Abstract We report an elderly woman with renal stones, in whom a calcified dissecting aortic aneurysm was discovered. We discuss the implications for subsequent management.
Abstract Physiological changes of pregnancy exert stress on the heart that could lead to cardiac decompensation, especially in the presence of background diseases such as cardiomyopathy, hypertension, valvular, or congenital heart diseases. Heart disease in pregnancy is an important contributor to maternal and fetal adverse outcomes. Although data on heart disease in pregnancy are generally scarce, a few available studies have shown higher prevalence in northern than southern regions of Nigeria. In addition, clinical outcomes among pregnant women diagnosed with heart disease are worse than among those without and apparently healthy women. The aim of this review was to describe the pattern and outcomes of heart disease in pregnancy in Northern Nigeria and to identify the existing gaps in knowledge, which can be explored in a subsequent multicenter national study.
Abstract Introduction: Patients with human immunodeficiency virus (HIV) infection are at increased risk of cardiovascular disease compared with the general population, and right ventricular (RV) systolic dysfunction is said to be associated with worse outcomes. HIV infection is an established risk factor for pulmonary hypertension. On the other hand, pulmonary hypertension directly affects RV function through an increase in pulmonary vascular resistance, causing right ventricle hypertrophy, chamber dilatation, and ultimately RV systolic dysfunction. We, therefore, sought to assess RV systolic function (RVSF) using RV fractional area change (RVFAC) among HIV patients on highly active antiretroviral therapy (HAART) and its relationship with viral load and CD4 cell count. Methods: The study was a cross-sectional conducted among HIV patients receiving HAART at the Federal Medical Center, Nguru, Yobe State, North Eastern Nigeria, using RVFAC among HIV patients on HAART and its relationship with viral load and CD4 cell count. Results: One hundred and seven subjects were recruited into the study, comprising 37 (34.6%) males and 70 (65.4%) females. Ninety-six (89.71%) had preserved RVSF, while 11 (10.3%) had reduced RVSF. The mean CD4 cell count of patients with preserved RVSF was significantly higher compared to those with reduced RVSF (838.4 ± 27.5 cells/μL and 301.7 ± 12.4 cells/μL), respectively P ≤ 0.001. The mean viral load of patients with preserved was significantly lower compared to those with reduced RVSF (547.9 ± 10.8 1 copies/mL and 10,293.00 ± 74.8 1 copies/mL), respectively P ≤ 0.001. Conclusion: The prevalence of RV systolic dysfunction among HIV patients on HAART was found to be 10.3% and there was a significant positive correlation between RVFAC with CD4 cell count and a significant negative correlation between RVFAC with HIV viral load.
Abstract Interest in cardiac electrophysiology is increasing in sub Saharan Africa, but the interpretation of results is poorly understood. Cardiac electrophysiology is the study of the electrical activity of the heart by virtue of catheters that are positioned in the heart in addition to leads placed on the chest surface. It is useful in identifying sites of origin of various cardiac arrhythmias, diagnosing conduction abnormalities, and treating various arrhythmias. This is the second in a series reviewing cardiac electrophysiology methods. The first introduced cardiac electrophysiology and assessment of the sinus and atrioventricular nodes. This paper reviews the assessment of supraventricular tachycardias.
Abstract Endomyocardial fibrosis (EMF) is characterized by the abnormal scarring of the endocardium with deposition of fibrous tissues in the apices and inflow tracts of the right ventricle, left ventricle, or both, leading to symptoms such as heart failure, arrhythmias, and intracardiac thrombosis. EMF is a rare cause of cardiac morbidity and mortality in children of the tropics including Nigeria, hence the presentation of this case report. A 12-year-old male presented to Children emergency ward with abdominal swelling from infancy, which worsened 3 months before presentation, leg swelling and weight loss of 3 months, cough of 1 month, and fast breathing of 1 week. Physical examination revealed dyspnea, pedal and leg edema, absent breath sounds in the right middle and lower lung zone, tachycardia, irregular pulse, elevated jugular venous pressure, and a grossly distended abdomen. Echocardiography demonstrated dilated atria, thickened AV valves, small, thickened ventricular cavities, intra-atrial thrombus, fibrous tissue in the apices and inlets of left and right ventricles, and pericardial effusion. Electrocardiography revealed first-degree AV block, left anterior fascicular block, and left atrial enlargement. Chest radiograph revealed right lobar pneumonia, pleural effusion, and cardiomegaly. The abdominopelvic scan revealed congestive hepatomegaly and ascites. He received diuretics, beta-blockers, aspirin, and antibiotics. Repeated abdominal paracentesis, thoracocentesis, and pericardiocentesis drained 14.2 L, 1.5 L, and 2.1 L of serosanguineous fluid, respectively. EMF is an enigmatic disease which requires further research to unravel its underlying mechanisms and develop more targeted therapeutic strategies.
Abstract Background: Obstructive sleep apnea (OSA), characterized by cessation of ventilation or occurrence of significant hypoventilation during sleep, is associated with several complications, including cardiovascular dysfunction. This study aims to determine the prevalence and determinants of elevated mean pulmonary artery pressure (mPAP) and right ventricular (RV) dysfunction in children with OSA. Materials and Methods: A cross-sectional comparative study was conducted on 75 eligible children with OSA aged 2–14 years and compared with 75 age- and sex-matched apparently healthy children. Trans-thoracic echocardiography was used to assess the pulmonary artery pressure as well as RV systolic and global function. Results: The mean mPAP was significantly higher in the children with OSA (20.41 ± 8.5) as compared to the controls (11.35 ± 2.8) ( P < 0.001). Elevated mPAP was found in 29.3% of the children with OSA, while 33.3% and 34.7% had RV systolic and global dysfunction, respectively. Children with a duration of OSA ≥2 years were more likely to have elevated mPAP than those with a duration of illness <2 years ( P = 0.046). RV systolic and global dysfunctions were significantly more common in the cases with elevated mPAP compared with those with normal mPAP ( P < 0.001). Conclusion: Elevated mPAP and RV dysfunction are common in children with OSA, especially those with a duration of illness ≥2 years. Children with OSA and elevated mPAP are more likely to have impaired RV systolic and global function.
Abstract Recent stroke is a recognized contraindication to anticoagulation. However, some patients with a recent hemorrhagic stroke develop deep venous thrombosis. This creates a dilemma whereby the physicians have to navigate the best in the risky line of management. We report a 65-year-old man with pulmonary embolism 3 weeks after hemorrhagic stroke. He was given conventional anticoagulant treatment and was discharged with clinical improvement 2 weeks later.
Abstract Introduction: Acute coronary syndrome is a medical emergency resulting from sudden obstruction of the coronary artery. The main objective of this study was to describe the pattern of rhythm abnormalities at the early stage of acute coronary syndrome and their possible associated factors in Brazzaville (Congo). Methods: A prospective and analytical study was carried out in the Cardiology Department of the University Hospital of Brazzaville from January 1, 2019, to December 31, 2021. We included consecutively all patients hospitalized for acute coronary syndrome and having carried out a Holter-electrocardiogram (EKG) during the first 24 h. Results: The study concerned 59 patients. Coronary syndrome including ST segment elevation in 54 patients (91.5%) and without ST elevation in five patients (8.5%). The location of electrocardiographic abnormalities was anterosepto-apical (30.5%), extensive anterior (22%), anteroseptal (20.3%), inferior (17%), lateral (6.8%), and apicolateral (3.4%). Rhythm and conduction abnormalities on Holter-EKG were supraventricular extrasystole (49.2%), ventricular extrasystole (47.5%), atrioventricular block (6.8%), atrial fibrillation (3.4%), and ventricular tachycardia (3.4%). No relationship was found between clinico-biological factors and the occurrence of ventricular extrasystoles. Conclusion: The early stage of acute coronary syndrome was mostly associated to ventricular and supraventricular extrasystoles without link with clinico-biological factors.
Abstract Background: The study aimed at establishing the normal value of electrocardiographic parameters in healthy young African population, in sub-Saharan Africa, using digital electrocardiogram (ECG) recordings and comparing between males and females. Methods: The study population included 656 healthy young adults from the ages of 15–40 years, undergraduate students, made up of 357 females and 299 males. The study took place in the Department of Human Physiology Laboratory of our University. The 12-lead ECGs were recorded and read using a validated computer program. Various parameters were recorded and the 2 nd and 98 th percentiles were taken as the normal range of the study population. Results: Findings from our study show some differences from studies made in the same region using manual methods of ECG readings and compared to studies done in other races. The 2 nd percentile, median, and 98 th percentile of the studied parameters were as follows: PR interval was 102 ms, 140 ms, and 196 ms, respectively, in females and 104 ms, 144 ms, and 202 ms, respectively, in males. P-wave duration was 76 ms, 100 ms, and 126 ms in females and 62 ms, 98 ms, and 130 ms in males, respectively. We found the QTc (Bazett) to be 371 ms, 420 ms, and 467 ms in females and 344 ms, 389 ms, and 442 ms in males, respectively. Frontal QRS axis was − 6°, 53°, and 113° in females and − 11°, 57°, and 108° in males; frontal T axis was − 8°, 36°, and 141° in females and − 127°, 48°, and 75° in males; and QRS-T angle was 8°, 43°, and 115° in females and 25°, 84°, and 153° in males, respectively. Conclusion: This study provided reference values for healthy young Sub-Saharan African population using digital 12-lead ECG. It will serve as a reference for what is normal in our race and also prognosticate and monitor those that are predisposed to developing some cardiovascular diseases in the future.
Abstract This is a case report of three patients who were managed for right sided infective endocarditis, each posing diagnostic challenges due to atypical clinical presentations and negative blood culture results. Case 1 is a 20-year-old female intravenous (IV) drug user who presented with septic emboli to the lung. Case 2 is a 43-year-old woman with a tunnel catheter for dialysis who had huge vegetations on the tricuspid valve which turned out to be fungal in origin. Case 3 is a 45-year-old female with background Ehlers-Danlos syndrome who developed tricuspid endocarditis following IV injections/line in a peripheral hospital. In this report, we discussed the factors causing late diagnosis of isolated tricuspid valve infective endocarditis in our environment, challenges of diagnosing this condition in patients with underlying health issues and the difficulties of obtaining blood culture results.
Abstract Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred ( P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI ( P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Abstract Background: Ideal cardiovascular health (ICH) is a metric for primordial prevention of cardiovascular disease. Its prevalence in Nigerians is not known. Methods: This cross-sectional study assessed the seven American Heart Association’s ICH metrics of 889 Nigerians. The metrics included nonsmoking, healthy diet, physical activity, body mass index (<25 kg/m 2 ), untreated blood pressure (BP) <120/<80 mmHg, untreated total cholesterol <200 mg/dL, and untreated fasting blood glucose <100 mg/dL). Logistic regressions were used to estimate associations between sociodemographic factors (age and sex) and meeting 5–7 CVH metrics. Results: No one met all 7 of ICH metrics while 70 (7.8%) had 5–7 metrics. The most prevalent and least prevalent ideal biological factors were ideal fasting plasma cholesterol (62.8%) and ideal BP (31.5%), respectively. The most prevalent and least prevalent behavioral factors were ideal smoking status (86.2%) and ideal diet (6.5%) respectively. Compared to males, females had better ideal BP, P = 0.005; better ideal fasting plasma glucose, P = 0.031; better ideal fasting plasma cholesterol, P < 0.001; and ideal smoking status, P < 0.001. Ages 45–64 had better ideal smoking status and ideal physical activity ( P < 0.001 and P = 0.001, respectively). Conclusions: There is a low prevalence of ICH among Nigerians. Concerted efforts should be made to improve healthy living among Nigerians.
Abstract A 73-year-old woman presented with metastatic lung disease with primary from the thyroid mass and with sepsis complicating gastroenteritis and respiratory tract infection. On a computerized computer tomography scan, an aberrant right subclavian artery was detected. It is a rare abnormality of the aortic arch. There is a need for increased awareness, knowledge of the implications for patient management, and development of cardiothoracic surgery.
Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia that is encountered in clinical practice and is associated with increased risk of stroke and death. Because both heart failure (HF) and AF are associated with significant morbidity and mortality, their coexistence identifies individuals at higher mortality risk. We set out to describe the determinants of short-term outcome of mortality among HF patients with AF in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methodology: We conducted a longitudinal study of all adults aged 18 years and above who presented at AKTH, Kano, within the study period and were hospitalized for HF. Those who consented were consecutively recruited into the study. Sociodemographic, clinical, laboratory, electrocardiographic, and echocardiographic characteristics of patients at presentation were documented. We divided the patients into two groups: Those with AF and those with sinus rhythm (SR). We followed both groups for 3 months to look for the causes of mortality for each of the groups. In addition, we documented the determinants of mortality among the AF group. Data analysis was done using Statistical Package for the Social Sciences (SPSS) application version 20. Results: Out of the 30 HF patients with AF studied, 17 (56.7%) died within the period of follow-up. In bivariate analysis, we found mortality among patients with AF was associated with high New York Heart Association functional class and nontreatment with Vitamin K antagonist (warfarin). In multivariate analysis, nontreatment with warfarin was the only independent predictor of death among the HF patients with AF, with odds of dying 19-times higher among patients who did not receive warfarin compared to those who received it (adjusted odds ratio = 19.4, 95% confidence interval = 2.6–148). Conclusion: HF patients with AF have high mortality and nontreatment with warfarin is an independent predictor of that mortality. However, more studies with larger sample size are needed in our country to fully study the determinants of short-term outcomes of HF patients with AF.
Abstract Infective endocarditis is not frequently reported in our environment, partly due to poor index of suspicion, inadequate investigation, and high mortality. We report a 52-year-old man who developed and presented with sepsis, hyperglycemia, cardiac failure, and echocardiographic detection of vegetation. We discuss management challenges in our environment.
Abstract Hypertension is still a silent killer, and many enlightened persons are not aware of this. We report a 44-year-old male, hypertensive but poorly controlled, who was discovered unconscious and found to have a pontine hemorrhage. This case highlights areas of improvement in the case management and the need for improved efforts at education for good control and management of hypertension.
Abstract The 2022 American Heart Association /American College of Cardiology /Heart Failure Society of America Guideline, for the Management of Heart Failure, aimed to provide an update and consolidate the earlier versions, into a new document. Areas of focus in the 2022 heart failure (HF) guidelines are the prevention of HF and the new treatment strategies in HF using contemporary approaches to care. Influenza vaccination, a key nonpharmacologic intervention tested in a large cohort of HF patients including Nigerians, could significantly reduce clinical outcomes. This commentary aimed to clarify the relevance of this international standard practice guideline on HF, to the practice in Nigeria, and highlight the existing peculiarities. It is hoped that this commentary would serve as a prelude to a future Nigerian guideline for the management of HF.
Abstract Introduction: The inferior vena cava (IVC) occupies a retroperitoneal position deep inside the abdominal cavity. Its location makes surgical access very difficult. The terminal part of the IVC enters the thoracic cavity behind the heart after traversing the diaphragm. IVC continuously drains the lower half of the body. The surgical management of IVC is thus challenging for surgeons. Objectives: The objective of the study is a retrospective examination of the IVC operations performed by our team members over the last decade. This would help analyze the difficulties of IVC operations. A better understanding of the previous surgeries would build a better management strategy for dealing with the difficult cases of IVC and reducing morbidity and mortality in the future. Methods: This retrospective observational study was conducted on cases operated between January 2009 and December 2018. Data were collected from patients’ files, admission registrars, operation theater notes, and intensive care unit record books. This study includes 22 patients operated in different hospitals in our country. Results: Among these 22 cases, 10 (45.5%) underwent elective and 12 (54.5%) underwent emergency operations. Of the routine cases, 7 (31.8%) were renal cell carcinoma, 2 (9%) were retroperitoneal sarcoma, and 1 (4.5%) was neurogenic tumor. Moreover, among the emergency cases, 2 (9%) were traumatic (bullet) injuries and the rest of the cases, 10 (45.5%) were iatrogenic injuries during other abdominal or thoracic surgery. There was no in-hospital mortality in this series. Conclusion: IVC surgery is very challenging. Appropriate assessment of the patients, timely management of shock, and proper planning is important for successful outcomes. Adequate operative facilities, a skilled team, blood for transfusion, vascular grafts, and the availability of cardiopulmonary bypass, when required, may play important roles in saving precious lives.
Sir, Ahmadu et al.[1] reported a case report of infective endocarditis (IE) due to Acinetobacter baumannii in a 2-month-old Nigerian infant with complex congenital heart disease. We believe that the following point is noteworthy. Through unrecognized mechanisms, human immunodeficiency virus (HIV) infection might cause different cardiac complications already present in childhood, such as pulmonary hypertension, structural and functional myocardial disorders, pericardial effusion, and endocarditis.[2] The rates of congenital cardiovascular anomalies have been reported to constitute 5.6%–8.9% in cohorts of HIV-infected and HIV-uninfected children with HIV-positive mothers.[3] Due to compromised immunity, patients with HIV infection are at increased risk to develop various infections, particularly with opportunistic pathogens. Indeed, IE has been reported in HIV-positive individuals and it could be the first presentation of underlying HIV infection in infancy.[4] In Nigeria, HIV infection is a major public health threat and its prevalence among pregnant women is substantial (12.3%).[5] Some sort of vertical HIV transmission to the infant would be inevitable if the mother had HIV infection during pregnancy. Importantly, evaluation of HIV status in the studied infant and mother was solicited. Regrettably, the case in question passed away despite the commencement of intensive therapy before contemplating HIV testing. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Abstract Ebstein’s anomaly is a rare congenital condition that presents with an apical displacement of the tricuspid valve leaflets. Much rarer is its coexistence with Chiari network (CN), and only a very few cases had been documented in the literature. We report a 30-year-old man who presented with a 5-month history of progressively worsening abdominal distension with associated weight loss, easy fatigability, early satiety, and loss of appetite. A chest X-ray revealed cardiomegaly with right ventricular preponderance. A 12-lead electrocardiogram showed atrial fibrillation. Transthoracic echocardiography revealed apical displacement of the tricuspid valve, severe right atrial enlargement, a small right ventricle, atrialization of the right ventricle, and CN. A diagnosis of Ebstein anomaly coexisting with CN in atrial fibrillation was made. To our knowledge, this is the first reported case of Ebstein’s anomaly coexisting with CN in Nigeria.
