1. PREVENTING SUDDEN CARDIAC DEATH
Dike Ojji
MBBS, PhD, FWACP, FACP, FESC
Senior Lecturer, Department of Medicine, Faculty of Health Sciences, University of Abuja & Honorary Consultant Cardiologist, University of Abuja Teaching Hospital, Gwagwalada, Abuja

3. LONG AXIS SECTION OF THE HEART REVEALING THE FOUR CARDIAC CHAMBERS

4. What is cardiovascular disease?
A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina
Accounts for 17million deaths worldwide
Heart Disease is the number one killer in the developed nations
It is also becoming a major concern in developing nations like Nigeria
Cardiovascular disease alone will kill five times as many people as HIV/AIDS in the developing countries in the next 10years

5. The multiple faces of cardiovascular disease

6. World Health Organization Global Burden of Disease 2004
Deaths Projected by Cause, in the Low, Middle and High Income Countries
World Health Organization
Global Burden of Disease 2004

7. Case Presentation 2
A 64-year old retired school teacher was brought to the Emergency Department of a Nigerian Teaching Hospital
Had fallen down at home two hours before presentation
The two sons who brought him said he had been previously well four hours before their presentation in the hospital
He was sitting in a chair when he suddenly slumped to the floor
He was not a previously known hypertensive nor diabetic
There was also no history of cigarette smoking nor alcohol ingestion

8. Case Presentation On examination: He was obese and comatose
Inability to move the left half of the body
BP was 210/140mmHg
He died with 48hours of admission without regaining consciousness

9. Types of Cardiovascular Disease
Coronary Artery Disease or Heart Attack
Heart Failure
Stroke
Peripheral Vascular Disease
Tuberculosis of the Pericardium of the Heart
Rheumatic Heart Disease

10. What Causes Cardiovascular Disease?
Atherosclerosis-fatty deposits of cholesterol
Hypertension or High Blood Pressure
Diabetes Mellitus or High Blood Sugar
Cigarette Smoking
Excessive Alcohol
Tuberculosis
Bacterial and Viral Infections
What causes heart disease? Two major conditions contribute Atherosclerosis it involves deposits of fatty substances cholesterol, cellular waste and calcium in the lining of an artery. It starts due to elevated levels of cholesterol, high blood pressure, and tobacco smoke.

12. Co-Morbid Factors in Hypertensive Subjects in Abuja%

13. Comparing some Results of the Abuja Study with that of Heart of Soweto
VARIABLE
ABUJA (1494)
HEART OF SOWETO (761)
Age(yrs)
51.1±13.8
58.0±15.6
BMI(kg/m2)
28.4±6.2
29.8±6.8
Dyslipidaemia(%)
21.8 24
DM(%)
8.4 12
Smoking(%)
7.8 38
HIV(%)
0.6
2.4
HF(%)
22.6 54
CAD(%)
0.26
6.2
CVA(%)
4.3
3.3

14. RISK FACTORS FOR STROKE
AND HEART ATTACK

15. Unchangeable Risk Factors
Age- the older you get, the greater the chance
Sex- males have a greater rate even after women pass menopause
Race- Stroke tend to be commoner in blacks
Family history- if family members have had CHD, there is a greater chance.
Unchangeable Risk Factors: Age, the older you get the greater the chance of heart disease. Four out of five people who die of congestive heart disease are 65 years of age or older. Sex, males have a greater rate of congestive heart disease. Race, minorities have a greater chance of heart disease. African Americans have a greater chance of high blood pressure. The risk is also higher in Mexican Americans, America Indians, native Hawaiians and Asian Americans. Also included as unchangeable risk factors is your family history and your own personal medical history.

16. Changeable Risk Factors
Hypertension or High Blood Pressure
Serum cholesterol (Fat in the blood)
Obesity
Diabetes Mellitus
Physical Inactivity
Cigarette Smoking
Excessive Alcohol Intake
Hypertension
Serum Cholesterol: As cholesterol rises so does the risk of congestive heart disease, and obesity. It is unhealthy because excess weight puts more strain on your heart. It can raise blood pressure and blood cholesterol and lead to diabetes. Diabetes Mellitus, Physical Inactivity, and Cigarette Smoking along with Alcohol intake are the other changeable risk factors. A smoker’s risk of a heart attack is more than twice that of a non-smoker.

17. CVA – Risk Factors

18. HIGH BLOOD PRESSURE

19. Blood pressure detection and confirmation
Bp measured with subject comfortably seated for at least 10 mins with arm at heart level.
At least 2 measurements 1 min apart
Both arms should be recorded on first occasion and arm with higher Bp used subsequently
<140/90mmHg
About 20-25% Nigerians have HT 19

20. Devices for Bp recording20

21. Symptoms and Signs of Hypertension
Uncomplicated hypertension may have no symptoms – “silent killer”
They may have headache, dizziness, vertigo, tinnitus (or ringing in the ears), blurring of the vision etc
Symptoms are usually those of the complications 21

22. Effects of Hypertension

23. HT LVH:20-40% CKD:25-30% HF:60-65% 82% of CVA patients
Burden of Complications of HT in Nigerians HT
LVH:20-40%
CKD:25-30%
HF:60-65%
82% of CVA patients

26. HIGH CHOLESTEROL

27. Comparing some Results of the Abuja Study with that of Heart of Soweto
VARIABLE
ABUJA (1494)
HEART OF SOWETO (761)
Age(yrs)
51.1±13.8
58.0±15.6
BMI(kg/m2)
28.4±6.2
29.8±6.8
Dyslipidaemia(%)
21.8 24
DM(%)
8.4 12
Smoking(%)
7.8 38
HIV(%)
0.6
2.4
HF(%)
22.6 54
CAD(%)
0.26
6.2
CVA(%)
4.3
3.3

30. Types of Cholesterol 4 main classes Total Cholesterol Triglyceride
Low Density Lipoprotein (LDL)
High Density Lipoprotein (HDL)- Good

31. Good versus Bad Cholesterol
LDL is known as bad cholesterol. It has a tendency to increase risk of heart disease
LDL’s are a major component of the atherosclerotic plaque (fatty deposits) on arteries
Levels should be <130mg/dl

33. Good versus Bad Cholesterol
HDL is known as the good cholesterol
It helps carry some of the bad cholesterol out of the body
It does not have the tendency to clog arteries
Levels should be >35mg/dl or 40mg/dl
HDL or high density lipoprotein is know as the good cholesterol, it helps to bind to some of the bad cholesterol and carry it out of the body. It does not have the tendency to clog arteries. The target level is greater than 35mg/dl. High levels of >60 can actually negate one other risk factor. Studies suggest that high levels of HDL cholesterol reduce your risk of a heart attack.

34. Diabetes Mellitus Characterised by too much sugar in the blood
The chemical in the body called insulin which helps in handling sugar and other food substances is not enough or not functioning well
It can affect any part of the body by affecting the blood vessels
It can cause heart, kidney, eye or skin disease

35. Obesity
People who are obese have 2 to 6 times the risk of developing hypertension.
Location of the body fat is significant.
People who are obese have 2 to 6 times the risk of developing hypertension even if they have no other risk factors.

36. Physical Inactivity
Physical inactivity has been shown to decrease blood pressure
Moderate physical activity for minutes on most days of the week is recommended.
Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure.

37. Cigarette Smoking Causes an increase in blood pressure
Usually have lower levels of HDL(good cholesterol)
Within 1 year of quitting, heart attack risk decreases
Within 2 years it reaches the level of a nonsmoker.

38. Coronary Artery Disease
Occurs when the coronary arteries that supply the heart muscle become blocked
Partially blocked it causes angina
Fully blocked it causes a myocardial infarction or a heart attack!

43. Coronary Angiogram of PCA

44. Causes High blood cholesterol High blood pressure Smoking Obesity
Lack of physical activity

45. Myocardial Infarction or Heart Attack
Uncomfortable pressure, fullness, squeezing pain on the chest
Pain spreading to the shoulders, neck and arms
Chest discomfort and light headedness
Anxiety/nervousness
Paleness or pallor
Excessive sweating
Increased irregular heart rate

46. Congestive Heart Failure
The right side of the heart collects the blood returning from the body and sends it to the lungs
If it is failing, the blood backs up into the veins, and there are signs of edema.
The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively.

47. Commonest cause of Heart Failure in Nigeria

48. Cerebrovascular Accident or Stroke
Blood vessel in the brain becomes blocked by atherosclerosis (fat deposits)
The tissue supplied by the artery dies
Embolus – A traveling blood clot can also block the artey supplying the brain
Blood vessel can also rupture leading to bleeding
Cerebrovascular Accident – Every 53 seconds someone in America has a stroke. Stroke is the nation’s #3 killer and is the leading cause of long-term disability. People with heart disease have twice the risk of having a stroke. It is caused when a blood vessel in the brain become blocked by artherosclerosis and the tissue supplied b the artery dies. It can also be caused by a traveling blood clot known as an embolus.

49. Symptoms of Stroke Happens suddenly
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking, or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause

52. Hemorrhagic Stroke

53. Coronary Angiogram of PCA

54. PREVENTING CARDIOVASCULAR DISEASE

55. TREATMENT
Treatment is divided into: drug-treatment and non- drug treatment
Non-Drug Treatment
Dietary modification
Weight Loss
Smoking Cessation
Increased Physical activity
Alcohol

56. How can You Stop Cardiovascular Disease?
Diet and Nutrition
Eat a variety of fruits and vegetables every day
Eat a variety of grain products
Choose nonfat or low-fat products.
Use lean meats- choose chicken, fish, turkey and lean cuts of beef and pork.
Switch to fat-free milk- gradually reduce the fat content of the milk you drink.
How can you stop cardiovascular disease? The heart healthy diet is designed to decrease sodium, saturated fat, including trans fatty acids which are all closely linked to high blood cholesterol and an increased risk of heart disease. It also encourages the increased intake of monounsaturated fat, Omega 3 fatty acids and soluble fiber which helps to lower blood cholesterol levels and reduce the risk of heart disease.

57. Dietary Guidelines
Choose fats with 2 grams or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil
Balance the % of calories you eat with the number of calories you use each day
Maintain a level of physical activity that keeps you fit and matches the % of calories you eat.

58. Dietary Guidelines
Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy
Limit foods high in saturated fat, trans fat and cholesterol
Limit salt intake (less than 6 grams a day)
What of alcohol?

60. Weight Loss
Lipid-lowering effect achieved by diet can be doubled by a 2.3kg loss in body weight
Reduces the production rate of VLDL by the liver and then LDL
Can reduce Triglyceride and mildly increases HDL
Obese & overweight individuals with high cholesterol should reduce their weight to BMI < 25
Diet &Weight Loss
1.High fibre
2.Moderate Carbohydrate
3.Low saturated fat and cholesterol

62. Other Measures
Smoking-Increasing levels of plasma cholesterol with increasing numbers of sticks
Excess alcohol consumption worsens dyslpidaemia in patients with raised Triglyceride

63. Exercise and CVD
Serves several functions in preventing and treating those at high risk
Reduces incidence of obesity
Increases good cholesterol
Lowers bad cholesterol
Helps control diabetes and hypertension
Aerobic exercise- cycling, jogging and swimming for 30minutes 3-5x/week

65. Prevention Get regular medical checkups. Control your blood pressure.
Check your cholesterol.
Control your blood sugar
Don’t smoke.
Exercise regularly.
Maintain a healthy weight.
Eat a heart-healthy diet.
Manage stress.
Prevention

66. ECG Tracing

67. Conclusion Cardiovascular disease is a number one killer
It is highly preventable and controllable with diet and exercise
Treating risk factors like hypertension, diabetes mellitus and high cholesterol will go a long way in prolonging life
Remember that prevention is far much better than cure!

68. THANK YOU VERY MUCH