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Sudden deaths! These early signs will save lives 

By Franka Osakwe and Paul Adunwoke
26 January 2020   |   2:42 am
A renowned cardiologist and the previous Chief Medical Director, Lagos State University Teaching Hospital (LASUTH), Prof. Wale Oke, said victims of cardiac arrest are likely to experience some symptoms, such as chest pain or angina days or hours before it strikes.

With more Nigerians slumping and dying, medical experts have again reiterated the need for adults to go for regular medical checks, at least once a year.
According to the doctors, warning signs such as shortness of breath and chest pain usually occur one month or 24 hours before the heart stops beating. 

A renowned cardiologist and the previous Chief Medical Director, Lagos State University Teaching Hospital (LASUTH), Prof. Wale Oke, said victims of cardiac arrest are likely to experience some symptoms, such as chest pain or angina days or hours before it strikes. “The individual may feel a crushing chest pain on exertion, which may spread to the arm or jaw and he may sometimes feel dizzy or faint. The chances of an attack increase, as the pain gets worse. Some patients may experience these signs two days before an attack,” he said.Oke said cardiac arrest could be both reversible and irreversible. “This will depend on who is there to help.”

According to him, anyone experiencing a cardiac arrest requires Cardiopulmonary Resuscitation (CPR) immediately to prevent an imminent damage to the heart, lung, kidney and brain. CPR is a basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac massage, although it is necessary in cases of cardiac arrest to establish effective circulation and ventilation to prevent irreversible cerebral damage.

Like most killer diseases, cardiac arrest can also be prevented. All it takes, according to the cardiologist, is a conscious effort to always keep the heart in good condition.
Indeed, Oke said no organ of the body should be neglected, especially the heart. Thus, to keep the heart trouble-free, it is recommended that individuals maintain a healthy routine.On his part, Consultant Family physician, Dr. Chukuma Ogunbor, explained that there are two major causes of sudden death, which may be traumatic or non-traumatic.

“The traumatic types may be from accidents, such as motor vehicle crash, drowning and homicide, among others. The major causes of non-traumatic sudden death are of cardiovascular origin. Sudden death, due to cardiovascular diseases (CVD) is one of the leading causes of death in the world. It is on the increase in Africa, as the incidence of cardiovascular diseases has also been found to be on the increase. It has equally 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 symptom onset.

“It is usually not curable, but can be managed, if the patient presents early at the hospital and urgent quality care is instituted. The common causes of sudden cardiac death can be classified by but not strictly by age. In patients over 35 years, the commonest causes are coronary heart disease, hardening of the heart arteries, while the commonest causes for those under 35 years are cardiomyopathies, heart muscle disorder, congenital heart disease, hole in heart and unexplained cardiac death in a structurally normal heart.

“This has been attributed to sudden arrhythmic disease syndrome (SADS), anomalies in the heart, such abnormal anatomical position of coronary blood vessels and myocarditis and infection or inflammation of heart muscle.”He listed the symptoms to include shortness of breath during exercise and chest pain with exercise.

“Others include dizziness at rest or with exercise, blackouts and palpitations. In many cases, however, there are no symptoms,” he explained. “If a patient has any of these symptoms, they are advised to see their doctor urgently. History and physical examination will be conducted. The doctor may also carry out echocardiogram (ECG), as the need may arise.

“In patients at risk of sudden cardiac death, the risk increases with increased activity, such as intense sports and exercise. In younger people over all, sporting activity increases risk by 2.5. Older adults who exercise frequently have five times increased risk of sudden cardiac arrest during vigorous activity, as well as coronary disease.

“Older adults who do not exercise frequently have 56 times risk of sudden cardiac death during vigorous activity. If you have one of these cardiac conditions, intense sporting activity will double risk of dying suddenly. An individual does not have to be an athlete to die from sudden cardiac arrest. You can die from sudden cardiac death at rest or during sleep.”He noted that it is imperative people have their blood pressure checked at every given opportunity.

“Things have been made so easy, as people can now purchase the electronic blood monitor machine and check their blood pressure regularly themselves. People should try and reduce stressful activities and adopt a moderate lifestyle. There is need to stop smoking, cut down on alcohol intake, engage in aerobic exercises, drink plenty of water and avoid some of these sodas. It is also important to cut down on fried foods,” he said.

A Cardiologist at Lagos University Teaching Hospital, Dr. Akinsanya Olusegun Joseph, said prevention of CVD ideally starts during pregnancy and lasts until the end of life. He said: “The reason for this is because certain conditions or situation during pregnancy can predispose the unborn child to cardiovascular diseases. For instance, a woman who smokes and/or takes alcohol, especially during pregnancy, can put the unborn child at risk of developing congenital heart disease or hole in the heart.

“Also, a baby with intrauterine growth retardation (poor growth while in the womb), with resultant low birth weight is at risk of developing CVD later in adult life, when compared with babies born with normal weight. On the other hand, very big babies at birth, usually of diabetic mothers, have an increased risk of developing diabetes and CVD later in life, as well.”He explained that prevention is divided into primary and secondary.

“Primary prevention is targeted at those at high risk of developing a first cardiovascular event,” he said. “These include for instance, men and women with combination of smoking, elevated blood pressure (BP), diabetes or dyslipidemia. This basically involves lifestyle modification and treatment of the risk factors identified in such high-risk patients.

“Secondary prevention targets those with established CVD, post stroke and post myocardial infarction. These are strategies aimed at preventing recurrence of the CVD they had encountered. This also involves lifestyle modification, treatment of the risk factors, the CVD and co-morbidities. Primordial prevention measures are targeted at preventing the expression or appearance of risk factors.

“It is necessary that preventive measures be put in place, even before birth. These include good antenatal care, avoiding risk factors that can predispose the unborn child to cardiac diseases, such as congenital heart disease, for example smoking as highlighted earlier and irradiation during pregnancy.

“It is equally important that pregnant women avoid infections, especially torches complex toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and syphilis. Furthermore, as much as possible, every form of nutritional deficiencies should have been corrected before pregnancy to eliminate the deleterious effects, which can include congenital heart disease on the unborn child.”He noted that educating the populace, especially women, is key in this regard. He said factors that can prevent the possibility of developing hypertension, diabetes mellitus, obesity and high cholesterol levels are also important in primordial prevention.

“The prevention strategies can be personal individualised or population institutionalised based approaches. Individualised approach entails education, counselling 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 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. Tobacco and erring companies can be heavily tasked. Furthermore, we can have national days that will promote health, for instance, 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 institutionalised approach. All this will help in having a health conscious, and healthy society.”

Olusegun said food is very important in the prevention of CVD, just as it can predispose to increased risk. So, for a heart healthy eating, it is crucial to reduce salt intake. “Increased salt has been implicated as a risk factor for hypertension, heart failure and heart attack,” he explained. “Reduction of salt intake is not limited to table salt, however, as it includes salty condiments. People should increase their intake of fish, especially those rich in omega three fatty acid like salmon. They reduce the risk of atherosclerosis.

“It is also important to increase intake of nuts like ground nuts, cashew nuts, and walnuts. Cereals and whole grains like oatmeal are also heart healthy. There is need to reduce cholesterol and fatty meals, which helps to reduce the risk of accumulation of cholesterol in the blood vessels with resultant reduction of atherosclerosis.

“So also, people should reduce intake of sugary foods and drinks, red meat and processed meal. They should rather increase intake of fruits and vegetables, which have lots of anti-oxidants, which are beneficial to the heart, reduces the risk of atherosclerosis, heart attack, as well as cancers. They also reduce ageing process, and improve the health of other organs like the brain and the kidneys.

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