Lately, many celebrities have been dying of Heart-related diseases. More than ever before many celebrities have been slumping and dying after suffering Heart Attacks or Cardia Arrest. What causes this? How can it be avoided or prevented and how can it be treated.
Dr. Folasade Alli, the Medical Director of the newly opened Lagos Executive Cardiovascular Clinic explained to City People last week why Cardiovascular Diseases (CVD) have been on the rise.
What are cardiovascular diseases? Dr. Alli says a diagnosis of heart disease sounds scary, but it does not have to be. “With appropriate treatment and lifestyle changes, heart failure, for instance, can be a manageable condition. Many people who are diagnosed with heart failure in developed countries live long, normal lives (to a large extent), however, this is not always the case in sub-Saharan Africa. In order to better understand how LECC can help you, and the first place to start is by teaching you about the heart”.
THE HEART AND HEART FAILURE
What do you know about the Heart? The heart starts working during the third week of intrauterine life, therefore making this organ the most hard-working and oldest functioning muscle in the body. It pumps between 5 to 6 litres of blood every minute during rest, and it also supplies nutrients and oxygen-rich blood to all body parts, including itself.
The heart consists of 4 chambers that work together to pump blood throughout the body. At LECC, we call the heart the engine of the body. The two upper chambers or atria collect the blood as it enters the heart. These chambers contract to squeeze blood into the lower two chambers called the ventricles, which pumps the blood out of the heart to create a heartbeat. A normal heart should beat between 60 to 100 times per minute (Bpm).
WHAT ARE THE RISK FACTORS FOR CARDIOVASCULAR DISEASES?
CVD risk factors include, but are not limited to: • Old age • High blood pressure • Heart attack • Viruses • High cholesterol • Diabetes • Smoking • Valvular disease • Congenital heart defects • Coronary artery disease • Irregular heart beats • Kidney conditions • Excessive alcohol use • Inactive lifestyle • Excess weight • Postmenopausal • Family history of heart attacks or strokes • Stress.
WHAT IS HEART FAILURE, HEART ATTACK, & CARDIAC ARREST?
Many people confuse the three terms of heart failure, heart attack, and cardiac arrest, however, each term is different from the other.
HEART FAILURE
Heart failure does not mean your heart has stopped beating, it means the heart muscles cannot pump (eject) blood out of the heart and around the body effectively and sufficiently, or your heart muscles are stiff and cannot fill up with blood easily. While the former is a systolic heart failure, the latter is called diastolic heart failure. Both of these problems means that the heart is no longer able to pump enough oxygen-rich blood out to the rest of your body. As the heart’s pumping action is lost, blood may backup in other areas of the body. This backup of blood causes fluid to leak from the vessels into tissues – ‘congestion’.
In the lungs, congestion may lead to difficulty in breathing; in the ankles and legs, the congestion or backup of fluid causes swelling; in the belly, congestion may cause fullness or loss of appetite; in the kidneys, it retains excess water and sodium. This buildup of fluid is called heart failure.
If the heart is weakened and cannot supply the cells with sufficient blood, the patient becomes tired and breathing becomes difficult. Activities once taken for granted become challenging, such as walking, carrying shopping bags, or climbing stairs.
Heart failure can involve the left side or the right side or both sides of your heart. Heart failure that begins with the left side – specifically, the left ventricle, which is your heart’s main pumping chamber is a condition we call “left-sided” or “left ventricular” heart failure at LECC.
Right-sided heart failure can occur independently, or as a result of “left ventricular heart failure”.
There are different Types of Heart Failure and What Occurs: The 1st one is Systolic Heart Failure : – That is when left ventricle loses its ability to contract vigorously, indicating a pumping problem. 2. Diastolic Heart Failure: – The left ventricle loses its ability to relax or fill fully, or both. 3. Idiopathic Dilated Cardiomyopathy: – The heart becomes weakened without explanation.
This distinction is Important because the treatments for each type may differ.
WHAT ARE THE Causes of Heart Failure?
They include any disease that weakens the heart muscles especially: • Diabetes • Inflection of the heart muscles • Cancer drugs • Genetic abnormalities • Blockage in the blood vessels • High blood pressure that may cause diastolic heart failure • Disease of the heart valves.
In many cases, the cause is never known, which is called ‘Idiopathic Cardiomyopathy’. Symptoms of heart failure include: • Coughing • Weakness or tiredness • Swelling in the ankles or legs • Breathing difficulty • Shortness of breath after climbing a flight of stairs or getting dressed • Loss of appetite • Belly pain and fullness.
For some patients, these conditions cannot be cured, however, we at LECC can help keep a patient’s condition from getting worse with medication, lifestyle and nutritional changes, and treatment procedures.
WHAT TREATMENTS ARE AVAILABLE?
If medication, lifestyle and nutritional changes are not enough to control your symptoms, your Cardiologist may suggest:
(1) CARDIAC RESYNCHRONISATION THERAPY (CRT)
A normal heart sends electrical signals to both lower chambers or “ventricles” of the heart to make them pump at the same time. Sometimes in heart failure patients, the two chambers do not pump together. A special pacemaker called CRT is a small battery-powered device that is placed under the skin that helps make the two sides of the heart beat together. It has special wires called “leads” that send tiny electrical signals to the heart telling the heart muscles when to pump. CRT is a pacemaker that tells both ventricles to pump at the same time, so it has leads on the right and left side of the heart. CRT can reduce your heart failure symptoms and increase your ability to exercise and be more active.
(2) IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)
Some patients with heart failure have dangerously fast heartbeats called “ventricular tachycardia” or “ventricular fibrillation.” This fast heartbeat can cause serious symptoms such as fainting or even death. An ICD is like a pacemaker that can be inserted under your skin. It can recognize a dangerous heart beat and send an electrical signal to the heart and return the heart back to a normal heartbeat. If your heart needs both a CRT and an ICD, they can be placed at the same time using one device.
(3) VENTRICULAR ASSIST DEVICE (VAD)
A Ventricular Assist Device (VAD) is a mechanical pump inserted into your body to improve blood flow. If you have severe heart failure, your heart is unable to pump enough blood to your body’s organs and tissues.
Therefore, a VAD may be needed. You will need an open-heart surgery to implant the mechanical pump.
The VAD works together with your own heart to pump more, effectively. VADs can stabilise your heart condition and allow you to become stronger and feel better. This option may not be possible for everyone.
WHY IS THE HEART’S RHYTHM SO IMPORTANT?
The sinus node is a group of specialised cells in the right, atrium that acts as the heart’s pacemaker to set the heart rate. When this electrical system is not working-properly, the heart may beat faster than normal. An arrhythmia may feel like a skipping or fluttering sensation in the chest. It may occur sporadically or chronically. A trial flutter occurs when the electrical signal circles around inside the atria, telling the heart to beat very quickly (150 to 200 bpm). Atrial fibrillation is when extra signals make the atria beat too fast and erratically. This may cause dizziness and weakness because the upper chambers are not able to move enough blood into the ventricles. The AV node, which acts as a relay station, allows only some of the impulses to stimulate the ventricles to push blood out.
When blood does not flow properly, it may pool and form clots that can move into other parts of the body and can result in stroke or heart failure.
WHAT IS ATRIAL FIBRILLATION?
Atrial fibrillation, or “Afib,” is a very common arrhythmia. In Afib, the upper chambers of the heart (the atria) contract in a rapid and disorganised motion, disrupting the heart’s ability to pump blood.
Atrial fibrillation can be caused by a heart attack, high blood pressure or a thyroid problem, but sometimes there is no known cause.
Atrial fibrillation affects people of all ages and races. It is rarely life threatening, but it can be frightening and may lead to other health problems such as stroke or heart failure. It becomes serious when the heart beats too slowly or too rapidly to pump blood effectively.
What are they symptoms of Atrial Fibrillation? • Palpitations (fluttering, fast heartbeat) • Weakness or tiredness • Shortness of breath • Chest pain or tightness • Dizziness • Fainting spells.
HOW DO WE DIAGNOSE IT?
Atrial fibrillation can be detected through an electrocardiogram (ECG or EKG). This test detects the heart’s electrical signals and its activity during exercise, such as a stress test. If an arrhythmia does not appear on an ECG, a portable recorder called a Holter monitor may be used to record symptoms 24 hours a day.
An echocardiogram, or video picture of the heart, also may be done to check the structures of the heart. LECC uses a 40 video (and picture) echocardiogram that enables our physician to analyse the structure of the heart in real time. This is much more efficient that 20 echocardiogram, which is used by most facilities in Nigeria.
An electrophysiology study can provide physicians an electrical “map” of the heart. In a cardiac catheterization lab, specially trained physicians place electrode wires directly into the heart through a large vein in the groin. The catheter delivers small electrical impulses to the heart to pinpoint the rhythm problem and determine how it can be controlled. Electrode catheters also can deliver tiny electrical impulses to pace the heart that can induce abnormal heart conditions that physicians can observe and control.
Our treatment options include: • Medication • Electrical Cardioversion • When neither medication nor Electrical • Cardioversion work, we use Catheter Ablation.
In the case of drug treatment, medications play a vital role in treating and managing heart failure. They can prevent the condition from getting worse or slow the process. A patient should never adjust or stop taking their medications without first consulting with our physician.
There are several types of medications that our physician may prescribe to treat heart failure. The physician will consider the patient’s specific condition and health history to determine which is the best option.
If medications do not restore normal rhythm as desired, the next step may be electrical cardioversion. In this procedure, the heart is given a small electric shock to stop all electrical activity in the heart for a moment, including the irregular signals that cause atrial fibrillation (read more on atrial fibrillation below) and restore the heart’s normal rhythm. There is no discomfort during the procedure, and the heart is monitored by electrocardiogram as the electric shock is delivered.
When medication and electrical cardioversion do not work, a nonsurgical technique called catheter ablation may be done. Catheter ablation modifies the tissue in the atria that is causing the rapid heart rhythm. An electro physiologist inserts a special wire (catheter) through a blood vessel into the heart directly to the area of the heart causing the arrhythmia. Heat energy is sent though the wire to destroy (ablate) the problem cells without harming the rest of the heart. This procedure can replace surgery in most instances.
The success rate of eliminating atrial fibrillation is about 60 percent, but that can be increased to 89 percent with medications after the procedure.
HEART ATTACK & CHEST PAIN
Heart attack consists of death of heart muscle due to an occlusion (blockage) of a coronary artery. Put simply, heart muscle tissue dies. The heart muscle dies because it is starved of oxygen (i.e. blood is not getting to it). Not all of the warning signs listed below occur in every attack. If you experience heart attack symptoms or recognise these symptoms in another, call our number immediately and contact our doctor through your patient app. Every second counts, so do not delay. Also note that heart attacks can mimic simple health conditions such as indigestion, panic attack, respiratory infection or sports injury.
SIMPLE CAUSES OF CHEST PAIN – A COMMON SYMPTOM OF HEART ATTACK
- Burping, belching, heartburn, nausea and a sour taste in the mouth usually accompany indigestion • Heart palpitations usually accompany a panic attack, shortness of breath and anxiety • Chest-wall or muscle pain from exercise or injury can be made worse when the sore area is pressed with a finger • Breathing pain of respiratory infections can’ be made worse by coughing and deep breathing. lt’s important to know that any of these symptoms also can be present with a heart attack. Do not assume that you are just having indigestion or a panic attack. Get medical help right away.
Lastly, Cardiac Arrest occurs when the heartbeat stops, the heart stops, blood circulation stops, and there is no cardiac activity – no pulse, no blood pressure.
This is a CODE BLUE situation that requires immediate resuscitator using defibrillator.
WHAT IS CORONARY ARTERY DISEASE?
Coronary- arteries surrounding the heart keep it nourished with blood. Coronary artery disease happens over time. It occurs when fatty deposits called plaque (which is made up of cholesterol deposits) build up within the artery walls. The artery becomes narrow. This is atherosclerosis. When this occurs in the coronary arteries, the heart does not get sufficient blood, and this condition is called coronary artery disease or coronary heart disease.
SYMPTOMS OF CORONARY ARTERY DISEASE
- No symptoms for long period • Chest pain for short period on exertion also known as Angina or minor heart attack • Myocardial infarction or major heart attack-severe chest pain, death of heart muscle, heart failure, irregular heart beats • Sudden death.
Coronary heart disease is not a major cause of death among men and women in Nigeria, however, there is the increasing trend of predisposing or coronary artery trigger diseases such as diabetes and hypertension, the #1 killer cardiovascular disease. This trend is increasing especially in burgeoning cities that are rapidly growing due to urbanisation, westernised diets that promote diabetes, reduced physical activity, obesity, and hyperlipidemia. At present, myocardial infarction is only about 6% of all cardiovascular diseases in Black Africans. The World Health Organization (WHO) has projected that the number of deaths from ischemic heart disease in the region will double by 2030. Also, several Nigerians experience heart attacks each year, and, unfortunately, many of them die before they get to a hospital.
Certain traits, conditions, or habits, known as “risk factors,” (see below) may raise your chance of developing a coronary artery disease (CAD). You can control most risk factors and help prevent or delay CAD.
CARDIOVASCULAR DISEASE (CVD)
CVD is a broad term referring to all disorders of the heart, as well as those within the entire circulatory system (“cardio” means heart, “vascular” means blood vessels) from head to toe. It includes coronary artery disease, valve disease, disease of the heart muscle, electrical disturbances of the heart rhythm, high blood pressure, aneurysms, stroke and peripheral vascular disease.
It is not a “man’s disease.” In fact, heart disease is the # 1 killer of Nigerian older women today, more than breast and lung cancers combined.
Whether you are female or male, recognising the symptoms and risks, making lifestyle changes and getting timely care can save your life. Visit a cardiologist today to assess your risks before it may be too late.
PREVENTIVE CARDIOLOGY
Preventive Cardiology focuses on the identification and management of risk factors. (a) Primary Prevention: – People with risk factors are prone to CVD such as heart attacks, strokes, heart failure and sudden cardiac death. Even if people do not have apparent heart disease, modification of risk factors is likely to lead to a longer life, free of heart attacks and other CVDs. (b) Secondary Prevention: – Preventive cardiology also provides a “maintenance check” for people with known CVD. To prevent additional CVD, these patients benefit from a thorough assessment of risk factors and their optimal modification.
Are you Prepared for a Cardiac Emergency – Take the following emergency actions ahead of time if you or a family member has a heart condition or is at risk of a heart attack: • Know in advance which hospitals/clinics in your area provide 24-hour emergency cardiac care. Tell family and friends where they are located • Know emergency rescue numbers, as well as the telephone numbers of your doctors and hospitals/clinics.
- LECC: +2348055228960. Lagos State Rapid Response Squad: 08056250710, 08033482380, 08023127350.
- Lagos State Distress Call: 767, 112 • Lagos State Emergency Management: 08060907333, 08023127654, 08022234870 • Lagos State Ambulance Service: 08022887777, 08022883678, 08022887788 • Advise family and friends to call for emergency care if chest pain lasts more than a few minutes.
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