The Fever That Breaks the Heart: Nigeria’s Hidden Cardiac Emergency

Nigerians are dying of heart disease that began as an infection: a sore throat, a fever, a cough. A Nigerian-born physician in the United States argues that the country needs a new kind of specialist, and a national plan, before the toll grows.

By Dr. Chinelo Chioma Madekwe

Every Nigerian knows the feeling. A fever comes, we buy malaria drugs from the chemist, we rest for a few days, and we go back to our businesses. We treat the infection and move on.

But for many of our people, the story does not end there. Weeks, months or years later, they come to the hospital breathless, with swollen legs and a heart that can no longer pump well. By then, the infection that started it is long forgotten. The damage to the heart is not.

I am a Nigerian physician training in internal medicine in the United States, and I have spent my research career at the meeting point of two fields that Nigeria too often treats as separate: infectious disease and cardiovascular diseases. My message is simple. Nigeria’s infections are quietly breaking Nigerian hearts, and as a nation we are not yet looking for the damage.

Malaria: the fever we underestimate

Nigeria carries the heaviest malaria burden on earth. The World Health Organization’s World Malaria Report 2024 estimated about 68 million Nigerian cases in 2023, roughly a quarter of all cases in the world, and the largest share of global malaria deaths.

We think of malaria as a disease of the blood and the brain. Yet researchers have documented myocarditis, heart attacks and dangerous heart-rhythm changes in severe malaria. A 2021 international review of 43 studies concluded that heart complications in malaria are not uncommon, in adults and in children, and called for more research. When a country has 68 million cases a year, even a small percentage is a very largenumber of hearts.

HIV: a heart disease hiding in plain sight

Antiretroviral drugs have turned HIV from a death sentence into a chronic condition. That is a victory. But people living longer with HIV are now facing its effects on the heart.

Nigerian studies show how common this is. At Jos University Teaching Hospital, 84 of 200 adults with HIV, most of them on treatment, had heart disease on echocardiography.

In Nigerian children, one study found weakened heart pumping in 27% of those with HIV and 81% of those with AIDS. Much of this damage is silent until heart failure appears.

Tuberculosis: when the heart’s lining fills with fluid

Tuberculosis can infect the sac around the heart, causing tuberculous pericarditis. The IMPI Africa registry, which included patients at University College Hospital, Ibadan, found that about 40% of patients with suspected TB pericarditis in Cameroon, Nigeria and South Africa had features of HIV. Left untreated or treated late, TB pericarditis can scar the heart into a rigid shell.

The sore throat that damages heart valves

Rheumatic heart disease begins with an ordinary streptococcal sore throat in a child. Without antibiotics, the body’s immune response can attack the heart valves. Nigerian hospital studies report that most patients arrive late, already in heart failure, and many cannot afford the valve surgery they need. Africa, with a tenth of the world’s population, has been estimated to hold about half of the world’s children living with this disease.
COVID-19: the lesson we must not forget

COVID-19 showed us that a respiratory virus can attack the heart. Doctors in three Lagos centers reported COVID-19 patients who arrived not with pneumonia but with new heart failure, myocarditis and stress cardiomyopathy. Some had no lung disease at all.

The next pandemic may do the same. Too few doctors watching the heart All of this lands on a thin workforce.

The Nigerian Cardiac Society has said the country has only about 400 cardiologists for more than 220 million people. Many trained specialists have left the country. Very few doctors are trained to see infection and the heart as one problem.

A new kind of specialist

In wealthy countries, heart disease is mostly blamed on cholesterol, smoking, and age. Nigeria has those problems too, and they are growing. But Nigeria also carries a second, older burden: heart disease caused by infection. Our medical system splits these patients between the infectious disease doctor and the cardiologist, and patients fall into the gap.

This is the field I have chosen: cardiovascular infectious disease. My published research covers malaria, HIV and COVID-19, monkey pox, and my cardiology research has examined how sex-based disparities affects the heart, with work presented at the American College of Cardiology and the American Heart Association.

The war that gave me my purpose

I grew up in Abuja. I went to secondary school there, and like many young Nigerians, I left home with one dream: to become a doctor. That dream took me to medical school in Vinnytsia, Ukraine.

Then the war broke out. Overnight, the future I had planned was gone. Like thousands of other Nigerian students in Ukraine, I had no choice but to leave my medical school behind and come home. Little did I know that this tumultuous chapter would lead me to discover my purpose.

I returned to Nigeria unsure of what came next. As I continued my training, I did not expect that time at home to decide what kind of doctor I would become. Around me, I saw people whose hearts had been damaged by infections: malaria, HIV, tuberculosis. Too often, no one connected the infection to the heart until the damage was done.

Today I am training in internal medicine in the United States, and I can see how much more Nigeria could do, and how much of it is affordable. Nigeria is home to one of the largest Black populations on earth. What we learn about infection and the heart here can also help people of African descent elsewhere, including African Americans. My goal is to build that bridge, and to bring the knowledge home.

What Nigeria must do now

1. Check the heart in high-risk infections. A simple ECG and, where available, an echocardiogram for patients with severe malaria, advanced HIV or TB would catch damage early.
2. Treat sore throats in children properly. A full course of penicillin for strep throat is one of the cheapest heart-protection tools we have.
3. Bring HIV and heart care together. HIV clinics should screen for heart disease as routinely as they check viral load.
4. Train cardio-infectious disease specialists. Our teaching hospitals and the diaspora can build joint training and research programmes, so expertise flows back home.
5. Count the problem. Nigeria needs a national registry of infection-related heart disease. We cannot fix what we do not measure.
To every Nigerian reading this: a fever that leaves you breathless, a cough that will not go away, or swollen feet after an illness is not something to endure. Ask your doctor to check your heart.

Nigeria has fought malaria, HIV and COVID-19 with courage. The next stage of that fight is protecting the hearts of the people who survive them.

Dr. Chinelo Chioma Madekwe was born and raised in Abuja Nigeria and is an internal medicine resident at SUNY Upstate Medical University, Syracuse, United States. Her research focuses on how infectious diseases, including malaria, HIV, and COVID-19, affect the heart. She can be reached at madekwec@upstate.edu.