Broken Heart Syndrome in Nigeria, a cause for concern?

The current economic situation in Nigeria, a self-acclaimed giant of Africa and an economic powerhouse, undeniably places tremendous stress and Nigerians in the same basket, making them involuntarily cohabit. The problem in Nigeria seems endless, encompassing inadequate healthcare, poor road infrastructure, inadequate power supply, currency depreciation and devaluation, corruption, high cost of transportation, high cost of food, lack of basic amenities, unemployment, low wage, banditry, kidnappings, insecurity, etc., and yet there appears to be no end in sight to these multifaceted challenges. 

According to the World Health Organization (W.H.O.), stress is a state of worry and a natural human response to challenging situations. Although stress can be positive when it keeps you alert and away from danger. For instance, the natural human body’s response to fright. 

However, it is primarily negative, especially when the stressors continue unabated, like the Nigerian economic climate. While Hypertension and Depression are common and well-known consequences of stress, broken heart syndrome is poorly acknowledged as a result of stress in our environment. Broken Heart Syndrome is otherwise known as Takotsubo Cardiomyopathy. It can occur when affected persons experience severe physical, emotional, or mental stress, resulting in sudden and transient weakening of the left heart, giving rise to symptoms that mimic a heart attack. Persons may present with chest pain, difficulty breathing, and even loss of consciousness. It was first identified by medical experts in Japan in 1990. Ever since, it’s been well-documented to occur all over the world.

While so many other disease conditions like myocardial infarction (heart attack), pulmonary embolism, and gastroesophageal reflux disease may have similar presentations, it is essential to consider broken heart syndrome as a differential, particularly in light of the difficulties Nigerians face daily. Several diagnostic tests are needed to establish a diagnosis, although a high index of suspicion is important, mainly when a stressor is present, and the person is an elderly female.

Again, females bear the brunt in society because they both carry out the social roles expected of them and, in addition, provide for the family. The abrupt onset of chest pain is perhaps the most common symptom of broken heart syndrome. Patients often describe chest pain as crushing, pressure-like, or squeezing in nature, and it is usually associated with spread to the shoulders, arm, upper belly, and jaw. Other pertinent symptoms are light-headedness, dizziness, nausea, sweating, or heartburn. In addition, there is often but not always an identified stressor. Sometimes, the triggers of broken heart syndrome are usually acute, emotional, or physical stressors. For example, arguments, public speaking anxiety, financial losses, death of a loved one, pain, or recently diagnosed infection or disease. It looks like a typical case of a heart attack. However, Nigerians’ awareness of cardiovascular symptoms and diseases is relatively low, so using this opportunity to explain the symptoms is necessary. For example, a research study by Okechukwu Samuel Ogah et al. reported that although the prevalence of hypertension in Nigeria is high at 30.6%, only 29% of Nigerians are aware of their hypertension, and a paltry 2.8% were at goal blood pressure control in 2020. Investigations to nail the diagnosis of broken heart syndrome include electrocardiography(EKG)- a test to record the electric signals of the heart; cardiac biomarkers- substances that are released into the blood when the heart is stressed or damaged; echocardiography- ultrasound of the heart; and coronary angiography- a procedure that uses X-rays to look at your heart’s blood vessels. A crucial distinguishing factor in coronary angiography is that usually, there is no obstruction of the coronary vessels, unlike the typical heart attack.

Raja Zaghlol et al. in 2020, using the N.I.S. database, performed the first sizeable US-wide analysis studying racial variations in broken heart syndromes outcomes, were able to show that African Americans had more in-hospital complications and that racial differences certainly affected the outcomes of Takotsubo myopathy. In a recent interview, Dr. Charles Poluyi (M.D., M.P.H.), who spoke about his current research paper on racial and ethnic disparity among patients diagnosed with Takotsubo Cardiomyopathy, similarly established that there were significant racial and ethnic disparities in broken heart syndrome hospitalizations and minority groups had more adverse outcomes and incurred higher healthcare costs. Although there are no recent research studies on broken heart syndrome hospitalizations and mortality in Nigeria, both medical personnel and Nigerians must be aware of the link between stress and cardiovascular symptoms of broken heart syndrome and take steps to eliminate the risk factors, make accurate diagnoses and treat accordingly.

Despite the many challenges facing Nigerians, it is pertinent that stress management be adopted as a significant step towards reducing physical and emotional stress, which can go a long way in reducing the incidence of broken heart syndrome. Relaxation techniques, including massage, music and art therapy, warm baths, and deep breathing exercises, are some stress-reducing strategies. Furthermore, healthy habits such as engaging in regular exercises, getting at least 7 hours of sleep each night, spending quality time with others, and avoiding tobacco products and illicit drugs like marijuana and cocaine are equally strategies to reduce stress. In addition, limiting alcohol intake to 2 drinks or less daily for men and 1 drink or less daily for women and eating diets such as Mediterranean, which consist of healthy fats and plant-based foods, are healthier lifestyles worth adopting. Perhaps avoiding negative news on various media sources, particularly given the current economic situation, is a significant step in stress management. Some of the medications used include the use of Aspirin, antihypertensives like Beta Blockers, Angiotensin Converting enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs), Diuretics, and lipid-lowering medications. Nonetheless, there is no unique medical treatment for broken heart syndrome.

It is treated similarly to a heart attack. Usually, people get better within a short time, but unfortunately, it can re-occur in the same individuals.

Given Nigeria’s economic situation, medical centers should be particularly vigilant for cases of Takotsubo Cardiomyopathy. Reducing the stress that may have triggered this disorder is also essential. As the adage goes, “prevention is better than cure,” so proactive measures to mitigate stress and promote heart health are crucial.

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Oluwakemi Akinyode (BPharm, RPh) is a highly qualified clinical pharmacist licensed in 3 countries- in New York, the United States; Ontario, Canada; and Nigeria. Currently, she is a clinical pharmacist in Canada and serves as a clinical educator. One of her unwavering goals is to elevate the standard of clinical pharmacy in Nigeria to meet first-world standards.

Adedunni Oyekanmi (BPharm, M.P.H., MPharm) is a pharmacist, public health practitioner, and transition and clinical officer in Australia. She is dedicated to bridging healthcare inequality gaps in low-resource communities through primary health promotion and disease prevention.