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Job Osazuwa
In April, a man in his early 50s who lived in Ketu area of Lagos collapsed at a bus stop on his way to his workplace in Victoria Island.
Passersby on this fateful morning were thrown into confusion. They apparently couldn’t fathom what was amiss.
About thirty minutes later, he gave up the ghost even before he was rushed to the hospital by Good Samaritans. Many people that heard of his death, especially his family members and close associates, described what struck the man as nothing but a mystery. Some of them attributed man’s demise to some spiritual forces at play.
It is often heard that someone who just fell dead was seen days or hours ago going about his or her normal business with no trace of ill health. Oftentimes, efforts by doctors to explain from medical perspectives that death could occur without signs of ailment, are always rebuffed by the bereaved.
Cardiologists have said that many factors that lead to cardiac arrest, including heart disease, could be prevented or treated with healthy lifestyle choices that individuals make. They alerted that in over half of the cases, sudden cardiac arrest occurs without prior symptoms. The patient collapses without warning; the heart stops beating, and blood stops flowing to the brain and other organs.
A Lagos-based cardiologist, Abdulateef Oyewole defined sudden cardiac death (SCD) as a sudden, unexpected death caused by a change in heart rhythm known as cardiac arrest. He revealed that SCD was responsible for half of all deaths caused by heart disease.
He said that in the first few minutes of cardiac arrest, the greatest concern is that blood flow to the brain will be reduced so drastically that a person will lose consciousness. He warned that death follows except there is a quick emergency treatment.
But he explained that sudden cardiac arrest is not a heart attack (myocardial infarction) but the former can occur during a heart attack.
“Heart attacks occur when there is a blockage in one or more of the arteries to the heart, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged. In contrast, sudden cardiac arrest occurs when the electrical system to the heart malfunctions and suddenly becomes very irregular. The speed at which the heart beats, one could sense that there is danger. The ventricles may flutter or quiver (ventricular fibrillation), and blood is not delivered to the body,” he explained.
He said that some people might experience symptoms of cardiac arrest, such as a racing heartbeat or feeling dizzy, alerting the victim that a potentially dangerous heart rhythm problem has started.
He said that though most sudden cardiac deaths were caused by abnormal heart rhythms called arrhythmias, the most common life-threatening arrhythmia is ventricular fibrillation. He enlightened that ventricular fibrillation is an erratic, disorganised firing of impulses from the heart’s lower chambers. He said that when this occurs, the heart is unable to pump blood and death will occur within minutes of inaction.
Said he: “There are certain identified risk factors leading to sudden cardiac arrest and sudden cardiac death. One of them is previous heart attack or attacks with a large area of the heart damaged. A person’s risk of SCD is higher during the first six months after a heart attack.
“Also, 80 per cent of cardiac deaths are linked to coronary artery disease. Risk factors for coronary artery disease include smoking, hypertension, family history of heart disease, and high cholesterol. Other risk factors are ejection fraction, which is a measure of how much blood the left ventricle pumps out with each contraction, and family history of sudden cardiac arrest or SCD, as well as history of congenital heart defects or blood vessel abnormalities.
“We must not forget heart failure: a condition in which the heart’s pumping power is weaker than normal. Patients with heart failure are six or nine times more likely than the general population to experience ventricular arrhythmias that can lead to sudden death. Obesity, diabetes, and recreational drug abuse are strong factors too.”
On how cardiac death could be prevented, Oyewole advised anyone with any of the risk factors to seek medical intervention from an expert. He said that taking steps to reduce one’s risk was the most effective ways to overcoming cardiac arrest.
“But Nigerians hardly go for medical checks except they are completely down. Whether you have coronary artery disease or not, there are certain lifestyle changes you can choose in order to reduce your risk of sudden cardiac arrest. One should quit smoking, lose weight, exercise regularly, follow a heart-healthy diet, and manage one’s diabetes and cholesterol.
“Patients and families should know the signs and symptoms of coronary artery disease and the steps to take if symptoms occur. If you are at risk of SCD, talk to your family members so that they can understand your condition and the importance of seeking immediate care in the event of an emergency. Make the doctor or a pharmacist your friend so that you could ask any question pertaining to your health. It is only through experts a patient can get the best treatment or management options,” he said.
In her contribution, a general practitioner, Elizabeth Fapohunda said sudden cardiac arrest could be treated and reversed through emergency response. She added that survival could be as high as 90 per cent, but that could be possible only if treatment is initiated within the first minutes after cardiac arrest.
She warned: “The rate decreases by about ten per cent each minute it takes to initiate therapy. Those who survive have a better long-term outlook.”
In her words, if one witnesses someone experiencing sudden cardiac arrest, any medical emergency personnel should be activated immediately. She also recommended defibrillation, which would be followed by a proper treatment in order to prevent future cardiac problems.
She said: “Many cases of SCD are related to undetected heart diseases. In the younger population, SCD is often caused by congenital heart defects, while in older athletes between the ages of 35 and older, the cause is more often related to coronary artery disease. In the younger population, most SCD occurs while playing team sports. It occurs in about one in 50, 000 athletes, and more often in males. In older athletes (ages 35 and older), SCD occurs more often while running or jogging.
“The immediate cause of most sudden cardiac arrests is an abnormal heart rhythm. The heart’s electrical activity becomes chaotic, and it can’t pump blood to the rest of the body. Other things that can raise your chance include: being a male. The risk is higher for men after age 45 and for women after age 55
“It should be noted that sudden cardiac arrest sometimes happens in people who have no known heart condition or any previous symptoms. But studies have showed that people who survive cardiac arrest often realize later that they had symptoms they were ignoring. It means that if they had sought treatment, they might have been able to prevent the sudden cardiac arrest.
“Men are generally at greater risk of heart disease. However, women’s risk increases after menopause. A diet that’s high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.
“Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood flows. High levels of cholesterol in your blood can increase the risk of formation of plaques and atherosclerosis. Unrelieved stress may damage your arteries and worsen other risk factors for heart disease.
“Let us not ignore regular washing of hands and establishing other habits that can help prevent viral or bacterial infections that can put you at risk of heart infections, especially if you already have an underlying heart condition. Poor dental health also may contribute to heart disease.”
