By Gloria Nakajubi
Previously, heart conditions were generally associated with old age and it was almost unheard of for children to be diagnosed with such complications.
However, recent statistics show that heart problems are increasingly becoming more prevalent in children, teenagers and young adults, says Didace Mugisa, a senior cardiothoracic surgeon at Nsambya Hospital.
Mugisa explains that the highest incidence of this condition is among late teenagers and young adults.
Understanding heart failure
Heart failure refers to the situation when the heart cannot supply oxygenated blood as required by the body tissues. This is always a result of other heart diseases. The primary complications that lead to heart failure are rheumatic heart disease and coronary heart diseases.
Mugisa explains that rheumatic heart disease is an infection of the throat caused by the streptococcus bacteria, and that it always presents with a fever and a sore throat, adding that it may be passed as tonsillitis.
The infection may be mild or recurrent.
“At the first infection, the body develops a defence mechanism by producing antibodies. But the challenge is that the protein composition of the bacteria is similar to that of the heart valves (mitral valve) located on the left side of the heart and as the antibodies attack the bacteria, they also attack the valves.
“The attack on the valves causes inflammation, which leaves them scarred and deformed. Eventually, they cannot effectively open and close as oxygenated blood flows through.
“So, since the valves are blocked, instead of blood flowing through, it collects in the left atrium (upper chamber of the heart) and causes a backward flow of blood. The blood goes back into the lungs and congests the chest making it heavy and stiff.
“On the other hand, the scarring may not totally close the valves, but push them apart stopping them from closing again. This leaves blood flowing to the lower chamber (left ventricle), so it becomes a continuous flow of blood back and forth,” says Mugisa.
He notes that valves are supposed to open and let blood in and after the chamber fills up, they close, but when affected, they are not able to do that.
Coronary heart disease is caused by the continuous deposition of cholesterol in the inner lining of the artery. As it accumulates, blood supply to the heart is reduced, hence leading to heart failure.
In fatal cases, this results in what is commonly known as cardiac arrest and one dies suddenly.
Coronary heart disease is also mainly a lifestyle condition that comes with eating high cholesterol foods and a sedentary lifestyle (commonly known as middle class syndrome).
Prevalence rates, who is at risk and prevention
Dr. Mugisa says they receive an average of 100 patients every month at Nsambya Hospital, both from first time visits and reviews.
Age groups from five to 40 years are at risk of getting heart diseases that lead to heart failure. Factors that increase this risk include; crowded areas, which increase the risk of the streptococcus bacterial infection since it is an airborne disease.
Those in sociologically disadvantaged groups with poor nutrition.
Mugisa says it is important for people to prevent the onset of the condition by following some basic routines. These include avoiding obesity, exercising, avoiding stressful circumstances and ensuring a healthy diet. These will especially reduce the risk of coronary heart disease.
However, he adds that if one is already infected, it is advisable that they have enough rest to let the heart heal.
“In case of rheumatic heart disease, eat a low salt diet, in addition to fruits and vegetables to boost immunity.”
Denis Katanku Musoga, a nutritionist with the Uganda Heart Institute, says avoiding obesity also comes in handy to prevent one from suffering from heart failure. This can be done through exercises, in addition to having a healthy diet.
“You should never be too busy for exercises because if your health fails, you won’t be able to even accomplish the schedules that previously made you busy,” Musoga warns.
Mugisa says medication for rheumatic heart disease includes drugs to treat the infection such as penicillin, which has to be taken for a long time.
He explains that if it happens in a young person, they might have to be put on medication until after the age of 40 so as to avoid reoccurrence.
In case of coronary heart disease, a doctor may recommend drugs which help unblock the heart and reduce the continued deposition of cholesterol on the arteries. He might also prescribe blood-thinning drugs that help to avoid clotting.
Surgical interventions for coronary heart disease include: Coronary bypass grafting
This involves getting a blood vessel from another part of the body and placing it in another location. For rheumatic heart disease, the doctor explains that this calls for either repair or replacement of the valve.
In replacement of the valve one undergoes an open heart surgery where they get a biological valve from a human or animal source or get a mechanical valve.
A mechanical valve though said to stay longer, the patient needs to be on blood thinning drugs for life to prevent blood clots.
The challenge is that blood thinning medication affects the foetus in cases of pregnant women. A patient undergoing blood thinning medication is not advised to conceive as they risk having children with abnormalities.
On the other hand, with a biological valve one doesn’t require the blood thinning drugs, but the organ degenerates after sometime and needs to be changed after about 10 years.
Mugisa says with the biological valve, one is advised to conceive during that first time of placement because the second surgery may require a mechanical valve which does not favour child bearing.
Mind what you eat
Denis Katanku Musoga, a nutritionist with the Uganda Heart Institute, advises people to mind what they eat in order to prevent heart failure.
He gives the following tips;
Control sodium intake
Since salt is one of the major sources of sodium, it should be taken in minimal amounts. He recommends just about 1.2g daily, which is an equivalent of a half a teaspoon.
That salt intake can be regulated by avoiding processed foods and desisting from adding salt to food at the table. Also there is no need to add salt to foods such as vegetable salads.
Increasing fibre intake
Fibre slows down the absorption of glucose and inhibits cholesterol synthesis by the liver. This is especially true with soluble fibre.
Fibre is present in plant foods such as vegetables and beans.
Intake of Omega 3 fats
Omega 3 fats help in reducing blood clotting, which is common among people with heart failure. Omega 3 fats also inhibit the synthesis of bad cholesterol. He says these can be found in sea foods.
Avoid saturated oils and fats
Musoga encourages people to cook with alternatives such as olive oil and sunflower.
Eat immune-boosting foods
Here, the advice is that immune-boosting foods, especially fruits, should be part of everyone’s daily diet. These also act as antioxidants in the body.
Signs and symptoms
Heart failure, as Mugisa explains, does not occur in an instant. It is a gradual process and symptoms may start showing after five to seven years. These include;
Effort intolerance – With this, an individual feels excessively tired, even after doing simple activities.
Difficulty in breathing – The fact that the lungs get filled up with blood, especially in case of rheumatic heart disease, patients tend to struggle for breath.
Swelling of the legs (oedema) – This is caused by the excess fluids.
Central chest pain and palpitations (increased heart beat) – This is experienced even when one is resting. And if the chest pain persists for more than 15 minutes, there is a likelihood that it will degenerate into cardiac arrest.
Dizziness and faint attacks – One will complain that they have to use a pillow in order to sleep, even when they never used to need one in the past. Some people might fail to walk even for a few metres, without making breaks let alone bend several times, for example while bathing.
Patients present with complications
In a study published last year in The Cardiovascular Journal of Africa, titled Cardiovascular Complications in Newly Diagnosed Rheumatic Heart Disease Patients at Mulago Hospital, Uganda’, it was established that about 50% of newly diagnosed rheumatic heart disease patients in Uganda presented with complications.
Heart failure and pulmonary arterial hypertension were the most commonly observed complications.
The study also highlighted that complications of rheumatic heart disease are associated with severe morbidity and mortality in developing countries, where the disease prevalence remains high.
Due to lack of screening services, many patients present late, with severe valve disease. In Uganda, the disease and its complications are still not well studied.
Of the patients under the study with definite rheumatic heart disease aged between 15 and 60 years, heart failure was ranked the most common complication at 46.9%.