Rising incidence of sudden cardiac death (scd) in the Nigerian African: Possible explanations, tips on diet, exercise and why patients who have heart related issues should come together.
In the past few weeks, news of Nigerians suffering sudden cardiac death(SCD) has added to the burden of uncertainties which ordinary citizens have had to bear as a result of the whiplash of the economy and other societal ailments . In their homes, on their exercise machines, even as they sleep, try to get out of bed and in hospitals all over the country , Nigerians , rich, and poor are being struck with identical disease conditions that characteristically kill the heart slowly ,steadily and suddenly . The unfortunate situation is being observed in spite of the fact that very many Nigerians frequently travel overseas to spend huge amounts of money on heart related medical issues in a manner that has forced concerned observers to describe some of these trips as medical tourism. It is not wrong for people to seek medical evaluation and treatment any where reliable facilities are available as long as the patient realizes that it is important to take into consideration the continuity of care when he comes back home. When complications declare themselves, there may be no choice other than to seek life saving help from the abandoned centers (stones that builders reject are often the ones they find suitable to hold corners of buildings). Travelling out of the country to different parts of the world for diagnosis and management of heart conditions seems to have benefitted only a limited number of Nigerians . It is time people came together and discussed the challenges patients with heart problems face so that needs assessment sheet can emerge ,with the hope perhaps they will one day make it into Government policy agenda. When a patient surfers sudden cardiac arrest (SCA), The heart can be released from what ever is responsible for stopping it from pumping blood . In extreme cases, the heart can even be operated upon without removing it from its normal anatomical enclosure while a life support machine or an artificial heart takes over the function of the heart. This can even be extended as desired to allow healing of dead or injured heart muscle (myocardium) depending on whether the procedure is being done in India, UK or America.
Whereas compared to black people it is less likely for whites to die suddenly from Cardiac arrest, people and governments of these countries have worked very hard and have continued to do so ,to ensure that Hospitals over there have the best equipment for the diagnosis and treatment (medical and surgical) of heart conditions. They have also ensured that when patients suffer cardiac arrest , there are well equipped emergency vehicles and first respond personnel within reach to convey them to the nearest hospital as quickly as possible .
Conditions that will lead to sudden cardiac death can remain silent for years, and when discovered, continuous evaluation and reevaluation to avoid tipping the patient into the region of death is mandatory. Very often ,the conditions imposed by travelling overseas for routing heart health care makes continuity difficult for the patient. The consequences are such that affected patients and their relations have no way whatsoever of getting help from their heart Physicians at very critical moments. On the other hand, more than half of Nigerians with manageable cardiac problems who have no means of traveling out of the country for treatment are doing remarkably well, the major problems being in the areas of access to essential medicines and adherence to drug treatment.
The human heart like the brain and penis are richly supplied with blood vessels but the arteries in these organs do not enjoy sufficient collateralization compared to the scapula, the elbow and the knee. The arteries therefore are simply end arteries and can be easily obliterated by trauma, and disease conditions that affect their ability to respond to changes in blood rheology. Diseases of the heart and its blood vessels are called silent killers because whether or not a patient knows he has any of them, they are quite capable of precipitating cascades of death related events any where, any day and at any time. Sudden cardiac death and stroke (cerebrovascular accident) may occur as separate events or simultaneously in situations which may be much more challenging especially when in the province of physicians forced to do their shopping in resource limited countries. Sudden cardiac death may be defined as unexpected natural death from cardiac (heart) causes, occurring within a short time not up to one hour. It is not the same thing as sudden cardiac arrest (SCD) which defines a condition where a previously normal heart suddenly stops beating and patient is alive. Some authors may add a few other characteristics but these have been well documented especially for purposes of ancillary investigations and decision making.
Contrary to what has been the belief for sometime that cardiac arrest and SCD occur more frequently in men, current evidence suggest that the number of women dying from heart attack is now coming to run parallel with that recorded for men . Recently , a young mother was dressing up a kid for school when she slumped and died .Perhaps the physical exertion of that morning coupled with flashing thoughts about traffic situation amongst others may have combined to give her heart the load that killed it. In another bad situation, a middle aged widow folded over as she shook out pieces of clothing she was looking to spread on the ropes . A third one had pain in the left side of her chest as she made to get out of bed .She was a trained medical person and a known hypertensive; yet in spite of her years of experience she ignored it and did go to work but died shortly after entering her office .
It is perfectly normal for people to think about many issues and ask questions as they reflect on current personal efforts to keep their own mortality as far away as they possibly can.
Space and time can only permit a few words, but the substance in a message simply providing a few explanations on the why of a common condition, and laying emphasis on paying maximum attention to family history, weight, food, drink, alcohol, caffeine, cigarettes and smoke might just be sufficient to stimulate action ,reduce anxiety and reduce the number of people dying from cardiac arrest and stroke.
For adults, risk factors for heart attack may be arranged into two broad groups; those factors arising from the structures that make up the human body including the heart itself and those outside it.
Further sub classifications can be made but they generally are interrelated and will include uncontrolled or poorly controlled disorders of metabolism such as hypertension and diabetes mellitus, obesity, chronic alcoholism, smoking, underlying congenital and other disease conditions of the heart(Wolf Parkinson white syndrome, viral or bacterial cardiopathy etc), blood, liver and kidney, environmental issues that cause stress in the home, office and on the roads, social and economic factors that allow the vicious cycle of suffering, poverty, ignorance and disease to subsist . Several large scale studies have shown that being a black African puts an individual at increased risk of dying suddenly from heart related issues, compared to a white person of the same age , occupation and sex. The risk is particularly higher for male Africans. Subtle but significant differences do exist between black people and whites in the mechanisms that control and regulate blood pressure and blood sodium(salt) on one hand, and the way individuals from different ethnic groups respond to therapeutic measures aimed at correcting the imbalance or derangement in the cardiovascular regulatory mechanisms at different levels in the brain(medulla oblongata), heart, the coronary blood vessels, the kidneys, the liver and the nerves including the nerves that connect the heart with the spinal cord and the Brain. Refutable data from several reports suggest that for any established disease condition of the heart ,the rate and speed of progression to sudden cardiac death differ for men and women with respect to race and ethnic category, and hence a drug designed for Japanese adult populations to mobilize salt and fluid out from body tissues into urine may not produce the desired effects when administered to Nigerian patients.
By the middle of the third week of intrauterine life, cells that will form the human cardiovascular system will have begun to form(cardiogenic center); and at a seventh amenorrhea, a fetal heart beat can be picked up by ultrasonography. Though the conducting system of the normal heart begins at a point located in the right atrium inside a small bundle of specialized cell; the sino atrial node(SAN) passes through the AVN, the His bundle and then through the Purkinje fibers into the cardiac muscle, any sliced piece of the heart under experimental conditions is capable of contraction on it’s own for some time in a phenomenon similar to what happens when the tail of a wall gecko is cut off .Congenital abnormalities of the heart can involve all the very important portions of the heart mentioned above. In the same way anatomical variations exist in the cytoarchitecture , and other morphological characteristics of these sites as well as other very important areas of the heart including the left anterior descending coronary artery( LAD) popularly called the artery of sudden cardiac death . Consequently unique physiological and pathophysiological patterning may occur without notice in individuals with diseases of the heart. For an example,the increase in heart rate of a ten year old Chinese during a ten minute rapid results test may therefore not be the same as that of a Nigerian of the same age and gender. For similar reasons, and controlling for confounding factors, the speed and smoothness of recovery of an American male cardiac patient to a 30 minute aerobic exercise will be different compared with a black male South African of the same age . This is because at the level of signal transduction , the two important laws of Laplace and Frank Starling operate differently in blacks compared with whites. For a patient undergoing life long management for hypertension or diabetes mellitus therefore, rushing into any exercise program no matter how mild because your Doctor overseas has told you it is safe is not good enough. Cardiologists and many other categories of Physicians are very much aware of this and hence the goal usually rather than focusing on drug treatment of pathological conditions is to ensure that a patient as a whole gets well , suffering is removed and the quality of life improved. Similarly it is also unwise for a hypertensive patient to go partying all over the place eating huge quantities of food, smoking packets upon packets of cigarettes and drinking large volumes of alcohol , just because someone with a similar problem has been doing the same thing and appears to be healthy .
TO BE CONTINUED NEXTWEEK
