Dealing with sudden death

Almost every Nigerian knows someone who has had a stroke, or died suddenly! Many leave home and never make it back even when they didn’t look sick while leaving home. In this report Omolara Akintoye and Medinat Kanabe explore the trend, causes and prevention

I know that it is important to go for medical checks, but I’m at work most of the time, moreover I do not see the need to go for it because I feel I’m healthy” these are the words of Mrs. Biola Adeyemo, a banker in Lagos.

 “Medical check up? I don’t need to go for it because I’m okay. I haven’t gone for medical check because I’m very busy”. This among others are reasons why people hardly go for medical check-up, some said they’ve only done it once.

Getting a clean bill of health from a routine medical check to many people is like a waste of time and money. Ten out of eight people spoken to said they did not have time to go for medical check because they are too busy or they don’t see the need for it.

Even when screening is free, people out of fear of the unknown still find it difficult to go for medical check.

Cases abound about people both young and old who suddenly slumped and died as a result of their inability to go foe medical check:

In January this year, the former Special Adviser to the Lagos State Governor on Commerce and Industry, Deji Tinubu slumped and died. He gave no sign of any ailment. Government sources said he suddenly shouted during a football match and then slumped and died.

Recently too, the former President of the Institute of Chartered Accountant of Nigeria (ICAN), Mrs. Olutoyin Olusola Olakunri slumped and died during a church service on Sunday morning.

Also, a corps member, serving with the Lagos State Government died after he slumped five days to the completion of his youth service. A Senator representing Bauchi South, Ali Wakili recently slumped and died at his Gwarimpa residence in Abuja.

In Anambra State, there was pandemonium inside a court after a prominent lawyer, Solomon Uzoigwe slumped and died during a court session. Another lawmaker in Cross River State House of Assembly, Steven Ukpukpen, slumped and died during an early morning workout, recently. He slumped and died around 7a.m., along Moore Road in Calabar. He represented Obudu Constituency in the State House of Assembly. Senator Isiaka Adeleke died on April 23, 2017 apparently of heart attack while Omamen Iyawe, wife of Pastor Idahosa Iyawe of The Standpoint Church, Abuja died after she slumped dueing a praise worship session.

Sudden deaths have become common sparing no one as prominent figures have become victims of the new trend, the silent killer.

Between last year and this year alone, the country has lost prominent people who are mostly at their prime to sudden deaths.

Health experts said many have lost their lives to sudden death in recent times. The World Health Organisation (WHO) defines sudden deaths as one occurring within 24 hours of an abrupt change in previous clinical status, adding that it was becoming prevalent in sub-Sahara Africa, including Nigeria.

Research has shown that over 93.7 per cent of Sudden Unexpected Deaths (SUD) in Nigeria are due to hypertension-induced medical conditions such as stroke and heart failure.

Professor Barnabas Mandong, of Babcock University, Ilishan-Remo, Ogun State, said sudden death is largely due to heart attack. According to him, “Heart attack is the commonest because of what you eat and sedentary life that we live. I want to say it out rightly that 50 per cent of Nigerians are hypertensive if you calculate the population. And so, you find people moving around with their hypertension and they don’t know.

“As pathologists, we investigate cause of death so we exhume bodies sometimes to do this to know whether the cause of death is homicide or not, so we are expert witnesses”, he said.

Citing the example of Michael Jackson whose doctor is serving a life term., he said “He assisted his patient to die. If a person with power is a patient, they tend to take control of the doctors; they tell him, do this or that and stupidly you will just follow the person when you know that what he is asking for is wrong. So, when Michael Jackson insisted on taking the painkillers, the doctor obliged and he died suddenly; this is another cause of sudden death,” said Mandong.

All age groups, according him, are involved in sudden death. “In children we call it sudden infant death. Children with bad kidneys can also die from sudden death.”

According to Mandong, there are three causes of diseases in life, “one is genetic- you can inherit diseases from members of your families, second one is environmental  90 per cent of our diseases are caused by environmental factors; our social life and the third one is a combination of both hereditary and environment. If in your family they have diabetes and you may inherit the gene but if you adopt a life style that will not expose that gene to diabetes, you will not have diabetes, if you are hypertensive in your family and you adopt a lifestyle that the hypertension will not be seen in you, then you will not have hypertension. If we modify our lifestyles, most of the diseases will be taken care of and we will not be dying suddenly,” he warned

Death could also occur if the heart is overstretched, this is usually common among sports people. Excessive or sudden fright could also cause death; if you are afraid, fear could knock off the heart because it shuts the nerve that is supplying the heart the beat.

Mandong advised athletes to go for medical check up before getting involved in any sport activity, “The doctor must check the heart to see if there is any heart problem that can cause any problems.”

But a consultant cardiologist and Executive Secretary of Nigerian

Heart Foundation (NHF), Dr. Kingsley Akinroye, defined sudden cardiac death as an unexpected natural death due to cardiovascular disease, which occurs within one hour of the onset of symptoms.

Sudden deaths according to him, is “a major proportion of sudden death of cardiac (heart) origin.” To address the situation, Akinroye recommended that compulsory electrocardiogram and echocardiogram should be included in the annual medical screening programmes of African footballers, athletes and referees. “In addition, any young person with a family history of sudden death and with any of the following complaints  dizziness, palpitations, fainting, chest pain or difficulty in breathing should have an electrocardiogram screening,” he said.

The cardiologist said thorough prospective epidemiological and population studies in Africa are necessary for prevention and control of sudden cardiac death. “Research and training of various experts in the relevant fields of electrophysiology, cardiology, cardiac surgery, cardiovascular epidemiology, intensive cardiac nurses and professionals in ambulatory care like ambulance drivers are necessary for the healthcare system to impact on interventions to control sudden cardiac death,” he said.

The National Sports Commission (NSC), Akinroye said needs to have a national data registry of sudden cardiac deaths in athletes and other sports in Nigeria.

“We should be more health conscious and also do routine medical checks especially for people who are 40 years and above. Also we should report any unusual symptoms to doctors because so many of the sudden death cases will have experienced some symptoms before the events which are usually ignored or are assumed to be trivial.”

A Laboratory Scientist, Mrs. Teniola Amore, lamented that despite the fact that some screenings are free; people still do not see the need to check their health status. “Some of the people I have screened say they are afraid that some ailment can be discovered, others say they cannot afford to pay for treatment and so they do not bother to check their status”, she said. Amore pointed out that the attitude of people toward their health is still very poor and this can be due to ignorance, poverty, fear and illiteracy.

These tests according to Amore, could help detect very early signs of some life threatening diseases and could most likely save their lives. “We must try as much as possible to protect our most priceless possession. You can’t go rent another body and you can’t go use someone else’s body. It’s all you have, so why not take good care of it”, she concluded.

‘People must inculcate appropriate measures to prevent sudden death’

In this interview with Omolara Akintoye, a Senior Cardiologist, Lagos State University Teaching Hospital (LASUTH), Dr Osaretin Aisen, explain why people must inculcate appropriate measures to prevent sudden death.

The rate at which people slump and die nowadays is on the rise, why?

When you talk about people ‘slumping and dying’, the term is a lay man’s language trying to describe sudden death arising from a cardiac arrest. It is also described as ‘Sudden Cardiac Death’. It is usually associated with so many factors, be it primary or secondary factors. The primary reason includes factors that are associated with primary disease of the heart:

Sometimes people with many long years of hypertension tend to have a big heart which is called Left Ventricular Hypertrophy or Cardio-megalli which occurs as a result of long standing hypertension or uncontrolled or poorly controlled blood pressure, such people are at risk of what is called sudden cardiac death.

Apart from hypertension there are some people that have Nutrisic hereditary or Genetic Related Cardiac disease called Cardio Myopathy. Those are additional common risk factor causes of sudden cardiac death; some may have other rare conditions involving release of excessive hormones that over stimulate the heart. Some people also develop heart muscle disease as a result of chronic or recurrent heart attacks that have damaged the muscle and affect the heart muscle function. So the commonest cause of sudden death in our environment is hypertension and also the commonest cause of sudden death in the world is hypertension.  Hypertension directly affects the heart muscle and can cause hypertensive cardio-myopathy or heart attack from mal-cardiac infarction which can lead to cardiac arrest. Heart muscle disease that is not related to heart attack but as a result of thickening or weakness of the heart muscle can also cause cardiac arrest, i.e those muscle activities can cause cardiac arrest. By cardiac-arrest I mean life threatening and electrical discharge in the heart that eventually stops the heart from working. Hypertension can also cause sudden death through bleeding into the brain. Many at times people just collapse and die, it can be as a result of sudden cardiac arrest or bleeding into the brain that eventually lead to cardiac arrest. So in the long run we have emphasized that hypertension is the main culprit because it is a risk factor for cardiac arrest and heart attacks.

Hypertension does not go alone, it usually goes along side with diabetes, overweight, abnormal cholesterol and associated with patients that are older, 40 and above and patients that have a tempered lifestyle i.e. patients that eat junks fried carbohydrates, excessive fats and oily foods, patients that smoke regularly, patients that take alcohol, that indulge in drugs, or is indulged in abnormal lifestyle that predispose them to obesity, these lifestyle predispose them to hypertension and make the hypertension difficult to control and put them at risk of cardiac arrest sudden death, sudden bleeding into the brain or sudden stroke that can kill.

What is the way forward?

The way forward is to follow simple preventive modalities, meaning inculcating appropriate measures to prevent sudden death. It can be categorised into four namely: Pre-modial, primary secondary and tertiary.

By Pre modial prevention is an attempt whereby people need to go for regular check up in an attempt to screen for hypertension, diabetes, abnormal cholesterol, abnormal weight, as well as screening for abnormal lifestyle, such as smoking, alcohol in-take, abnormal eating habits, drug intake such as cocaine. Once you go for screening you are able to identify those that are at risk factor for hypertension, diabetes, abnormal cholesterol among others and they are enlightened on what to do so as not to have the disease, so you want to prevent them from getting the disease. So primary prevention is identifying those that already have hypertension, diabetes, abnormal weight and cholesterol already and we treat appropriately, control them with medications, lifestyle, counselling them with regular medical check up, adequate drug compliance and clinic attendance. So we are able to put those risk factors on check. This helps such risk factors not to result in heart disease, because it is the heart disease that predispose them to cardiac arrest and sudden death as well as poor quality of life because they are usually unhappy and they lack the energy to work for their living thereby becoming a burden to others.

Some people will say they prefer sudden death than to die of heart attack or diabetes, none of them is good because if you die now, your family bears the brunt, your children will be destitute and your spouse will be left in the care of another person. Sudden death is not the solution, so people that have heart disease and are having poor quality of life as a result of their big heart also wish to die, that this is where the tertiary prevention comes into play. For people that already have the disease, you prescribe specific drugs for them that can improve their quality of life and prevent sudden cardiac arrest, you follow them up with regular counselling, and this also requires big cooperation from such patients to adhere strictly to the rules.

That is the prevention method. Poor funding and poor staffing in the health sector also contribute to the increase and this is where the role of government comes into play, most times people don’t have easy access to health because of their location. Few doctors are attending to millions. You see few doctors attending to hundreds of patients in a clinic that is supposed to last for six hours, how do you expect the doctor to spend quality time with each of them? Most patients wait for endless hours from morning till evening to see the doctor, waiting on prolonged queue lasting for almost 24 hours in the hospital, they come very early in the morning to see doctor, only to leave late in the night, how do you encourage such patients to come back again because they know it will be difficult for them to see the doctor, that can also interfere with ability to follow them up to treat adequately the blood pressure and the risk factors and those who already have the disease to interfere with them, some of them will just stop coming, then you hear cases of them dying, because they have lost out of follow-up.

Government should also employ more doctors and other medical personnel as well as build more health institutions and fund the health sectors by providing adequate facilities that will go round up to the grassroots. Also the Primary Health Centres that is closest to the patients at their local communities should be well equipped with adequate infrastructures and qualified medical personnel.

first published in The Nation of July 25, 2018