Why pregnant women must avoid unprescribed medications —Dr Adebiyi

Dr Adewole Adebiyi is a consultant cardiologist with University College Hospital (UCH), Ibadan, Oyo State. In this interview by YINKA AJE, he talks about the causes of heart diseases, why children develop hole in the heart and the need for people to live healthy lifestyles. Excerpts:


WHO is more prone to heart diseases, women, men or children?

Heart disease is common to all age groups. The older you are, the more the risk of the disease but children have their own pattern of heart disease. Congenital heart diseases are seen in young children. The other forms of heart disease caused by hypertension and many other things are found in both sexes. However, before menopause in women, men have more heart diseases.  After menopause in women, the incidence of heart disease in both men and women are about the same. At times even more than in the men too, but largely, heart diseases is common in all age groups.


What are the major causes of heart diseases?

We have talked about the ones that are common in children, the congenital heart disease. In the adolescent period, there is a form of heart problem that accompanies sore throat infection. Young children develop sore throat and when the body attempts to fight the throat infection, the heart becomes affected. This leads to some form of heart diseases in late adolescence and early adulthood.  Hypertension is also a major risk factor for heart diseases all over the world. When we talk about the disease that leads to heart attack, what is called coronary artery disease, hypertension, diabetes, smoking, alcohol, high cholesterol and all that are the risk factors for that form of heart disease. But overall, hypertension contributes significantly to the burden of heart problem in Nigeria. Although there are some other infections that will affect the heart but they are minor compared to the ones that hypertension is the direct cause.


What are the symptoms of heart attack?

Heart attack is at the end of a spectrum of the diseases that affect the blood vessels that supply the heart with blood.  This is called coronary artery disease. In some people, it might be completely silent, that the first symptom they might have is that they might just die suddenly. And in others they may manifest as a very severe chest pain of the typical heart attack. In between, there are others with complaints of chest pain especially in the center of the chest that is brought on when they exert themselves. They have this tightening chest discomfort that they describe many times as a pressure in the chest and are brought on when they exert themselves like when someone has been climbing one or two flight of stairs and feels some tightness in the chest, and can cause them to slow down, to stop and within a few minutes of resting their chest pain and discomfort reduces.


How can one prevent heart attack?

Heart attack is not just an event that happens, it is a process so what you need to do is to prevent, reduce or limit that process and this is something that everyone needs to be aware of and start implementing those preventive measures. One, everybody should check their blood pressure regularly and if they have high blood pressure, they should be treated properly. The tragedy of hypertension is that in this part of the world especially in our country, we don’t take it serious. Many people find that their blood pressure is high, they get to the doctor, the doctor gives them some medications but  they don’t see the need to continue taking the medication. What we should realise is that high blood pressure is not a one off thing. It is a continuous thing. It is important to know that if you have high blood pressure, you must take care of it. know your cholesterol levels, if it is high, you can treat it. The role of diet and cholesterol is still a controversial subject. Before we would hear people say don’t eat eggs, but the effect of dietary cholesterol on blood cholesterol is not as clear cut as that. But the guideline about diet and cardiovascular disease is to avoid saturated fats. So reduce intake of saturated fat and some of these pastries, biscuits and the likes  which are rich in saturated fat. And then what about diabetes, the people should check their blood pressure, blood sugar level and blood cholesterol so as to  know how to take care of them. These are the risk factors that lead to heart attack. Another thing is to maintain  a normal body weight because when you maintain a normal body weight, it helps with the  prevention of hypertension, diabetes and elevated blood cholesterol. People should watch what they eat. One of the problems in our environment is that we tend to eat too much. People eat a lot and when they are getting to their late 30s early 40s and 50s they bloat up. As you over eat, you increase in weight and the risk of hypertension, diabetes, the risk of high cholesterol grows. So watch and limit what you eat, maintain normal body weight. Exercise is extremely important to maintain cardiovascular fitness. Exercise has a way of preventing hypertension and if it is high, it helps you to control it better and has a way of preventing diabetes. It also helps with the increase of good cholesterol that also protects against heart attack. It is said that there is no “cure-all medicine”. But the nearest thing to a “cure-all” is exercise because of the beneficial effect of strengthening your heart, preventing stroke, preventing diabetes, increasing the level of good cholesterol, reducing the level of bad cholesterol, maintaining your bones so that you don’t fall readily and if the person falls, he won’t break his bones. So exercise is beneficial in all ramifications not only for the heart but for everywhere in the body.


What is the cure or treatment for heart attack?

The most important thing is to stop people from getting to the stage of blockage of the coronary arteries. If there is some blockage of the arteries and before the heart attack comes, we need to identify the risk factors and tighten up those risk factors. We call that secondary prevention.  For people who have heart attack, the critical issue is that blood does not flow properly to the portion of the heart. The major concern is to open up the vessel to take care of this blockage. It has to be done almost immediately. So the rule says, within twelve hours of the onset. It is important that people having heart attacks with serious chest pain should get to a hospital immediately. In ideal situation, in other countries, an ambulance comes within the five minutes and transports the person to the hospital, but here, we don’t have ambulance that we can call. So, get the person to the hospital quickly and then we will be able to identify whether the person has heart attack or not and if we think that there might be heart attack by the nature of the chest pain, we do what is called ECG to see the effect of the blockage of the blood vessel on the heart and some other tests. If heart attack is confirmed, then we start treatment immediately. We either use clot busters, a group of drugs administered to the patients and dissolves this clot because it is just forming.   Another form of treatment is to remove the clot but that is done in a Cath lab when you pass a balloon on a stent through the artery and open it up,  thus taking care of that obstruction and allowing blood to flow. That is the immediate treatment for somebody having heart attack. But the key issue is that somebody having heart attack should get to the hospital immediately.


We hear of cases of children with holes in the heart, what is responsible for it?

When we talk about the disease affecting children, they are congenital in the sense that they are developmental abnormalities. The heart is a very complex structure and what happens is that the entire heart develops from a pile and does a lot of enlargement, turning and the rest of that, so it is a very complex developmental process that happens right from the sixth week of conception. So, about six weeks from the time of conception, the heart starts to form and it is a very complex developmental process, molding the heart into the structure that we have. The  process will have hiccups along the line that is  taking drugs in pregnancy and  some infections in pregnancy at that early stage of development affects the heart.  Some, because of inherited disorders, have problems with development of the heart. So, those are the things that lead to congenital heart problem. The hole in the heart in children is therefore as a result of defects in development that can happen either spontaneously or probably some agents associated. There is a failure in one part of development of the heart. There are many forms of heart disorders; some are so bad that the child does not even live  but dies in infancy or dies very early in life. Some are not even compatible with life that the child might even become stillborn so the milder ones that happen when a child comes and where there should be a partition, the partition did not close completely so, that leaves like a defect either in the upper chamber, the atrium or in between the lower chambers, the ventricle. It is a defect in the developmental process of the heart that leaves that space and there will be communication where there shouldn’t be communication and that is essentially what hole in the heart is about.


Can it be prevented?

I talked about the issues of development, some either from infections or drugs. That’s why pregnant women or ladies who are likely to get pregnant are warned not to take unprescribed medications so that’s how we can prevent some of them but others, we really can’t, We don’t really know. It just comes like that. There is nothing you can do about that because there are varying factors. What we know is that young women who are likely to get pregnant should not just take drugs indiscriminately.  The main issue is that there are some you cannot prevent; there are some you can prevent like the issue of drugs.


Can one take aspirin to prevent heart diseases?

Now, the role of aspirin and prevention of heart diseases is undergoing a lot of review and the present guidelines about aspirin are that the dangers of aspirin outweigh the benefit in the general population. So the guideline now is aspirin for prevention of cardiovascular diseases is not recommended for the general population. I know a lot of people buy aspirin especially junior aspirin and take, but that is no longer recommended. What is recommended is that if somebody has very high risk factors for heart problem or has suffered a stroke or a heart attack previously or has any of the established cardiovascular risks factors for example, if somebody is hypertensive, diabetic and the risk of heart disease is so high, you use aspirin. Also, for someone that has had a heart attack before who had received stents in the coronary artery must take aspirin. But for everybody, taking aspirin is no longer recommended.

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