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Hidden heart disease in Nigeria is drawing concern as Dr Chinelo Chioma Madekwe urges earlier screening and better care for infection-related heart complications

Dr Chinelo Chioma Madekwe, a Nigerian physician and internal medicine resident at SUNY Upstate Medical University in Syracuse, New York, has urged Nigeria to strengthen the detection and treatment of heart disease linked to infectious illnesses, warning that complications associated with malaria, HIV, tuberculosis and other infections may remain unnoticed until patients develop serious cardiac problems.

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In an article published on 26 October 2026, Dr Madekwe called for closer cooperation between infectious disease specialists and cardiologists, wider access to appropriate heart investigations and a national registry to help Nigeria understand the scale of the problem.

The appeal brings renewed attention to an often overlooked aspect of public health: surviving an infection does not always mean escaping its consequences.

For some patients, the illness that initially appeared manageable can be followed by damage to the heart muscle, its valves or the protective sac surrounding the organ.

“Nigeria’s infections are quietly breaking Nigerian hearts,” Dr Madekwe wrote, capturing the central concern behind her call for a more coordinated approach to treatment.

Nigeria’s substantial infectious disease burden makes the issue particularly important. The World Health Organization’s World Malaria Report 2024 estimated that the country recorded approximately 68.1 million malaria cases in 2023, accounting for about 26 per cent of the global total.

The figures underline the scale of the challenge facing a health system already working to address a growing range of cardiovascular conditions.

Evidence also suggests that malaria can affect more than the blood and brain. A systematic review published in 2021 examined 43 studies of cardiovascular complications among people with symptomatic malaria.

Among adults included in the clinical studies, the researchers estimated that 7 per cent experienced a cardiovascular complication, although the findings varied across studies and populations.

Reported complications included myocarditis, which is inflammation of the heart muscle, and acute coronary syndromes.

The researchers cautioned that further investigation was needed to clarify the frequency and mechanisms of these complications.

The findings do not mean that every malaria infection causes heart damage. They do, however, support closer clinical attention when patients with severe malaria develop symptoms or signs suggesting cardiovascular involvement.

HIV presents another important dimension of the problem. Although antiretroviral treatment has substantially improved the prospects of people living with HIV, cardiovascular health remains an important part of long-term care.

A study involving 200 adults attending the HIV clinic at Jos University Teaching Hospital in north-central Nigeria found that 84 participants, or 42 per cent, had cardiac abnormalities identified through clinical assessment and echocardiography.

Most participants were receiving antiretroviral treatment.

The researchers identified abnormalities including impaired heart-muscle function, changes in the heart’s filling capacity and pericardial disease.

The study was hospital-based and cannot establish the prevalence of cardiac disease among all Nigerians living with HIV, but it illustrates why symptoms affecting the heart deserve attention alongside routine infection management.

Tuberculosis can also reach the heart, particularly the pericardium, the thin sac surrounding the organ. Inflammation and fluid accumulation can interfere with normal cardiac function, while prolonged disease may lead to constriction that prevents the heart from filling properly.

The Investigation of the Management of Pericarditis in Africa registry, which included patients treated in Nigeria, Cameroon and South Africa, enrolled 185 people with tuberculous pericarditis in 2004.

Forty per cent had clinical features of HIV infection, highlighting the overlap between two major infectious diseases in the region.

Although the registry reflects an earlier period and should not be treated as a measure of present-day prevalence, its findings remain relevant to understanding the clinical complexity of tuberculosis-related heart disease.

The COVID-19 pandemic offered a more recent reminder that infections can affect several organs at once.

A preliminary report examining 10 patients with COVID-19 and cardiac complications across three centres in Lagos documented new-onset heart failure in six patients.

Other reported presentations included myocarditis, probable pulmonary embolism and stress cardiomyopathy.

The small study was not designed to measure how frequently these complications occur among all people with COVID-19.

Its findings nevertheless demonstrated the range of cardiac problems that can accompany a serious viral illness, including in patients without extensive pneumonia.

Another preventable condition begins with a seemingly ordinary childhood illness. Rheumatic heart disease develops when the body’s immune response to a group A streptococcal infection damages the heart valves, often following untreated or inadequately treated strep throat.

The World Health Organization identifies rheumatic heart disease as a major cause of avoidable illness and disability, particularly in low- and middle-income countries.

Prompt diagnosis and appropriate antibiotic treatment of confirmed streptococcal infections can help prevent acute rheumatic fever and its potentially lasting effects on the heart.

For children who develop established valve damage, however, treatment can become considerably more complex. Some patients require long-term medical supervision or specialist procedures, placing additional pressure on families and already stretched health services.

These conditions illustrate why infection-related heart disease should not be viewed in isolation from Nigeria’s wider cardiovascular challenges.

Hypertension, diabetes and other non-communicable conditions are also contributing to the demand for cardiac care, making it essential to build services capable of addressing both infectious and chronic causes of illness.

The availability of specialists remains a significant concern. The Nigerian Cardiac Society has been cited in recent reporting as estimating that about 400 cardiologists serve a population exceeding 220 million people.

The uneven distribution of specialists, limited diagnostic capacity and the cost of treatment can make timely assessment difficult for patients outside major urban centres.

For households paying directly for healthcare, the financial consequences can be particularly severe when a condition is detected only after it has progressed.

Patients may require repeated consultations, investigations, prolonged medication or surgery, depending on the nature and severity of the damage.

Dr Madekwe’s proposed response centres on bringing the relevant services closer together.

She advocates considering electrocardiography and, where clinically indicated and available, echocardiography for patients with severe malaria, advanced HIV or tuberculosis when cardiac involvement is suspected.

An electrocardiogram records the heart’s electrical activity, while an echocardiogram uses ultrasound to assess its structure and function.

Neither investigation is necessary for every uncomplicated infection, and decisions should be guided by clinical assessment, available resources and established medical protocols.

The physician also argues that HIV services should pay greater attention to cardiovascular health, rather than concentrating exclusively on viral suppression.

Better coordination between HIV clinics, general medical services and cardiology teams could help identify patients who need further assessment before complications become advanced.

Training is another priority. Dr Madekwe wants Nigerian teaching hospitals to develop programmes that connect infectious disease medicine with cardiovascular care, drawing on collaboration with specialists and researchers in the diaspora.

Her own professional journey gives the proposal a personal dimension. Raised in Abuja, Dr Madekwe pursued medical education in Vinnytsia, Ukraine, before Russia’s full-scale invasion disrupted her studies and forced her to leave the country with other international students.

Returning to Nigeria created an unexpected interruption to the path she had planned. The experience also shaped her perspective on the gaps in care facing patients whose infectious illnesses later develop into serious cardiac problems.

She subsequently continued her medical training in the United States, where her research has focused on the cardiovascular effects of infectious diseases, including malaria, HIV and COVID-19.

Her work has also examined sex-based differences in cardiovascular outcomes.

The combination of clinical training and research has informed her argument that Nigeria needs a more deliberate way of identifying, recording and treating infection-related cardiac complications.

A national registry, she argues, would help policymakers and researchers establish the scale of the problem, identify gaps in care and determine where limited resources could have the greatest impact.

Such a registry would require clear diagnostic criteria, reliable reporting from hospitals and sufficient investment in data collection.

Screening programmes would also need to be designed carefully so that additional testing reaches patients most likely to benefit without placing unnecessary demands on facilities that already face shortages.

The wider policy challenge is therefore one of implementation as much as awareness.

Early detection can improve the chances of timely treatment, but it must be supported by affordable investigations, access to appropriate medicines, referral pathways and specialist care when necessary.

For patients and families, the message is equally practical. Persistent or worsening breathlessness, unexplained swelling of the legs, chest discomfort, fainting or a racing heartbeat following an illness should prompt medical assessment.

Such symptoms can have several causes, and their presence does not automatically mean that an infection has damaged the heart.

Severe breathlessness, chest pain or collapse requires urgent medical attention.

People recovering from malaria, tuberculosis, COVID-19 or other infections should follow their clinicians’ advice and seek reassessment if concerning symptoms develop.

Nigeria has made important gains in the prevention and treatment of infectious diseases, but the consequences of illness can extend beyond the initial infection.

Recognising that connection offers an opportunity to strengthen existing services rather than create an entirely separate system of care.

Dr Madekwe’s central argument is that protecting patients must include attention to the health of the heart, both during serious infections and in the months that follow.

Turning that principle into practice will require stronger evidence, coordinated medical teams and sustained investment in accessible healthcare.

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The task is demanding, but the potential benefit is clear: fewer patients reaching hospitals only after preventable cardiac damage has become difficult and costly to treat.