Heart disease describes a range of conditions that affect the heart. Diseases under the heart ailment umbrella include blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects one is born with (congenital heart defects), among others.

The term "heart disease” is often used interchangeably with the term "cardiovascular disease”. Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

Evarist Ntaganda, the director of Cardiovascular Diseases Unit at Rwanda Biomedical Centre (RBC), says that other heart conditions, such as those that affect the heart’s muscle, valves or rhythm, also are considered forms of heart disease.

HOW THE HEART WORKS

He explains that the muscles of the heart are the ones that participate in movement; they help the heart in making movement when it comes to pumping of the blood.

Because the heart is supposed to pump the blood to the rest of the body, he says when this is affected, the whole process is restricted.

Ntaganda talks about coronary artery disease (CAD), also known as ischemic heart disease (IHD), for instance.

The usual cause of this is build-up of plaque. This causes coronary arteries to narrow, limiting blood flow to the heart and this is where heart attacks originate from, he says.

There is also congenital heart disease, which can affect any part of the heart,

According to MedlinePlus, a medical information medium, a congenital heart defect is a problem with the structure of the heart. It is present at birth. Congenital heart defects are the most common type of birth defect. The defects can involve the walls of the heart, the valves of the heart, and the arteries and veins near the heart. They can disrupt the normal flow of blood through the heart. The blood flow can slow down, go in the wrong direction or to the wrong place, or be blocked completely.

Doctors use a physical exam and special heart tests to diagnose congenital heart defects. They often find severe defects during pregnancy or soon after birth. Signs and symptoms of severe defects in new-borns include;

Rapid breathing

Cyanosis - a bluish tint to the skin, lips, and fingernails

Fatigue

Poor blood circulation

Walking can improve your cholesterol levels, blood pressure and energy levels, plus it can fight weight gain to improve heart health overall, explains the American Heart Association. Walking can also reduce stress, clear your mind and boost your mood.

HIGH BLOOD PRESSURE

Medics say one of the main causes of heart disease in Rwanda is hypertension.

According to RBC, the prevalence of hypertension in Rwanda now stands at 15.9 per cent, and it is one of the reasons for consultation handled by medics in almost all health facilities.

Hypertension is a medical term but it means raised blood pressure. Ntaganda says psychologically, the range varies and is not supposed to go too low or too high.

The top number is the maximum pressure your heart exerts while beating (systolic pressure), and the bottom number is the amount of pressure in your arteries between beats (diastolic pressure). The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure.

If your systolic pressure is elevated and your diastolic pressure is not, that doesn’t mean you have isolated systolic hypertension. It most likely means you have standard high blood pressure.

 "Basically, we consider someone to have high blood pressure when they have 140 out of 90 millimetres of mercury. The blood pressure is normally considered as cardiac output, this is amount of blood that heart pumps against different resistance,” Ntaganda says.

Joseph Mucumbisti, a paediatrician at Oshen-King Faisal Hospital in Kigali, cardiologist and president of Rwanda Heart Foundation, says that high blood pressure is a common condition in which the long-term force of the blood against the artery walls is high enough that it may eventually cause health problems, such as heart disease.

He says blood pressure is determined both by the amount of blood the heart pumps and the amount of resistance to blood flow in arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

He says one can have hypertension for long without their knowledge because the signs and symptoms are rarely there.

The worst, he says, is that without symptoms, as damage to blood vessels and that of the heart continues. Uncontrolled high blood pressure increases the risk of one developing serious health problems, including heart attack and stroke.

COMPLICATIONS

Francis Kazungu, a general practitioner, says that sometimes, the calibres of the vessels are altered by many things. For instance, eating fatty food.

"When one eats a lot of fatty food, and gains weight, there could be fat in the vessels of the heart too which will cut down the ability of the vessel; and this creates blockage of blood flow,” he says.

He says that high blood pressure can cause hardening and thickening of the arteries, which can lead to a heart attack, and other complications.

Again, he says, to pump blood against the high pressure in the vessels, the heart has to work harder.

"This causes the walls of the heart’s pumping chamber to thicken. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body’s needs, which can lead to heart failure.

WHAT TO WATCH OUT FOR

Kazungu says that high blood pressure is genetic or acquired through one’s lifestyle.

This includes risk factors such as unhealthy foods, smoking, excessive use of alcohol and not being physically fit.

He says these are the major factors that can lead to hypertension.

He warns that hypertension doesn’t come with a warning, it can happen any time and to anyone.

Hypertension can result in stroke, which he says is becoming common among patients going in for consultation in different hospitals.

For example, Kazungu says, the force that the heart uses to pump the blood that has been blocked can make some vessels in the brain burst causing bleeding and later, a haemorrhagic stroke.

It can also result in heart failure and kidney problems which are all complicated.

Ntaganda says hypertension can also lead to hypertensive retinopathy, which is retinal vascular damage. Signs usually develop late in the disease. Funduscopic examination shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped haemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema.

 "High blood pressure can cause damage to the blood vessels in the retina, the area at the back of the eye where images focus, leading to what we call hypertensive retinopathy,” he says.

The only way to avoid this deadly ailment, Ntaganda says, is by going for screening and check-ups at least once a year. Age can also be a factor and that women above 35 years of age and men above 40 should make a point to go for screening.

However, he notes, when it comes to the age, with regular sports and healthy living, one can cut the risk of getting hypertension.

STRATEGIES FROM THE MINISTRY

To deal with hypertension, the Ministry of Health is now training practitioners to engage in decentralisation of services in all health facilities across the country, and all physicians are in a position to treat hypertension.

The Ministry has also come up with different strategies to create awareness about the risk factors of hypertension, and encourages people to go for annual check-ups.

Ntaganda says early detection is best, because it helps one get treatment as early as possible.

THEIR VIEWS

There is need to train the public on how to carry out cardiopulmonary resuscitation (CPR). It’s important, especially if one collapses because of a heart attack, it’s possible for them to get the help need before they are taken to hospital.

Immaculate Kiiza, Medical student

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Diet always plays a significant role when it comes to the health of a human being. It’s therefore important for people to always eat healthy so that they avoid many diseases and complications that come with poor diet.

Erick Musengimana, Nutritionist

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Although a lot has been done when it comes to awareness, there is still much more that is needed for the population to be educated on what is right for them as far as staying healthy is concerned.

Claudine Uwajeneza, Nurse

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Healthy feeding should be like a culture and parents should instill this in their children, and it should start as early as possible. In case of any problem as far as health is concerned, seeking medical help early is ideal.

Elias Ntwali, General practitioner

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