Date: 2017-08-20

An Associate Professor of Medicine and Cardiology, Department of Medicine, University of Ilorin, Kwara State, Dr. Philip Kolo, tells ARUKAINO UMUKORO about heart attack and how to prevent it

How would you define heart attack and how vulnerable are Nigerians to it?

Heart attack is a serious medical emergency in which the blood supply to the heart is suddenly blocked usually by blood clot, leading to serious damage to the heart muscle. In medical parlance, heart attack is called acute myocardial infarction, and it is a common cause of sudden and unexpected death in affected persons.

In terms of epidemiology, previously, heart attacks were very rare among Africans, especially those residing in Africa. But there has been a gradual increase in the incidence of heart attacks among Nigerians. This is believed to be due to the sophistication and improvement in nutrition, unhealthy diet and reduction of physical activities.

What age group and gender are prone to heart attacks?

The age group most affected is usually the middle- age and elderly population. It is more common among Caucasians than blacks or Africans. Also, men seem to be more affected than women, although one must plead caution here, because the presentation in women may not look typical as it occurs in men. So, it is possible that many of the cases are meek in women. But generally, the disease tends to affect men more than women. Other groups most affected include individuals that have hypertension, diabetes; those who live a sedentary lifestyle or don't do a lot of physical activities and obese people. Cigarette smoking, like I mentioned earlier, is also a risk factor.

What kind of food rich in cholesterol should people not take too much?

One should start early to begin to watch one's consumption of food rich in cholesterol, especially when one reaches the age of 30-35 going on 40, as some of the ability to metabolise these cholesterol may not be as effective as they were when one was younger. The conditions of many of the cardiovascular diseases that we see in adults usually start at a younger age. We should start watching our diet early.

Generally, red meat – beef, goat meat, and some bush meat - has a lot of cholesterol. White meat (fiber) like meats from chicken and birds contain less cholesterol compared with red meat. Fish oil contains omega-3-fatty acids which is cardio-protective. Some also say that in place of red meat, they take intestines from cows (shaki), but these also have a lot of cholesterol, so they should be avoided altogether. If one looks at meat from animal organs, including liver, as long as they are from cows, they have a lot of cholesterol. So, we usually advise people to avoid eating too much of cow meat.

Also, one fries food substances to make them more appealing, but the danger of frying is that fried meat, eggs and related products tend to convert the cholesterol to more harmful fatty acids or trans fat (trans fatty acids). It is better we boil our food instead and eat them.

What are some of the symptoms of coronary artery disease?

The spectrum of manifestation is many. Those who have these narrow arteries usually have predictable chest pains. For example, if they walk like two or three poles, the chest pain begins, it subsides when they rest. This is called stable Angina Pectoris, a chest pain that one can predict. Some would describe the pain as a feeling of heaviness or constriction on the chest. Such pain may spread to the arms, the neck or part of the abdomen above the umbilicus. The second mode of manifestation is unstable angina, that is, chest pain one cannot predict or does not get better. Unlike stable angina, which gets better with rest or drugs, unstable angina does not usually get better with rest or drugs. But these are different from acute myocardial infarction – heart attack. There are special tests that can be done in the hospital to differentiate unstable angina from the two types of acute myocardial infarction, these are ECG (Electrocardiogram) and cardiac biomarker (troponin). The ECG would determine the kind of treatment the individual would be given.

However, a good number of chest pains may not be related to the heart. But when you look at the signs, one would be able to differentiate it. Usually, the pain from the heart is specific, and the individual tend to hold the left side of the chest in such situation. This kind of pain is usually brought on by physical exertion.

What should be done immediately when one notices someone having a heart attack?

One of the major problems that we have with patients with heart attack is late presentation to the hospital. In Nigeria, because most people are not aware about heart attack, when they experience the symptom, they tend to seek for treatment at nearby chemists or health workers living around them. In developed countries, there are specific code numbers one can call on during an emergency such as 911 0r 999.

The first thing to do is to take that person experiencing chest pain to the hospital immediately where help can be given. A tablet of aspirin can be given immediately because that can help in improving the disease condition. In some patient, once they experience such, they have a cardiac arrest instantly. In some public places, even in Nigeria, there are machines called defibrillator, which can restart the heart immediately. If this machine is not available, chest compression needs to be done on the person so that the heart can restart while they are on their way to the hospital. Once they get to the hospital, the doctors know how to manage the condition. First they would do the resuscitation of the patient by ensuring that the airways are clear and the circulation is okay. Also the ECG needs to be done urgently to know if it was a heart attack or not. Another test called cardiac enzymes is done. Oxygen is then given to the person, as well as drugs to relieve the pain. If available, Percutaneous Coronary Intervention is also another procedure done too to remove clot from the arteries. If not available, medications called clot buster drugs are administered in the hospital through an IV to break up blood clots.

What are the risk factors of heart attack and how can they be prevented?

Diet and low levels physical activities are major risk factors. When individuals consume diets that are very rich in saturated fatty acids, especially animal fat, which is very common in our environment, increases their risks. Cigarette smoking, systemic hypertension and excessive alcohol consumption also increase the risk of a heart attack. Heart attack is also one of the manifestations of coronary artery disease. Coronary arteries supply blood to the heart, a muscular organ, which pumps blood to all parts of the body. In individuals who are not careful about their diet, especially diets that are rich in cholesterol, what usually happen is that there is a deposition of fat on the walls of the arteries that supply blood to the heart. These deposited fats may eventually cause a narrowing of the arteries. So, during strenuous activity, the arteries in this individual cannot dilate so that more blood can get to the heart, and the person may experience pain.

Also, occasionally, the surface of the deposited fats can get injured and the collagens are exposed, leading to the formation of clots inside the coronary arteries. If this happens, the area that is supplied by those arteries would experience severe blood shortage, and it may lead to death. So the person may experience the sudden onset of pain as a result of sudden obstruction to blood supply to that part of the heart, which cause severe oxygen lack. That is what then cause heart attack.

To prevent heart attacks, one needs to watch one's weight and diet early in life. Try to prevent having excessive weight gain from eating too much food with a lot of cholesterol and not partaking in exercises or outdoor activities. A 30-minute of regular exercise on three non-consecutive days per week would help a lot in this regard. People should also stop smoking cigarettes and avoid excessive intake of alcohol.

Are there enough specialists in hospitals in Nigeria to handle cases of heart attack?

More importantly is the issue of awareness. Many Nigerians are not so aware of this condition, so they don't come to the hospital on time. Treatment is best given within the first two hours of a heart attack to prevent death. We need to create awareness among the population on heart attack. We have lots of facilities to manage heart attacks and improve on them. For example, very few medical centres have access to the percutaneous coronary intervention facility. In developed countries, that is the gold standard for treating patients with heart attack. There are trained personnel but without the PCI, they cannot treat patients with heart attacks when they come to the hospitals. I believe government needs to equip our hospitals, especially with what I would call cardiac catheterisation laboratories so that these coronary interventions can be done as we are seeing more of such cases in Nigeria.