[Venous thrombosis and bilateral arterial occlusion of lower limb revealing HIV infection]. / Thrombose veineuse et occlusion artérielle bilatérale des membres inférieurs révélant une infection par le VIH.

Human immunodeficiency virus (HIV) infection can cause vascular complications. This is most often of lower limb venous thrombosis. Rare cases of limb ischemia indicative of HIV infection have been described.We report a case of venous thrombosis of the left lower limb and bilateral lower arterial ischemia revealing an HIV infection in a patient of 44 years. The CD4 count was 195/mm(3). Investigations on coagulation were not realized. The patient was amputated both his legs.

[Epidemiological, clinical and ultrasonographic aspects of right-sided infective endocarditis in Senegal: 6 cases]. / Aspects epidémiologiques, cliniques et echographiques des endocardites infectieuses du coeur droit au Sénégal: 6 observations.

Right-sided infective endocarditis accounts for 5 to 10% of endocarditic involvement and usually affects the tricuspid valve. The purpose of this report is to describe epidemiological, clinical and echocardiographical aspects of 6 cases of right-sided infective endocarditis observed in the Cardiology Department of Aristide Le Dantec Hospital in Dakar, Senegal from December 2007 to February 2010. Diagnosis was based on Duke's modified criteria. There were 3 men and 3 women with a mean age of 28.2 years (range: 20 and 43). Five of the 6 patients presented tricuspid endocarditis including one case associated with pulmonary endocarditis. In another case, pulmonary endocarditis was associated with aortic endocarditis. Infective endocarditis was acute in three cases and primary in four. One case of infective endocarditis was observed in a tetralogy of Fallot. Fever was present in 4 cases with an mean temperature of 38.4 degrees C (range, 37.2 to 40 degrees C) and heart failure was present in 5 cases. In 2 patients, blood cultures were positive for Staphylococcus aureus. All patients had leucocytosis with a neutrophilic predominance. Doppler echocardiography depicted vegetations in all cases. Contributing factors included congenital heart disease in 1 case, insertion of a venous catheter in 2 and dental infection in 2. No patient was addicted to intravenous drugs or infected by HIV. Outcomes included one in-hospital death with signs of refractory heart failure. Right-sided endocarditis is often primary and is dominated by the tricuspid involvement. It affects both sexes. Contributing factors include venous catheterization during the postpartum period and dental infection. Prevention requires strict asepsis during venous catheter insertion, treatment of dental infections and improved management of congenital heart disease.

Acute circulatory failure in two cardiology departments in Dakar: 44 cases.

INTRODUCTION: Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar. METHODS: This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients. RESULTS: Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance. CONCLUSIONS: Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.

[Ambulatory Blood Pressure Measurement's Reults And Indications At Cadiology Department At Hôpital Aristide Le Dantec]. / Indications Et Resultats De La Mesure Ambulatoire De Pression Arterielle Au Service De Cardiologie De L'Hopital Aristide Le Dantec.

High blood pressure (HTA) is a public health problem. It affects more than one billion people around the world, more than a quarter of the world's population. In recent years the ABPM (Ambulatory Blood Pressure Measurement) has become a valuable and widely used tool for the diagnosis and management of hypertension. The aims of this study were to determine the indications of MAPA to the cardiology department of Aristide le Dantec Hospital; to determine the results and to evaluate the blood pressure profile of our patients. METHODS: We carried out a retrospective study, over 37 months from December 2010 to December 2013 covering all the results of the ABPMs recorded during this period. Was included any patient over 18 years of age with an ABPM. All ABPMs with less than 50 good measures per 24 hours were not included. RESULTS: A total of 204 MAPA results were included of a total of 307. The mean age was 49.6 ± 11.5 years with extremes of 25 years and 78 years. The sex ratio was 1.5 in favour of women. Indications were dominated by labile HTA (34.8%); masked HTA (27.9%) and suspicious of the white coat effect (12.3%). The analysis of the results showed that MAPA was normal in 49.5%. The white coat effect was found in 32% (65 patients) of ABPM. In patients with abnormal ABPM, permanent systolic-diastolic hypertension predominated (57%). HTA masked was noted in 25.7% of our patients and HTA white coat was found in 3.8% of cases. In the hypertensive patients treated, MAPA revealed a poor blood pressure balance in 42.1%. Among the HTA prognostic factors we noted32.4% of patients were "Non Dippers", a pulse pressure greater than or equal to 60 mmHg in 59%. CONCLUSION: The use of this exploration is an important aid to practitioners in the diagnostic, therapeutic and prognosis phase of the management of hypertension. It should become more important as it provides better information on the blood pressure profile for the patients.

INTRODUCTION: L'hypertension artérielle(HTA) représente un problème de santé publique. Elle concerne plus d'un milliard d'individus à travers le monde, soit plus du quart de la population mondiale. Ces dernières années la MAPA (mesure ambulatoire de la pression artérielle) est devenue un outil précieux et largement utilisé pour le diagnostic et la prise en charge de l'HTA. Les objectifs de ce travail étaient de déterminer les indications de la MAPA au service de cardiologie de l'hôpital Aristide le Dantec ; d'en déterminer les résultats et d'évaluer le profil tensionnel de nos patients. MÉTHODES: Nous avons réalisé une étude rétrospective, sur 37 mois allant de Décembre 2010 à Décembre 2013 portant sur l'ensemble des résultats des MAPA enregistrées durant cette période. Était inclus tout patient âgé de plus de 18 ans chez qui une MAPA a été enregistré Toutes les MAPA ayant moins de 50 bonnes mesures par 24 heures n'ont pas été inclus. RÉSULTATS: Au total 204 résultats de MAPA ont été inclus sur un total de 307. L'âge moyen était de 49,6 ± 11,5 ans avec des extrêmes de 25 ans et 78 ans. Le sex ratio était de 1,5 en faveur des femmes. Les indications étaient dominées par l'HTA labile (34,8%) ; l'HTA masquée (27,9%) et la recherche de l'effet blouse blanche (12,3%). L'analyse des résultats avait montré que la MAPA était normale dans 49,5% des cas. L'effet blouse blanche était retrouvé dans 32% (65 patients) des MAPA réalisées à visée diagnostique. Chez les patients dont les résultats étaient anormaux l'HTA systolo-diastolique permanente prédominait (57%) avec une différence significative (p=0,003). L'HTA masquée étaient notée chez 25,7% de nos patients et l'HTA blouse blanche était retrouvée dans 3,8% des cas. Chez les hypertendus traités, la MAPA avait révélé un mauvais équilibre tensionnel dans 42.1% des cas et cela au dépens de la systolique avec une différence significative (p=0,02). Parmi les facteurs pronostiques on retrouvait 32,4% de patients « Non Dippers ¼, une pression pulsée supérieure ou égale à 60 mm Hg dans 59%. Le caractère adrénergique était retrouvé chez 65,7% de nos patients. CONCLUSION: L'utilisation de cette exploration constitue une aide importante aux praticiens à la phase diagnostique, thérapeutique, et pronostique de la prise en charge de l'HTA. Elle devrait occuper de plus en plus de place car elle donne de meilleurs renseignements sur le profil tensionnel dans l'environnement quotidien habituel du patient.

[Prevalence of cardiovascular risk factors in semi-rural area in Senegal]. / Prévalence des facteurs de risque cardio-vasculaire en milieu semi-rural au Sénégal.

OBJECTIVES: We aim to determine the prevalence of cardiovascular risk factors in the semi-rural population of the community of Gueoul in Senegal. PATIENTS AND METHOD: This is a cross-sectional, observational and descriptive study. We conducted an exhaustive survey in 2012 according to the STEPS wise approach of the world health organization against Senegalese aged of 35 years and over who resided for at least 6 months in semi-rural area in the community of Gueoul. Pregnant women were excluded. Classical cardiovascular risk factors were collected and data analyzed using SPSS 18.0 software. The significance level was agreed for a value of P<0.05. RESULTS: We examined 1411 subjects (1052 women) with a mean age of 48.5±12.68 years. The main cardiovascular risk factors were dyslipidemia (61,1%), physical inactivity (56.2%), abdominal obesity according to the International Diabetes Federation (53.9%), hypertension (46.4%), global obesity (13%), diabetes (7.2%) and smoking (2.5%). Hypertension was significantly associated with diabetes (P=0.001), abdominal obesity (P=0.001) and global obesity (P=0.0001). Sedentarity (P=0.001), global obesity (P=0.0001) and hypertension (P=0.001) were more frequent in women. CONCLUSION: Cardiovascular risk factors are frequent and often associated in semi-rural area of Senegal, particularly in women. This condition should lead to develop prevention strategies of cardiovascular complications.

[Comparative Study Of Coronary Artery Disease In Diabetics And Non-Diabetics In The Department Of Cardiology Of Aristide Le Dantec University Hospital]. / Etude Comparative De La Maladie Coronaire Chez Les Diabétiques Et Non Diabétiques Au Service De Cardiologie Du CHU Aristide Le Dantec.

The aim of this study was to compare the features of coronary artery disease between diabetic and non-diabetic patients. PATIENTS AND METHODS: A case-control study was carried out from 1 May 2013 to 31 July 2015 in the department of cardiology of Aristide le Dantec university hospital. Forty-five diabetic patients and forty-five non-diabetic patients who underwent coronary angiography and / or angioplasty were included. RESULTS: There was a male predominance with a sex ratio of 1.6 in both groups. The mean age was 62.26 years for diabetics and 59.06 years for non-diabetics (p = 0.6). In diabetics, symptomatology was dominated by silent ischemia (48.9%) versus typical angina pain (68.9%) in non-diabetics. Myocardial infarction was the most common indication of coronary angiography in both groups. Coronary angiography revealed one-vessel disease (46.6% versus 41.7% p = 0.822), double vessel disease (26.7% versus 41.7% p = 0.091) and triple vessel disease (26.7% versus 16.6% p = 0.561). Angioplasty was indicated in 37.8% of diabetics versus 63.9% of non-diabetics. Nine diabetic patients and three non-diabetic patients had an indication of coronary artery bypass grafting. CONCLUSION: Our study confirms the greater frequency of silent ischemia and multiple-vessel disease in diabetics as well as a more frequent indication of coronary artery bypass grafting in these patients.

L'objectif de cette étude était de comparer les aspects de la maladie coronaire entre les patients diabétiques et non diabétiques. PATIENTS ET MÉTHODES: Une étude cas-témoins a été réalisée du 1er mai 2013 au 31 juillet 2015 au service de cardiologie du CHU Aristide le Dantec. Quarante cinq patients diabétiques et 45 patients non diabétiques ayant bénéficié d'une coronarographie et/ou d'une angioplastie avaient été inclus. RÉSULTATS: Nous avions retrouvé une prédominance masculine avec un sex ratio de 1,6 dans les deux groupes. L'âge moyen était de 62,26 ans pour les diabétiques et de 59,06 ans pour les non diabétiques (p=0,6). Chez les diabétiques, la symptomatologie était dominée par l'ischémie silencieuse (48,9%) et la douleur angineuse typique (68,9%) chez les non diabétiques. L'infarctus du myocarde était l'indication de la coronarographie la plus fréquente dans les deux groupes. La coronarographie retrouvait respectivement chez les diabétiques et non diabétiques une atteinte mono-tronculaire (46,6% versus 41,7% p=0,822), une atteinte bi-tronculaire (26,7% versus 41,7% p=0,091) et une atteinte tri-tronculaire (26.7% versus 16,6 % p=0,561). Une angioplastie avait été indiquée chez (37,8%) des diabétiques et (63,9%) des non diabétiques. Neuf patients diabétiques et trois patients non diabétiques avaient eu une indication de pontage coronaire. CONCLUSION: Notre étude confirme une plus grande fréquence de l'ischémie silencieuse et de l'atteinte multi tronculaire chez les diabétiques ainsi qu'une indication plus fréquente de pontage aorto coronaire.

[Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]. / Cardiopathies congénitales de l'adolescent et de l'adulte : prise en charge dans un service de cardiologie générale au Sénégal.

BACKGROUND: Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes. METHODS: We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography. RESULTS: We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%). CONCLUSION: Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.

[Left ventricular hypertrophy in black African subjects with artery hypertension: Results of a cross-sectional survey conducted in semi-rural area in Senegal]. / L'hypertrophie ventriculaire gauche chez le sujet noir Africain hypertendu : résultats d'une enquête transversale, réalisée en milieu semi-rural au Sénégal.

OBJECTIVES: To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. PATIENTS AND METHODS: According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05. RESULTS: We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003). CONCLUSION: Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

[Study of echocardiographic parameters of rheumatoid arthritis black African without clinically evident cardiovascular manifestations: A cross-sectional study of 73 cases in Senegal]. / Étude des paramètres échocardiographiques de la polyarthrite rhumatoïde noire africaine asymptomatique au plan cardiovasculaire : étude transversale de 73 cas sénégalais.

INTRODUCTION: Research of cardiac involvement in patients with rheumatoid arthritis can prevent complications and place in a logical secondary prevention. The objective of this study was to investigate the echocardiographic parameters in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations. PATIENTS AND METHOD: We conducted a descriptive cross-sectional study, which included prospectively from outpatients in the internal medicine department of university hospital center Aristide Le Dantec in Dakar, Senegal, with a diagnosis of rheumatoid arthritis without clinically evident cardiovascular disease. It focused on a sample of 73 patients of both sexes aged at least 18 years. Following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, rheumatoid factors: Latex and Waaler-Rose, anti-CCP, antinuclear factors and anti-ENA antibodies), ECG, echocardiography standard. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables. RESULTS: A total of 73 patients with rheumatoid arthritis without obvious cardiac events and meeting the criteria of definition of the ACR 1987 were included in the study. The mean age was 44.17±14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93±4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). The abnormalities found in Doppler echocardiography were dominated by diastolic LV dysfunction (42.46%), increased left ventricular mass in 35.61%. Valvular leaks of variable grades were highlighted regarding all orifices but were rarely significant. CONCLUSION: The realization of echocardiography in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations helps to highlight cardiovascular abnormalities related to the natural course of the disease.

[Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]. / Prévalence des porteurs de plaques d'athérome carotidiennes dans la population semi-rurale de Guéoul au Sénégal : enquête sur 1411 sujets.

AIMS: The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal. PATIENTS AND METHOD: This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant. RESULTS: The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5). CONCLUSION: Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]. / Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

[Pseudoaneurysm of the left ventricle in young patients: A propos of three cases]. / Faux anévrisme du ventricule gauche du sujet jeune : à propos de trois cas.

Pseudoaneurysm of the left ventricle is a rare late complication of myocardial infarction. So-called non-coronary forms have been described in young people. In this context, we report three cases. Mr. M.B., aged 20, consulted for chest pain associated with palpitations. Cardiovascular examination found a pulsatile, expanding precordial bulging and a mesocardiac systolo-diastolic murmur. We noted a sinus rhythm with ventricular extrasystoles on ECG. The chest radiograph showed cardiomegaly and aneurysmal deformation of the left lower heart border. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mrs. O.B., aged 23, was admitted for biventricular heart failure and in whom the examination found a systolic murmur in the apical area. ECG showed a regular sinus tachycardia, left atrial and ventricular hypertrophy. The chest radiograph showed cardiomegaly and aneurysmal deformation of left middle and lower heart borders. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mr. I.S., aged 24, admitted for the management of congestive heart failure. The patient had non-specific laboratory inflammatory signs, a sinus tachycardia and extrasystoles on the ECG. Chest radiography showed a discontinuation at the posterior arch of the sixth rib, a cardiomegaly and a neurismal dilatation of the left lower heart border. Doppler echocardiography showed a large apical pseudoaneurysm of the left ventricle.

[Prevalence of congenital heart diseases in Koranic schools (daara) in Dakar: a cross-sectional study based on clinical and echocardiographic screening in 2019 school children]. / Prévalence des cardiopathies congénitales en milieu scolaire coranique (daara) à Dakar : étude transversale basée sur le dépistage clinique et échographique de 2019 élèves.

Congenital heart diseases are one of the major cardiovascular diseases in developing countries. Most prevalence studies were based on clinical examination of children with echocardiographic confirmation of suspected cases and underestimate its prevalence. The objective of this study was to investigate the prevalence of congenital heart disease in "daara" (Koranic schools) in the city of Dakar and its suburbs on the basis of clinical examination and Doppler echocardiography in school children. This cross-sectional survey was carried out from 9(th) August to 24(th) December 2011, and included a population of 2019 school children aged 5 to 18 years in 16 selected "daaras" under the Academic Inspectorate of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were recorded in a validated questionnaire. A p < 0.05 was considered to be statistically significant in bivariate analysis. 2 019 school children were included out of which 60.1% were male (sex-ratio: 0.66). The average age was 9.7 years (± 3.3 years). 18 cases of congenital heart diseases were detected being a prevalence of 8.9 per 1 000 (95 % CI: 1.8 to 7.9). This included 6 cases of inter-atrial septal aneurysm, 5 cases of peri-membranous ventricular septal defects, 4 cases of patent ductusarteriosus and 3 cases of tetralogy of Fallot. Factors correlated with the presence of congenital heart disease were ageless than 8 (p <0.001) and residence in the suburbs of Dakar (p <0.001). We also detected 10 cases of rheumatic valvular disease, a prevalence of 4.9 per 1 000 (95% CI: 2.4 to 9.1). Our study shows a high prevalence of congenital heart diseases, which is almost identical to the WHO estimates and that ultrasound screening is more sensitive than clinical screening. Reducing the prevalence of these diseases requires implementation of appropriate policies, focusing on awareness and early detection.

[Aneurysmal dilatation of pulmonary artery and its branches on mitral stenosis: a case report]. / Dilatation anévrismale de l'artère pulmonaire et de ses branches sur sténose mitrale à propos d'un cas.

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.

[A familial form of ventricular non compaction in a mother and two of his sons in St. Louis, Senegal]. / Une forme familiale de la non-compaction ventriculaire chez une mère et deux de ses fils à Saint-Louis du Sénégal.

We report a familial form of ventricular non compaction in a mother and two of her sons. It was a young man of 25 years who presented with NYHA stage III dyspnea and a cough with bloody sputum. The clinical examination found left ventricular failure. The echocardiogram done showed left ventricular dilatation with large trabeculae separated by deep intertrabecular recesses in both ventricles suggestive of a non-biventricular compaction. It was possible to note from the family screening by echocardiography of the mother and half-brother a left ventricular non compaction while they were asymptomatic. Thus we concluded a familial form of ventricular non-compaction. This is the first familial case described in Senegal.

[Prevalence and factors related to therapeutic adherence among black African outpatients with stable coronary artery disease in a cardiology department of Dakar in Senegal]. / Prévalence et facteurs liés à l'observance thérapeutique chez des patients noirs africains coronariens stables, suivis en ambulatoire en service de cardiologie de Dakar au Sénégal.

INTRODUCTION: The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease. METHODOLOGY: We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence. RESULTS: We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014). CONCLUSION: Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

[Prevalence survey of cardiovascular risk factors in the general population in St. Louis (Senegal)]. / Enquête de prévalence des facteurs de risque cardiovasculaire en population générale à Saint-Louis (Sénégal).

BACKGROUND: Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal. METHODOLOGY: This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome. RESULTS: The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE). CONCLUSION: This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

[Aortopulmonary infectious endocarditis with fatal evolution: a case report]. / Endocardite infectieuse aortopulmonaire d'évolution fatale : à propos d'un cas.

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.

Infections secondary to pacemaker implantation: a synopsis of six cases.

INTRODUCTION: Permanent cardiac pacing is a technique whose indications have increased in the last 20 years. As with any foreign body, pacemaker implantation is associated with the risk of infection. The objective of this study was to describe the clinical, paraclinical and treatment options of infections secondary to pacemaker implantation at the Cardiology Department of the Aristide le Dantec Teaching Hospital (CHU Aristide le Dantec) in Dakar, Senegal. METHODS: We conducted a retrospective study over a period of three years (from January 2005 to December 2007) during which pacemaker implantation was carried out in 107 patients. All patients with local and/or systemic signs of infection were included in our study. RESULTS: The prevalence of infection in patients with pacemakers was 5.6% in our series and infection occurred in three women and three men, with a mean age of 66.2 years (range 23-83). The delay time for the onset of clinical signs of infection was 6.6 months, with a range of eight days to 12 months. The clinical signs were externalisation of the pacemaker with suppuration (five cases), fever (one case) and inflammatory signs (one case). Factors favouring the occurrence of infection were co-morbidity (four cases), pre-operative length of stay (average eight days), use of temporary cardiac pacing (three cases), the number of people in the theatre (average 4.5), postoperative haematoma (one case) and repeating the surgical procedure (three cases). Staphylococcus epidermidis (two cases), Staphylococcus aureus (two cases) and Klebsiella pneumonia (one case) were the organisms isolated at the local site. Transthoracic echocardiography showed no objective signs of endocarditis. The treatment was antibiotic therapy for an average duration of 50.4 days after debridement of the infected site (six cases). We noted four recurrences at six months and one death from sepsis at 12 months. CONCLUSION: Infections secondary to pacemaker implantation are rare but serious. Their management is difficult and requires the removal of the implanted material, hence the importance of prevention of infection, or the removal and re-implantation of the pacemaker at another site in cases of infection. This is particularly important in our region where pacemakers are very expensive.