This is one disease condition that Nigerians have long found to be mysterious. At some point, nearly everyone who was dying in Nigeria was speculated to have died from it. But that is not always the case and it is important to emphasise that while it may be of a sudden occurrence in a great number of people, it is also sometimes slow in coming, often giving important warnings several weeks in advance. Therefore, features of an impending heart attack may consist of shoulder pain or pain in the arm, often in the left side that may extend to the tip of the shoulder or even the root of the neck, shortness of breath and discomfort in the chest. Any of these or a combination of them could occur several hours or weeks before an attack happens. In any case, it is important to stress that heart attack is a leading cause of death around the world, affecting both men and women. The sudden passing just 10 days ago of a senior colleague in dramatic circumstances helped bring this topic to the front line. It takes us back to a high school old students’ meeting a decade or so ago during which another colleague passed away in a stunning fashion. Seeking early intervention even if it turns out to be a false alarm can be the difference between life and death.
In both instances, there may have been warning signs that were missed or ignored although the latter case may have been triggered by the generous intake of an energy drink. In either case, no post-mortem examination was conducted and the possible causes were, therefore, left to speculation. Heart attack is certain to grow in prominence across the world as developing countries, long impoverished, create a burgeoning middle class whose patterns of food consumption are certain to exacerbate the global burden. As usual, they are always the ones least equipped to cope with the rise in numbers and one critical factor which we discussed on this page just a week ago remains the absolute dearth of the kind of citizenry who are able to provide first aid to victims who sustain sudden heart attacks. The signs of a heart attack can be difficult not to be spotted. Tightness in the chest and pain in the upper part of the body are absolutely very obvious. However, heart attack can also present other symptoms that may be mistaken with relative ease for some other ailments. For example, nausea, fatigue and heartburn may be early features of the disease which often will arrest the attention of a healthcare professional.
As a result of the foregoing, about two-thirds of women experience less typical features of a heart attack primarily because of their gender. The very first of these features is an uncomfortable kind of pressure within the chest with a squeezing sensation. There may be a sense of fullness inside the chest and pain in its center. That discomfort can arrive in waves, not unlike labour pains, and last for several minutes in each wave of attack. During a heart attack, your nervous system activates a fight or flight response which puts you into a survival mode and a sweat could break out. We have discussed the “fright, fight or flight” response before on this page and this is the system which a problem like this can activate. There is no reason for a perfectly healthy person to suddenly break out in a sweat when they are well. The onset of a heart attack on the other hand is one condition during which there is the feeling of impending doom. Sweating is profuse and it may be slowed by sitting down to rest. If your thyroid gland works properly and you have not been working out, and yet you experience that sequence of events, then a heart attack might be in the offing. At this same time, the heart goes into overdrive and palpitations begin to form a part of the picture.
Palpitations are described as a condition in which the heart beat becomes evident to the owner of the heart, and it is found at such times to be beating faster than usual. This situation can be caused by medications such as anti-hypertensive drugs, thyroid disease, dehydration due to diarrhoea and vomiting or due to rapid blood loss from a variety of causes. If any person is not on any medication belonging to the above group and does not suffer from any obvious disease condition to warrant the onset of palpitations, then the time has come to raise an alarm for help from your neighbours as we often do here or to call the emergency medical services in those countries where sanity prevails. The ambulance crews in those lands are populated by skilled people who would perform a quick assessment and start any pre-hospital treatment as they may deem fit while planning your evacuation to the hospital. Here at home, you sometimes have to drive yourself to the hospital at great risk to other road users. With unrelenting palpitations comes some anxiety in the person about what it could mean. Sometimes, when there is a lot of anxiety, mistakes can be made.
In addition to all the above, there may be pain occurring in other parts of the body. That kind of pain is called referred pain. The shoulders for one, like we mentioned before would be very painful especially at their tips; the arms, neck and jaw also. If an artery in the heart, for example, is blocked the heart will activate other parts of the body through their common nerve supply provided by a long nerve, the vagus nerve nicknamed the vagabond nerve because of the large number of organs that it subserves. This nerve sends its signals to the brain, neck, chest and intestines in addition to the heart. As a result, there will be pain sensations sent to all those other regions of the body apart from the heart itself. When these problems are on, even the routine task of climbing a flight of stairs within your home becomes an ordeal because there will be associated shortness of breath. If you have not previously been undergoing treatment for a heart-related ailment and this develops suddenly, it could indicate that your heart is in danger. When shortness of breath is coupled with chest pain, and dizziness develops it could be that a heart attack is close. These may also indicate that the blood volume is less than normal due in part to the fact that the heart is no longer able to pump enough of it.
Fatigue, especially among women, can occur even one full month before an actual heart attack. According to Harvard Health Publishing reports, this particular feature is prominent particularly among women. Besides that, signs like excessive belching, an upset or unsettled stomach and vomiting can also develop in relation to a situation where the heart is not in receipt of enough blood supply.
These are frequently misdiagnosed as peptic ulcer disease or heart burn but if they become associated with abnormal sweating, fatigue and tightness in the chest, it is important to see a doctor who could refer you to a cardiologist specifically or at least a physician. In addition, if you have indigestion with nausea and stomach pain or pain that also spreads to the arm or shoulder, you must not ignore the association; you should go to the hospital. Prevention in this as in other disease conditions is better than cure, it is cheaper but unfortunately, not enough attention is paid to it as a preventable condition. If that is done and the people who have got diabetes, hypertension and raised blood cholesterol control their figures, a lot more lives will be saved. In the final analysis, what all these facts tell us is that if people pay attention to their bodies, they can notice some of these symptoms even several months before tragedy strikes.
Questions and answers
Dear doctor, I got your number from Sunday PUNCH. My nine-month-old baby has an umbilical hernia which is big. Please, I need your advice on what to do. Thank you sir. 0703xxxxxxx
Good day to you as well. When a child has an umbilical hernia, most often it is left alone especially if it is not causing any problems like pain and swelling of the abdomen or vomiting in association with the pain because most will close on their own at between two and four years of age. If however, it is truly big like you say it is, it can be repaired through an operation. You should see a paediatrician for examination and advice. They will help you determine if it needs to be repaired based on the size you have mentioned.
Dear doctor, last year, 2021, 42 million abortions were recorded worldwide. Warn the girls: abortion is killing. I am in shock about that number actually. Happy new year PUNCH doctor. Cheers. 0806xxxxxxx
That is a very large number and it is an estimate. The total number is probably more. Two years ago, we did a series on this page about the different types of abortion. The girls and young women know what the risks are but it is not within the scope of this column to pass moral judgments about whether it represents killing or it is therapy. But thank you for your comments dear reader. You are appreciated and your number regularly features here as well.
Dear doctor, please what causes a woman’s belly to become hot to touch (even during the cold harmattan) and throughout the second half of the menstrual cycle? She has to wipe her tummy with a piece of wet cloth several times per day. Won’t it prevent pregnancy or cause a miscarriage? What is the permanent solution? Thanks. 081xxxxxxxx
This is definitely not a disease condition and may be a reflection of an anxious state of mind. Often, women who are in this kind of state are those of child-bearing age who have been married for some time but have no children yet or have developed a long interval between one child and another. As a result, the hotness per se does not require any treatment. When what is desired takes place, which is pregnancy, the hotness will naturally disappear.
Dear doctor, I have severe pain in my chest with tightness and difficulty with breathing during at least two nights in every five five and have suffered this for the past two years. Recently, I went to see a set of doctors at LUTH (Lagos University Teaching Hospital) and after examination, I was told I have gastro-oesophageal reflux disease. I was given some medicines such as Omeprazole, Gascol and Kotase and told to take the Omeprazole for six weeks. The pain is always on the right side and it improves when I change my sleeping position to lie flat on my tummy, so, I was told to do upper endoscopy. When I used the medicines for two weeks and did not feel better, I stopped on my own. What do you advise me to do, sir? 0703xxxxxxx
You have gone to a good hospital in the first instance. The rest should be easy and you ought not to stop the treatment on your own. By your account, you have had this problem for two years, so it is not likely to resolve in only two weeks of treatment. The key to solving this problem is constant check-up and follow-up as requested by your doctors and after a few more tests, including upper gastrointestinal endoscopy, the answer should be obvious and treatment can be a success. Unfortunately, you did not disclose your age or your gender. Some of these problems are easier to understand and explain when the information is fuller.
Dear doctor, I am 50-year old widow and my late husband was sick for a long time, almost six years, before he died in November 2021. Since he fell sick, I have not had any urge to have sex. Is this normal or is something possibly wrong with me? 0802xxxxxxx
There is nothing wrong with the way you feel. It is certainly not an adverse health condition and a lot of the emotions you might have will be determined by your own attitude to things and men around you. It could be that you do not find anyone interesting or your priorities have become different and also that the idea of having sex has become an unimportant need. If that is so, there will be no reason to worry about it.
Dear doctor, I have been having back pain for a whole month now. I am 42 and I have been to the hospital but no drug was given to me. The doctor only said I should stop using a particular pillow which I have done but the pain is still there. What do I use please? 0803xxxxxxx
This is very interesting because I am intrigued that a doctor practically dismissed you with a verbal recommendation. You do need to return to that hospital if it is actually one and get a proper examination following which X-rays of the back, around where the pain is centered, may be required. Only then can you have meaningful treatment. If you live in a town where there is a large hospital with orthopaedic surgeons among the staff, I would advise you to seek a referral to one of them. But judging by your account of your treatment at the hospital you visited, I am convinced that you probably did not get to be seen by a doctor.
Dear doctor, how are you today? I am a 69- year-old retiree residing in the state capital of one of the “O” states. Armed robbers attacked my residence in Lagos in 2008 that left me with a facial palsy. I have been on daily medications since that attack. A month ago, I noticed a swelling on my two feet. I applied “ori” and ‘anointing oil’ on alternate days for a week. There is no pain. I walk daily for 30 minutes or more. I went to a clinic where a number of tests were carried out on me and I was found to be okay. A week ago, I was placed on Esidrex and an uncle gave me Gaurapad antitoxin pads applied on each foot for three nights. Please come to my aid. 0807xxxxxxx
The facial palsy you now have may have been a consequence of that attack. It is not related to the swollen feet. However, it is important for us to know what kinds of tests were conducted on your body to be able to make a reasonable judgement and offer advice. That insight is lacking now and so the advice you will get cannot be full also. It is good thing to walk around like you do but if there is no ailment, that should help clear out the fluid in the feet. Consequently, it is perfectly likely that you may have some liver, kidney or heart disease that your doctors have not told you about or have not discovered yet. Once that point is reached, treatment will be successful in getting rid of the swelling. Perhaps you should go to a teaching hospital in your city. In Ondo, Oyo, Osun and Ogun states, there are teaching hospitals in each one. Visiting any of them should help provide a solution and help to also review the need to continue taking medicines for your facial palsy.
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