Heart failure: Why the condition is on the rise

It is known as death by stealth from pain that comes without warning in many cases leading to sudden death.

It is known as death by stealth from pain that comes without warning in many cases leading to sudden death.

That is death by sudden cardiac arrest or heart attack. As Rwanda joins the rest of the world to mark World Heart Day tomorrow, health experts have warned that the places where we live, work and play have an effect on our cardiovascular health.

Cardiovascular diseases (CVDs) are on the rise and no one is immune.

“Both adults and the young can have heart problems,” says King Faisal Hospital cardiologist, Dr Joseph Mucumbitsi.

Mucumbitsi attributes the rise in CVDs to a set of ‘imported’ lifestyle habits that have now taken root in homes.

“Unlike our parents who used to eat health foods, mainly fruits and vegetables, people find it convenient to pack fast foods filled with fat and excess sugar without any fruits and vegetables. These foods are highly linked to heart problems such as heart failure,” Dr Mucumbitsi says.

An illustration of how a normal heart works. (Net photo)

When heart failure manifests

According to Dr Mucumbitsi, a heart failure will occur if the heart cannot pump enough blood to meet the body’s needs, or when the heart cannot fill with enough blood.

A heart failure may also be due to insufficient pumping force through the coronary arteries linked with the heart.

Because the heart is surrounded by three major coronary arteries to supply it with blood and oxygen, when you eat food laden with cholesterol, the inner lumen of these blood vessels becomes clogged with fat.

To counteract this effect, the heart will increase pressure but not forever. Eventually, a blood clot is formed and blood supply to that area will stop. Concomitantly, the heart muscle will stop, a condition known as heart attack or medically termed as coronary thrombosis or myocardial infarction.

Dr Mucumbitsi further points out that when a heart attack occurs, individuals experience severe chest pains behind the breastbone, often radiating towards the left arm.

“If the blockage is not dissolved quickly with medication or treated with an emergency catheter procedure, the area of heart muscle that is not getting enough oxygen will stop working properly and death follows,” he warns.

Lifestyle and CVDs

It is believed that most lifestyle diseases are linked to heart problems.

Dr Evarist Ntaganda, the head of cardiovascular diseases at Rwanda Biomedical Centre, says CVDS can result from a combination of other diseases.

“Hypertension, diabetes, hyperlipidemia or other infections, if not detected early, may result into cardiovascular diseases,” Dr Ntaganda says.

And not all heart conditions arise from poor lifestyle habits because out of 1,000 heart cases four to eight are acquired from birth (congenital).

According to Dr Ntaganda, congenital and rheumatic heart diseases are among the most pediatric heart cases.

He, however, points out that rheumatic heart diseases arise from infections that have been neglected.

“If streptococcal infections of the throat or other areas are ignored, they may end up causing an inflammation in the heart,” Ntaganda says.

Rheumatic acute or chronic heart disorders are common in five to 15-year-olds and arise from rheumatic fever which eventually causes heart valve damage, according to US Mayo clinic.

Dr Mucumbitsi explains the causes of heart failure. (Solomon Asaba)

Managing heart defects

Getting valve damage is not a problem but the challenge is living on drugs for the rest of your life.

Dr Mucumbitsi says those individuals who have valve replacements besides undergoing expensive operations are encouraged to keep taking certain drugs as anticoagulants.

“In situations of valve damage, mechanical valves can be fitted. From valves to medication in situations of heart failure, all heart operations are expensive” he clarifies.

For example, the cheapest drug called streptokinase that has to be administered before six hours elapse but it is rare on the market. The most effective drug known as TPA is more costly and goes for about Rwf1m.

Heart conditions could be expensive to manage but cheaper options exist.

It is believed that with good exercise and less ergonomic stress, the risks for cardiovascular problems would be minimised.

Dr Damascene Gasherebuka, the president of Rwanda physiotherapist association advises that individuals should spend more time exercising through small walks.

“Do not neglect exercise; if you want to remain health engage in walking every day and always ensure to do the right exercises,” Dr Gasherebuka says.

He also advises on good feeding habits among other things.

“To remain healthy, ensure that you eat plenty of fruits, vegetables and consume only safe oils,” he advises.

Audrey Mutabazi, a food consultant at Gasp Foods, also warns about consumption of fatty foods and red meat products.

“If individuals want to use fats, they should look out for vegetable fats such as olive oil that are free from cholesterol. Concerning meat, white meat should be encouraged since it contains less cholesterol compared to red meats,” Mutabazi says.

Severity of cardiovascular diseases

Although coronary heart diseases claim a lot of lives, other cardiovascular problems exist.

Globally, heart disease and stroke claim more lives than any other disease and it is estimated that 17.5 million people died of heart-related cases in 2012.

These deaths represent 31 per cent of all global death burden, according to World Health Organisation (WHO).

From this figure, 7.4 million died from coronary heart disease, whereas 6.7 million died because of stroke.

Pain in the left part of the chest is a sign of a sick heart. (Net photo)

But out of the 16 million deaths under the age of 70 due to non-communicable diseases, 82 per cent live in low and middle income countries and 37 per cent of these are caused by CVDs.

Currently, statistics about CVDs are not available in Rwanda, many patients receive heart surgery each year at King Faisal Hospital.

Experts, however, say since heart attacks usually kill in a short time, most individuals could be dying before being referred to the hospital.

“The figures we have are for those who are referred to the hospital but remember there are those who may die before receiving any kind of medical treatment,” Mucumbitsi adds.



Common heart conditions

Aneurysm: An aneurysm is a bulge or weakness in the wall of a blood vessel. Aneurysms can enlarge over time and may be life threatening if they rupture. They can occur because of high blood pressure or a weak spot in a blood vessel wall. Aneurysms can occur in arteries in any location in your body. The most common sites include the abdominal aorta and the arteries at the base of the brain.

Atherosclerosis: In atherosclerosis the walls of your arteries become thick and stiff because of the build up fatty deposits. The fatty deposits are called plaques. When this happens, the flow of blood is restricted.

Atherosclerosis can happen throughout the body. In the arteries of the heart it is known as coronary artery disease, in the legs, peripheral arterial disease. Atherosclerosis happens over a period of time and its consequences can be grave and include heart attack and stroke.

Peripheral arterial disease: Peripheral arterial disease (PAD) is caused by atherosclerosis, which is the narrowing and / or blockage of the blood vessels in the legs. PAD manifests as pain in the legs when walking, which is relieved by rest. If you have PAD you are at greater risk of developing gangrene in your legs.

Angina: Angina manifests as pain in the chest that results from reduced blood supply to the heart (ischemia).

Blood carries oxygen around your body and depriving the heart of oxygen has serious consequences. Angina is caused by atherosclerosis, that is the narrowing and / or blockage of the blood vessels that supply the heart.

The typical pain of angina is in the chest but it can often radiate to the left arm, shoulder or jaw. If you have angina you will have noticed that the pain is related to exertion and is relieved by rest.

Coronary artery disease

Coronary artery disease is also known as ischemic heart disease. It is caused by atherosclerosis, that is the narrowing and / or blockage of the blood vessels that supply the heart. It is one of the most common forms of heart disease and the leading cause of heart attacks and angina.

Coronary heart disease

Coronary heart disease refers to the disease of the arteries to the heart and their resulting complications, such as angina, heart attacks and heart failure.

Cardiomyopathy: Cardiomyopathy refers to diseases of the heart muscle. Some types of cardiomyopathy are genetic, while others occur because of infection or other reasons that are less well understood. One of the most common types of cardiomyopathy is idiopathic dilated cardiomyopathy, where the heart is enlarged. Other types include ischemic, loss of heart muscle; dilated, heart enlarged; hypertrophic, heart muscle is thickened.

Valvular heart disease: The heart’s valves keep blood flowing through the heart in the right direction. But a variety of conditions can lead to valvular damage. Valves may narrow (stenosis), leak (regurgitation or insufficiency) or not close properly (prolapse). You may be born with valvular disease, or the valves may be damaged by such conditions as rheumatic fever, infections connective tissue disorders, and certain medications or radiation treatments for cancer.



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