Sudden death: How to manage hypertension, cardiac failure and others
Lately, there has been an increase in cases of people slumping and dying. This trend is particularly worrisome because young people are now being affected, unlike before, when it was mainly an old people’s problem. According to professionals, the medical conditions that usually lead to sudden deaths include, diabetes mellitus, hyperlipidemia, heart attack, hypertension and cardiovascular diseases, among others. However, if detected early, these health conditions are treatable and manageable.
The economic situation in the country, which is causing a lot of stress and depression, leading to damage in body system, dictates that Nigerians go for regular medical check ups to help detect the problem in time.
Dr. Akinsanya Olusegun Joseph, Consultant Cardiologist, with the College of Medicine University of Lagos, Idi-Araba, Lagos, said one of the major causes of slumping and dying is heart attack, which happens when there is blockage in the heart. If the affected area is much, it can lead to slumping and dying. He explained that another cause of this problem is heart muscle diseases, whereby the heart muscles sometimes become extremely large, which consequently obstruct free flow of blood. This leads to shortage of blood in the body system, including the brain and other parts.
He said: “Stress could cause abnormal heartbeat that can actually damage the heart, causing the patient to slump and die. Other diseases include, uncontrolled diabetes, hypertension, HIV/AIDS and stroke.
“The release of stress hormone is not friendly to the heart, as it can cause abnormal heartbeat that might lead to heart diseases, causing the patient to slump and die. People that are hypertensive would have uncontrolled blood pressure with the possibility of sudden death.
“Primary prevention targeted at those at high risk of developing a first cardiovascular event, for instance, men and women with combinations of smoking, elevated blood pressure (BP), diabetes or dyslipidemia, basically involves lifestyle modification and treatment of the identified risk factors.
“Secondary prevention targeted towards those with established CVD, post stroke and post myocardial infraction is aimed at preventing a recurrence of the CVD they had previously encountered. This also involves lifestyle modification, treatment of the risk factors, the CVD, and co-morbidities. Primordial prevention- measures targeted towards preventing the expression or appearance of risk factors.
“The prevention strategies can be individualised or institutionalised. Individualised approach entails education, counseling on lifestyle modification, and treatment of risk factors. Institutionalised approach has to do with educating and increasing awareness of risk factors for CVD, and how healthy lifestyles prevent CVD events.
“It also involves making policies targeted at reducing the risk factors in the larger society. For instance, policies aimed at reducing salt and saturated fat content of foods, as well as smoking habits and tendencies. In such a case, tobacco and erring companies can be heavily tasked.
“At the national level, we can have days that will promote health. For example, National Walk for life day, national exercise day and national cycling day, among others. Companies, organisations, schools and local government areas can also imbibe the above-institutionalised approaches. All these would help in having a health conscious, and healthy society.”
Dr. Ademola Olumide Orolu, a Consultant Family physician said using demographic risk classification, sudden slump, which may be complicated by death, is usually commoner among the elderly. This is because with ageing, homeostasis— the stable equilibrium in the body— gets progressively impaired. Hence, medical conditions, which would not have disturbed a younger individual, may have devastating effect among the elderly with possible slumping and dying.
He said: “With ageing also comes impaired blood circulation to the heart and brain, resulting from narrowing of arterial blood vessels, deposition of fat in the walls of blood vessels, blood clots and rupture of fragile vessels. These are some of the reasons an ageing individual may collapse and die. Chronic medical conditions, which can affect free circulation of blood, include heart diseases, poorly controlled hypertension, diabetes mellitus and hyperlipidemia, among others. Loss of balance can cause falls and attendant head injuries with possible collapse. These conditions are usually associated with increasing age.
“However, when a young individual slumps, a myriad of possibilities are sought. Chronic medical conditions, as alluded to above are initially considered. After this, other possibilities, including exhaustion or burn out, since that age group is the most physically and emotionally active, are considered. There is also the situation, whereby blood loss, whether concealed or revealed, may also cause collapse and death if the lost blood is not replaced in time before irreversible multiple organ damage occurs.
“Among women, ruptured ectopic pregnancy, which causes bleeding in the abdomen, and if excessive may cause collapse and death. Conversion disorder, a mental disorder, may manifest as collapse, though not necessarily resulting in death. Drug and alcohol intoxication, deliberate self-harm and suicidal attempts are also probable causes in young individual slumping and dying.”
Orolu stated that upon ruling out organ system causes of slumping, it is very important to evaluate the psychosocial health of the individual. This would entail a careful consideration of the history to identify previous or ongoing stressful events, emotional disturbance, coping methods to stress and other unpleasant events. Family history of psychosocial disturbance is also evaluated. Any positive finding in this search may explain the precipitating event that could lead to slumping. Severe depression, which most times is associated with suicidal ideations, may provoke a young individual to make suicidal attempts with medications, objects, and other harmful measures, which can cause sudden slump or death.
“Blood pressures, when severely high, may cause rupture of fragile vessels in the brain. The pressure of blood on the soft tissues of the brain may compromise the viability of vital centres in the brain that control breathing and heart function. This will cause collapse and possibly death, if the blood is not evacuated through emergency brain surgery. Dissecting aortic aneurysms may, under severely high blood pressures, cause blood to flow in between the walls of the affected areas of the aorta, the big artery, which circulates blood away from the heart to body tissues. Prior to collapse or death, an individual with dissecting aortic aneurysm may complain of sudden onset of severe chest or back pain.
“In cardiogenic shock and heart failure, a state where the heart fails to pump blood adequately to meet the demands of the body and especially the brain, fatigue, dizziness, difficulty with breathing and impaired alertness are antecedent symptoms, which an individual may experience. In cases of advanced heart failure, such individual may collapse.”
It should be noted, however, that heart failure would have given warning signs, which were ignored or poorly managed before an individual collapses or dies. A heart valve replacement or heart transplantation is usually the ultimate treatment, after initial use of medications in very advanced cases of heart failure.”
Orolu urged individuals to be mindful of their health, as prevention is better than cure. They are, therefore, advised to seek medical evaluation when ill. Such visit to a health facility affords the patient the opportunity to identify at an early stage any medical condition that may cause sudden death.
Dr. Chukwuma Ogunbor, also a Consultant Family Physician, explained that there are two major causes of slumping and dying: Traumatic and non-traumatic medical condition. Traumatic types may be from accidents, such as, auto crash, drowning and homicide, among others, while the major cause of non-traumatic sudden death is cardiovascular in origin.
“Sudden death, due to cardiovascular disease (CVD), is one of the leading causes of death in Europe and the United States. It is on the increase in Africa, as the incidence of cardiovascular diseases has also been found to be on the increase,” he said. “It has also been found to be on the increase in young adults. Sudden cardiac death is death from definite or probable cardiac causes within one hour of onset of symptom. It is usually not curable, but can be managed if the patient presents early at the hospital and urgent quality care is instituted.
“In patients over 35 years of age, the commonest causes are coronary heart disease and hardening of the heart arteries, while the commonest causes for those under 35 years of age are cardiomyopathies, heart muscle disorder, congenital heart disease (hole in the heart) and an unexplained cardiac death in a structurally normal heart. This has been attributed to sudden arrhythmic disease syndrome (SADS), anomalies in the heart, such as abnormal anatomical position of coronary blood vessels and myocarditis, infection or inflammation of heart muscle.
“Symptoms may include shortness of breath while exercising, chest pain usually with exercise, dizziness at rest or with exercise, blackouts, palpitations, and in many case there are no symptoms.
“It is advisable to go for regular medical check, at least once or twice a year, as you get older. Individuals should have their blood pressure checked at any opportunity. It is possible to regularly check one’s blood pressure personally by acquiring electronic blood monitor machine. People should try and reduce stressful activities and live a moderate lifestyle.”
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