‘Sometimes heart disease may be silent and not diagnosed’

Synopsis: President, Nigerian Cardiac Society, Dr Okechukwu Ogah, in this interview by SADE OGUNTOLA, says all individuals, irrespective of age, stand a risk of having heart disease and explains the way forward in stemming the increasing cases of heart diseases in Nigeria as the country joins other countries to mark the World Heart Day.

What are heart diseases and how common are they?

A: Heart or cardiac diseases, simply put, are diseases that affect the heart. Sometimes, we call them cardiovascular diseases and these are diseases that affect the human heart and the pipes that either take blood away from or back to the heart. Globally, they are the commonest cause of death. Now, more than 500 million people around the world are living with cardiovascular disease, and it contributes to more than 80 million deaths every year. However, its pattern differs from continent to continent and from country to country.

In developed countries, the commonest cardiovascular disease is heart attack. In Africa, hypertension appears to be the commonest cause of heart disease. It is the same in Europe, North America and Asian countries like Japan. However, a heart attack is also becoming a common problem in Africa, followed by diseases of poverty (cardiomyopathy, rheumatic heart disease and pericardial problems) and issues that surround HIV and AIDS.

 

How can HIV and AIDS affect the heart?

The virus can attack the heart to cause heart muscle disease. It can reduce the immune system in people and they become prone to opportunistic infections that also affect the heart, including tuberculosis. Also, some drugs used in treating HIV also alter their metabolic state, thereby increasing the risk of having heart disease.

 

What makes an individual prone to developing heart disease?

There is what we call modifiable and non-modifiable risk factors. Non-modifiable risks are things that you cannot change and these include increasing age, male gender, and family history of cardiovascular disease. But some of the modifiable risk factors include being overweight, smoking, high blood pressure, diabetes mellitus, sedentary lifestyle and excessive alcohol consumption. Also, high cholesterol diet and high cholesterol in the blood itself are common risk factors for cardiovascular disease in Nigeria.

 

What are the things people with heart problems experience?

Sometimes heart disease may be ‘silent’ and not diagnosed until a person experiences signs or symptoms of a heart attack, heart failure, or arrhythmia. When these events happen, symptoms may include chest pain or discomfort, indigestion, cough at night, heartburn, extreme fatigue, upper body discomfort, dizziness, breathlessness, heart palpitations and leg swelling. Of course, they get fatigued over doing minor work that they usually do easily without any effort before then. Chest pain can also occur because of other things, but this is worsened by activity and reduced when resting. The dizziness occurs when the heart is not pumping enough blood to the brain, especially when the heart is beating irregularly or there is an obstruction to the flow of blood to the brain.

 

Is chest pain in a healthy middle-aged individual something to be concerned about?

We are not supposed to have symptoms. So, a symptom that is disturbing is not something that should be overlooked. It needs the doctor for proper evaluation to know the cause of the chest pain. Chest pain is common usually in middle-aged and elderly people due to heart attack. So, an individuals with persistent chest pain that is gripping in nature and gets worse during activity needs to see a doctor. Of course, chest pain can also mimic other problems. People with stomach ulcers also have chest pain. It is not all chest pain that is from the heart

 

Oftentimes, people overlook heartburn. When does it become a red flag for heart problems?

When we say heartburn, it is usually due to excessive acid in the stomach and it gives a burning sensation in the throat. However, in certain cases, it may mimic or may be a symptom of a heart problem, especially if the vessel supplying the lower part of the heart is affected.

 

How can regular heart checkup save one’s life?

Yes, regular heart checkups can save your life, especially after the age of 40 years. You don’t know when those symptoms or those risk factors for heart conditions are developed. Early identification of the risk factors is important to ensure that they can be properly treated and addressed in order to prolong life. For a heart checkup, usually, the doctor will take some information from the patient; trying to identify the symptoms or even the risk factors that the individual has, including probing the family history. Tests such as blood pressure, blood sugar and cholesterol levels are done as well as a routine 12-lead ECG test.

 

Many young people have the impression that only old people can have heart conditions. Is this true?

Well, it is not true. People can have heart disease from age zero when they enter the world. Some children are born with congenital heart problems because there was a malformation of the heart during conception. So, it is wrong to say that heart disease does not occur in young people. However, apart from congenital heart diseases, heart disease is generally higher in elderly people than in young people. Nonetheless, if a young person has symptoms attributable to the heart, it needs to be properly evaluated. A lot of young people slumped on the field of play because they had heart disease before it was detected. But individuals with heart conditions need to be properly evaluated and treated.

 

Oftentimes, people have the impression that since their blood sugar and blood pressure levels are controlled, they cannot have heart problems. Is this true?

It depends on when the blood pressure or the blood sugar was taken. Some of these things would have started years back and had already caused damage to their heart. Yes, if the blood pressure or blood sugar is well controlled, then the likelihood of developing complications as a result is less when compared to when the blood sugar or pressure level is not well controlled. It is not absolute because some of the damages may have actually started before hypertension and/or diabetes is detected. And drugs may not totally reverse some of the changes that have been caused by diabetes or hypertension. Yes, there is still a small risk. With well-controlled blood sugar or blood pressure, the likelihood of developing complications is reduced.

 

Can individuals that have heart problems, including hypertension running in their families end up with heart disease?

Well, it is not absolute but it is more likely than for those without a family history. A family history of a heart problem, including hypertension, is not a modifiable risk factor. The only way to prevent it is early detection of these conditions and then complying with the instructions to reduce the risk. For instance, hypertension starts at an earlier age in subsequent generations than in their parents.

Howbeit, even if it runs in their family, modifiable risk factors like hypertension, diabetes, high cholesterol and cigarette smoking are the things that one needs to change in order to modify a tendency of developing that heart disease.

 

How important is emotional health in managing heart disease?

Emotional health is part of well-being. It is not only physical illness that confers that somebody is ill. If somebody has a physical illness and is also depressed, the outcome is usually worse than somebody who is not depressed. Yes, psychological illness and problems have an impact on the outcome of physical illness, especially heart problems or any other problem. Once a psychological problem sets in, it can affect the way a person copes, the way the person tends to use the medications and so on. This will eventually affect the outcome of that condition in the individual.

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