Cardiovascular Diseases and Heart Attack in Africa

 

By Rosemarie Tracy, RN, BSN, with editorial contribution from the Datelinehealth Africa Team.

 

 

Introduction

Heart attack, is the leading cause of death worldwide. It is also becoming increasingly so in Sub-Saharan Africa (SSA) over the last 30 years.

A  2017 global report indicated that heart attack was responsible globally for about 9 million deaths (16% of all deaths) and accounted for 50-60% of all cardiovascular deaths. For comparison, in SSA, heart attack was estimated to cause 5% of all deaths, and 40% of cardiovascular disease (CVD) deaths.

There is growing evidence however that the low heart attack rate in SSA may be due to a lack of awareness of symptoms, poor access to care because of scarce resources, poor infrastructure, and deficit of cardiac professionals to provide care for those with cardiovascular diseases. 

Additionally, victims of heart attacks and other cardiovascular diseases in SSA are significantly younger compared to higher-income countries. This indicates a mounting risk to sustainable socioeconomic and national development. Primary prevention should always be the key course of action to reduce disability and deaths from CVDs.

Global initiatives to combat this increasing burden, including DatelineHealthAfrica.org can cultivate knowledge about diseases, disease prevention, and health policy that can foster the development of healthcare infrastructure for vulnerable populations in Africa.

 

More light will be shed on the following:

• Basic Heart Anatomy.
• Brief Overview of Cardiovascular Disease.
• Heart Attack.
• Risk Factors.
• Signs and Symptoms of a Heart Attack.
• Things You Should Know.
• Women and Heart Disease.
• Heart Attack First Aid.
• Become trained in Cardiopulmonary Resuscitation (CPR).

 

 

Basic Heart Anatomy

The heart, is a muscular organ that pumps oxygenated blood to the body. It contains four chambers through which blood flows in specific patterns. The chambers include the right and left atria on top, and the right and left ventricles on the bottom (figure 1).

The heart has several amazing mechanisms that trigger each beat. These include:          

• Automaticity: the ability to generate and discharge electrical impulses.
• Excitability: the ability to respond to electrical impulses.
• Contractility: enables the heart to produce the power necessary for its pumping function.

 

Coronary Arteries 

All body tissues need oxygen to survive. The coronary arteries deliver oxygenated blood to heart muscle tissue through an intricate system of arteries that originate from the ascending aorta and wrap around the outside of the heart (figure 2).

 

 

Brief Overview of Cardiovascular Disease

Cardiovascular Disease refers to several conditions that include:             

• Heart attack (Myocardial Infarction, MI).
• Stroke (Cerebrovascular accident, CVA).
• Heart failure.
• Arrhythmias.
• Heart valve disease.

 

In Sub-Saharan Africa, Heart attack and stroke are significantly associated with high blood pressure (hypertension) than seen in other high income countries (HIC). However, a build-up of fatty deposits (atherosclerosis) on the inside walls of the arteries called plaque is also a contributory factor. Atherosclerosis and high blood pressure often co-exist and have a cause-effect relationship.

 

Other contributory mechanistic factors include blood clots (soft coagulated blood) that may form elsewhere in the body (usually leg veins) and becomes lodged in the vessels of the brain, heart, or lung.

 

A blood clot called a thrombus remains in the place where it forms. When a thrombus breaks loose and travels through the body, it becomes an embolism. In this discussion, I will focus on thrombus/thrombosis.

 

Plaque carries a two-fold threat;

• It can build up in one or several locations in the vessels of the heart and obstruct blood from flowing to the heart muscle, possibly causing a heart attack.

 

• The build-up of plaque hardens, breaks off, travels through blood vessels, and becomes lodged in narrow parts of the vessel of the heart or brain, thus causing a heart attack or stroke.

 

 

Heart Attack (Myocardial Infarction or MI)

When plaque inside the heart arteries thickens, it obstructs the free flow of blood, and you can suffer a heart attack (see figure 3).

 

When a piece of plaque breaks off inside the heart arteries, plaque rupture takes place. Your body responds to it like a cut on your finger, and blood starts to clot to stop the bleeding.

 

At the site of the plaque rupture, a clot called a thrombus forms. A thrombus can block the artery from allowing blood to circulate. A more severe type of heart attack ensues, although in both scenarios, you may experience severe symptoms or very little at all.

 

A blockage of the vessels supplying the heart prevents oxygenated blood from reaching heart tissue. When heart tissue doesn't receive sufficient oxygen supply, ischemia (i.e., nutrient and oxygen starvation) occurs. Ischemia can progress to tissue death (necrosis). Ischemia and necrosis can damage the heart and cause mild to severe dysfunction. This results in a decrease of the pumping action of the heart and may lead to heart attack and death.

 

 

Risk Factors for Heart Attack and other Cardiovascular Diseases

The two categories of risk factors are classifiable as:

1. Traditional.
2. Risk enhancing.

 

Traditional risk factors

In Africa, the four highest risk factors in this category include:

• High blood pressure.
• Diabetes.
• Obesity.
• Smoking.

Others are:

• A diet high in saturated fats and cholesterol
• High cholesterol and high triglyceride blood levels

 

Risk-enhancing factors 

These include:

• Family history.
• Metabolic syndrome.
• Chronic kidney disease.
• Chronic inflammatory conditions.
• History of preeclampsia or early menopause.
• High-risk ethnicity.
• Young, male gender.

 

Unfortunately, family history won't change. Taking control of traditional risk factors such as making lifestyle modifications can lessen your risk of having a major cardiovascular event such as a stroke or heart attack:

• Control blood pressure.
• Control of metabolic state.
• Weight control.
• Diet.
• Quit smoking.
• Exercise.
• Control cholesterol.

 

 

Signs and Symptoms of a Heart Attack

Include:

• Chest pain (Angina) or discomfort in the center or left side of the chest. Discomfort feels like uncomfortable pressure, squeezing, fullness, or pain.

• Feeling weak, light-headed, or faint. 

• Sweating accompanied by chest pain.

• Pain or discomfort in the jaw, neck, or back.

• Pain or discomfort in one or both arms or shoulders.

• Shortness of breath can show up with or without chest pain and can be the single symptom of a heart attack.

• Nausea.

• Vomiting.

• Anxiety.

• Heartburn.

One or a combination of the above signs and symptoms may signal a heart attack.

 

 

Things You Should Know

• You can cut your risk of a heart attack in half by managing your blood pressure to bring it within normal range as well as by quitting smoking.

• Even secondhand smoke can increase your risk of a heart attack.

• Diabetes also increases risk for heart disease. So, bringing diabetes under control will also cut your heart attack risk.

• Note that with nerve dysfuntion associated with diabetes (diabetic neuropathies), you may not feel chest pain or other pain related symptoms of a heart attack.

More than 40% of patients with diabetes are not aware of their diagnosis in SSA.

• HIV/AIDS increases the risk of heart disease in relation to low CD4 count and certain HIV medications. Research in this area continues.

• The baseline risk for women with HIV/AIDS is double the risk for men. Research in this area continues.

• Avoid foods high in saturated fat and cholesterol, i.e.:
  • Full-fat dairy such as whole milk, butter, and cheeses.
  • Red meat.
  • Processed meat such as bacon, sausage, hot dogs.
  • Fried foods.
  • Baked goods and sweets.

 

 

Women and Heart Disease

Globally, women tend to have signs and symptoms unrelated to classic chest pain, such as:

• Neck, jaw, back, and shoulder pains.
• Upper belly discomfort.
• Shortness of breath.
• Feeling tired.

Because their symptoms may be less obvious, physicians tend to misdiagnose a woman's heart attack, leading to poor outcomes.

Preeclampsia (high blood pressure during pregnancy) predisposes women to a two-fold increase in the risk of coronary heart disease, stroke, and death.

Menopause increases women’s risk of cardiovascular disease. Less estrogen relates to increased cholesterol, thus plaque building up on vessel walls that may result in a heart attack or stroke.

Metabolic Syndrome and high cholesterol:  These cardiovascular risk factors increase with menopause beyond the effects of normal aging. Metabolic syndrome is diagnosed when a person has three or more of these individual risk factors: abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure, and high blood sugar.  

For women, the years leading up to and after menopause are a critical time to care for their health. 

More research is critically needed on several aspects of heart attack and cardiovascular diseases in African women for purposes of informing policy towards care.     

 

 

Heart Attack First Aid

• Call your local emergency system or get help from a neighbor, friend, or relative to get you care as urgently as possible.

• Do not delay getting help.

• Chew and swallow an aspirin, unless you are allergic to aspirin or your doctor told you to never take aspirin.

• If no ambulance is available, have someone take you to a hospital.

• If you are with someone having a heart attack and they become unconscious, call for help and perform CPR (Cardiopulmonary Resuscitation).

CPR is a lifesaving practice that can greatly increase the chances of survival in a heart attack.

• Preferably, you need to go to a facility that can perform emergency cardiac catheterisation to revascularise the heart. Revascularisation restores blood flow to the coronary artery. The sooner revascularisation takes place, the less damage occurs. Time is muscle.

Regrettably, facilities that are equipped to perform cardiac catheterisation are limited and in some cases are not available in many African countries.

 

 

Become trained in Cardiopulmonary Resuscitation (CPR)

As much of Africa progresses in its rapid urbanisation and the burden of cardiovascular disease rises, it is hugely important for a majority of Africans to be continuously trained at say yearly or bi-yearly intervals in CPR Basic Life Support (BLS) in public or private training facilities within the context of public health policy. Funding for the training is a wise public health investment and should be readily provided.

 

Categories of people that should be trained include:

• Interested members of the general public.

• Senior secondary school and college level students.

• All frontline health workers.

• Private and public sector workers.

• General and specialist medical practitioners.

• Representatives of traditional, non-governmental and religious organisations, and

• Many other diverse stakeholders in healthcare in the society.

 

 

Key Takeaway

Heart attack is the leading cause of death globally and the burden is increasing in Africa with rapid urbanisation occurring in the region. Here are things you can do to take control of your heart attack risks:

• Commit to a heart-healthy lifestyle.

• See your doctor for regular check-ups.

• Get your blood pressure and cholesterol levels checked at regular intervals.

• Get screened for diabetes.

• Make healthy food choices.

• Control weight, blood pressure, and diabetes.

• Quit smoking.

• Start a regular exercise program.

• Be trained in Cardiopulmonary Resuscitation (CPR).

      

Doing these things can reduce your risk of a heart attack. Your heart will thank you.

 

 

Resources

Minja NW, Nakagaayi D, Aliku T,  Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E,  and Kayima, J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Frontiers in Cardiovascular. Volume 9.  2022. https://doi.org/10.3389/fcvm.2022.1008335

American Heart Association. What is Cardiovascular Disease? Last reviewed, May 17, 2017. Accessed, April 14, 2023.

Chandrashekhar, Y. , et al. Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low-middle-income countries. Circulation. 2020;141:2004–2025. https://doi.org/10.1161/CIRCULATIONAHA.119.041297

Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Glob Heart. 2020 Feb 12;15(1):15. doi: 10.5334/gh.403.

American Heart Association. What Is A Heart Attack? Last reviewed, December 2, 2022. Accessed, April 18, 2023.

Bentzon JF, Otsuka F, Virmani R. Mechanism of plaque formation. Circulation Research. 2014;114:1852–1866. https://doi.org/10.1161/CIRCRESAHA.114.302721

American Heart Association. Understand your risks to prevent a heart attack. Last reviewed, December 6, 2022. Accessed April 18, 2023.  

Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep. 2013 Sep;10(3):199-206. doi: 10.1007/s11904-013-0168-6

American Heart Association Newsroom. Early menopause linked to higher risk of future Coronary Heart Disease. Published, May 20, 2021. Accessed, April 20, 2023.

Wu. P, Haththotuwa R, Kwok S, Babu A, Kotronias RA,  Rushton C, Zaman A, Fryer AA, Kadam U, Chew-Graham CA, Mamas MA. Preeclampsia and Future Cardiovascular Health: A systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes. 2017;10:e003497. https://doi.org/10.1161/CIRCOUTCOMES.116.003497

American Heart Association. Changing the Way We View Women's Heart Attack Symptoms. Published, March 6, 2020. Accessed, April 18, 2023.

 

Related: Hypertension in Nigerian adults: Essential things to know.

 

 

 

Published: April 21, 2023

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