On his 40th birthday, Maxwell Okoh [not real name] went out on a date with his wife. That night he felt cold, and was sweating, his wife recalls, as the couple retired to bed by morning, he was dead.His death was sudden. Sudden deaths have become a syndrome that doctors have linked to heart diseases. And they are increasing.
Right on the 58th Independence Day, Yakubu Nataala, a lecturer became the latest casualty to make news headlines. But information manager Haruna Ibrahim has compiled a total 37 slump deaths reported this year alone.
Six deaths each occurred in January and June, three each in February and July, five each in March and April and three in May. Before Nataala’s case, three more slump deaths were reported in August and one in September.
When a cardiac service opened in Abeokuta in 2005, cardiologist Okechukwu Ogah and a team of seven other experts ran a study among 1,441 patients in Abeokuta.
The study considered patients over a three-year period. Among them, 817 had heart conditions caused by blood pressure, 53 had a damage to one or more heart valves in the wake of rheumatic fever, 44 had a condition in which their heart was unable to pump enough blood because it had become enlarged and weak.
In 26 others, the study found diseases that restricted blood flow from and to the heart, heart disease linked to diabetes, sickle cell. Only 449 of the patients were normal.
While heart disease linked to hypertension was prevalent, the “relatively frequent diagnoses of rheumatic heart disease, cardiomyopathies and pericardial diseases reflect the impact of infections and infestations on the cardiovascular health of adult Nigerians,” the study noted.
“We suggest that prevention and treatment of cardiac diseases in our setting should among other things focus on blood pressure control and early treatment of infections causing heart diseases.”
Doctors are frequently seeing more heart conditions, and they explain it in two ways.
“It could be that people are becoming more conscious and they are coming to hospital so more diagnosis is being made, compared to previously when people don’t come to hospital,” says Ejiroghene Umuerri, cardiologist at Delta State University Teaching Hospital, Oghara.
“When they die, they don’t get autopsy, so we don’t know what is killing them. On the other hand, what is apparent is that our lifestyle has changed.”
Eight years ago, Umuerri began work at the Delta State University Teaching Hospital, Oghara. It was a rural setting. On her drive to work, she saw people going to farm on their bicycles. Then she did her own study.
“I went to the market place, and it was only about two people that were obese. Now I can hardly find a bicycle. Okada has taken over. You have more cars, the people are becoming more obese, the economy is improving, life is getting better and they are taking on the risk.”
“Transporting to their farm alone, they now have a risk factor for their heart as against riding their bicycle that was protective for them.”
The heart is a muscle, and its function is to pump blood around the body through a complex network of blood vessels. Arteries take blood from the heart to body parts and veins return the blood. For that to work well, the vessels have to retain their integrity and texture.
“Whenever there is narrowing in blood vessels by whatever factor, it leads to problems,” says Dr Kelechi Okonta, cardiothoracic surgeon at University of Port Harcourt Teaching Hospital and senior lecturer at the school’s surgery department.
“Those narrowing destroy the texture of blood vessels, and when the texture is destroyed, they don’t respect the normal mechanism of expanding and contracting.”
They simply start blowing out: that’s what aneurysm is.
Cardiovascular diseases generally affect the heart and blood vessels, and the risk factors commonly associated with them are known-smoking, alcohol, cholesterol are known.
“Even the common man on the street know the risk factors. The important thing is how do you explain these things,” says Okonta.
Start with cholesterol. It isn’t necessarily bad high levels of it causes fat to be deposited along the walls of blood vessels, narrowing or in more extreme cases, blocking them. When the vessels get blocked, the portion of the body that receives blood from that particular vessel “will not get nourishment via blood,” explains Okonta.
When this happens, the result is ischaemic heart disease or a myocardiac infarction.
The restriction or blockage may cause blood flow to the limbs to reduce, resulting in peripheral vascular disease.
The neck also has a blood supply. If the vessels that supply the neck are affected, blood flow to the brain reduces and leads to stroke, he explains.
“If the vessels to the abdomen are affected, it could lead to aneurysm. The chest and trunk can get dilated to the point that, if nothing is done, it will rupture and the person will lose all his blood.”
Combination of two separate risk factors can also escalate heart diseases. For instance, hypertension and high cholesterol levels, obesity and diabetes, smoking, which causes blood vessels to constrict, and a sedentary lifestyle. A general and noticeable change in lifestyle brought on by urbanization has brought on increased risk of heart diseases, says Umuerri.
“The reality is that this problem of heart disease is getting worse. Whether our diagnosis has increased remarkably compared to the past is a different kettle of fish,” she says.
“In the past, you hardly find people that come to the hospital with heart attack. Now you have more people coming, even young people. And you have the issue of drugs too. It is bringing down a lot of our young people.
“It is not a story in the air. It is reality. More people are having heart diseases.”
The key is a healthy lifestyle.
“Weight gain is a function of what goes in and how you use the energy thereafter. People will tell you I’m not eating too much. If you are not eating too much and you are not engaging in physical activity, it invariably means you are eating too much,” says Okonta.
“The best eating style is what you eat to sustain you for a day. If there is reduction in activity, a proportion of that food is now stored in the body. Besides the heart forcing itself it feed [pump blood] to all these structures, the heart will be under a lot of pressure to supply all of them.”
Measuring personal risk factors is important, says Umuerri.
“Sometimes people don’t even have the knowledge that they have these risk factors or that things they engage in put them at risk,” she says.
“Another thing is perception. Heart disease is a chronic disease. There is a latency period, a period when the patient is apparently healthy. They just feel the perception of ‘I am healthy, it is not my portion, I am a Nigerian’, and they do nothing about it.”
There is also the financial reason. Up to three-quarters of all spending on health is out of pocket, which keeps many from visiting hospitals. It gets worse by geography.
“In the rural areas, you will not even find hospitals,” says Umuerri.
“The primary health centres are not well equipped, and you don’t have personnel. The people attending to them do not even have the knowledge to know what to do look out for.”
Data compiled by Haruna Ibrahim