervasio Lamas, chief of cardiology at Mount Sinai. “We’ve set up a really effective team. Arteries can be opened as quickly as 20 minutes from time of arrival.”

Heart disease continues to be the leading cause of death for both men and women in the United States. According to the Centers for Disease Control and Prevention, every year about 715,000 Americans have a heart attack. And about 600,000 people die from heart disease.

In recent years, doctors are seeing more and more patients in their 20s and 30s with cardiovascular disease, including having heart attacks. Smoking, drinking, obesity and lack of exercise all contribute.

A 2013 Statistical Update by the American Heart Association, citing a National Health and Nutrition Examination Survey report from 2007-10, showed that among adults ages 20-39, 12.8 percent of men and 10.1 percent of women have some form of cardiovascular disease, including coronary heart disease, heart failure, stroke, and hypertension.

“With the unhealthy lifestyle we have now, we are starting to see the disease progress in younger patients,” said Dr. Jonathan Fialkow, medical director of clinical cardiology for Baptist Cardiac and Vascular Institute in Miami.

Fialkow said he sees about four or five patients per month with heart attacks, or blood clots, under age 40.

While some heart conditions are caused by congenital heart defects, high risk factors play a major role, including family history, smoking, diabetes, drinking, drugs and a poor diet.

The path to a clogged artery is about the same regardless of age, but there are higher risks of death in young patients, doctors say.

“Younger people tend to have more open arteries that may not look abnormal. Unstable plaque settles within the arteries of the heart and can cause a rupture. They may not have chest pain, go out, and suddenly wake up and have a massive heart attack,” said Dr. Randy Katz, medical director of Memorial Regional Emergency Services in Broward.

Ramlal doesn’t have a family history of heart disease. He started smoking cigarettes when he was a young boy, but he’s still not sure if that’s the exact reason for his condition. Two weeks before his first heart attack, he got his first physical in decades at his mother’s insistence, but never went back to get the results.

Without health insurance and a half-million dollar debt in hospital bills, Ramlal said he can’t afford to follow-up with a cardiologist. He’s downloaded an application on his smartphone to count calories and started a party bus service to “stay out of the clubs,” but he’s not sure that’s enough.

“I don’t know what caused it. If you break a bone, you go to some sort of rehab. There’s no therapy for this,” he said.

Two of his friends died of heart attacks in the past couple of years. He worries it might happen to him.

“It’s like walking that street every single day waiting for the bus to hit you,” he said.