Prevalence of Aortic Root Dilation and Correlates of Aortic Root Dimensions in Treatment Naïve Hypertensive Patients in North-Eastern Nigeria.

Background: Systemic arterial hypertension is an independent predictor of cardiovascular diseases including aortic root dilation. Aortic root dilation is a hypertension-mediated organ damage entity regardless of age, gender, and body size. This study aims at determining the prevalence and associations of aortic root dilatation among treatment naïve hypertensive patients. Methodology: The study was a cross-sectional study conducted at the University of Maiduguri Teaching Hospital from June 2019 to June 2021. Study participants were treatment naïve hypertensive patients recruited consecutively from the outpatient clinic of the hospital and normotensive sex- and age-matched controls. End diastolic aortic root diameter was measured using 2D transthoracic echocardiography at the annulus, sinuses of Valsalva, and Sinotubular junction by leading-edge to a leading-edge convention as recommended by the American Society of Echocardiography in parasternal long-axis view. Results: Three hundred treatment naïve hypertensive patients (39.0% females) and 300 health normotensive age-and sex-matched controls (38.3% females) were enrolled. The mean ages of the patients and controls were 46.4±12.5 years and 46.4 ± 12.4 years respectively. The mean aortic root diameter (in mm) was significantly higher in the treatment naïve hypertensive arm of the study at the levels [AoA (24.7 ± 3.9mm versus 22.5 ± 2.0mm, p = 0.002), SoV (33.1 ± 3.4mm versus 31.4 ± 3.4mm, p = 0.023), and STJ (27.8 ± 3.5mm versus 25.9 ± 2.2mm, p = 0.002)]. Males had larger absolute aortic root diameters than females, however, after indexing aortic root diameters for BSA, there was no significant difference. The prevalence of aortic root dilatation amongst the treatment naïve hypertensive patients was 1.3% at all considered levels. Conclusion: The aortic root dimensions in the treatment naïve hypertensive patients were larger than in normotensive adults. The prevalence of aortic root dilation at all levels amongst treatment naïve hypertensive patients is 1.3%.

Digoxin and Symptomatic Bradyarrhythmia: the 'demon' or a 'red herring'.

Digoxin toxicity has been implicated in all forms of cardiac arrhythmias with the notable exception of Mobitz II atrioventricular block, which is very rare. The manifestation is quite variable, ranging from being asymptomatic to gastrointestinal, cardiac, and neurologic symptoms. The manifestations can be protean in the elderly, the most vulnerable group, where degenerative cardiac conduction system diseases add another layer of intrigue by providing an intrinsic substrate for cardiac dysrhythmia. This is in addition to age-related alteration of digoxin pharmacokinetics, use of multiple medications, chronic conditions, and electrolyte derangement, all of which increase the propensity for digoxin toxicity. We present a case of various atrioventricular conduction blocks in a septuagenarian following the use of digoxin.

Hypertrophic Cardiomyopathy and Wolff-Parkinson-White Syndrome in a Young African Soldier with Recurrent Syncope.

Syncope is a common manifestation of both hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White (WPW) syndrome. The most common arrhythmia in HCM is ventricular tachycardia (VT) and atrial fibrillation (AF). While preexcitation provides the substrate for reentry and supraventricular tachycardia (SVT), AF is more common in patients with preexcitation than the general population. Concurrence of HCM and WPW has been reported in many cases, but whether the prognosis or severity of arrhythmia is different compared to the individual disorders remains unsettled. We report a case of HCM and Wolff-Parkinson-White (WPW) syndrome in a 28-year-old male Nigerian soldier presenting with recurrent syncope and lichen planus.

Prevalence and Aetiology of Left Ventricular Thrombus in Patients Undergoing Transthoracic Echocardiography at the University of Maiduguri Teaching Hospital.

Objectives. We sought to determine the prevalence and aetiology of LVT among patients undergoing echocardiography. Methods. We reviewed case notes and echocardiographic data of patient diagnosed with LVT using noncontrast transthoracic echocardiography. Definition of various conditions was made using standard guidelines. Mean ± SD were derived for continuous variables and comparison was made using Student's t-test. Results. Total of 1302 transthoracic echocardiograms were performed out of which 949 adult echocardiograms were considered eligible. Mean age of all subjects with abnormal echocardiograms was 44.73 (16.73) years. Abnormalities associated with LVT were observed in 782/949 (82.40%) subjects among whom 84/782 (8.85%) had LVT. The highest prevalence of 39.29% (33/84) was observed in patients with dilated cardiomyopathy, followed by myocardial infarction with a prevalence of 29.76% (25/84). Peripartum cardiomyopathy accounted for 18/84 (21.43%) cases with some having multiple thrombi, whereas hypertensive heart disease was responsible for 6/84 (7.14%) cases. The lowest prevalence of 2.38% (2/84) was observed in those with rheumatic heart disease. Left ventricular EF of <35% was recorded in 55/84 (65.48%). Conclusions. Left ventricular thrombus is common among patients undergoing echo, with dilated cardiomyopathy being the most common underlying aetiology followed by myocardial infarction. Multiple LVTs were documented in peripartum cardiomyopathy.

Peak expiratory flow in normal medical students in Maiduguri, Borno state, Nigeria.

BACKGROUND: The assessment of lung function is of considerable importance in the diagnosis of respiratory diseases, normal reference values need to be determined. The peak expiratory flow (PEF) is a simple, reproducible and easily affordable test of lung function which has been used in resource poor countries like Nigeria. A study PEF was carried out in medical students of the University of Maiduguri and the result was compared with various prediction equations calculated in other parts of Nigeria. METHODS: It was a cross-sectional study involving 255 medical students. Data was collected between March and June 2010 using MicroPeak™ peak flow meter (Micromedical MEI 2A2 Kent) as the instrument. RESULTS: There was a statistically significant difference between the measured PEF and the predicted values based on different formulae derived from the different parts of Nigeria. However, the values in females in this study was consistent with the one obtained by one investigator in the north western part of the country. PEF positively correlated with the measured anthropometric parameters and age. CONCLUSION: The result of the study showed that the prediction formulae of Njoku et al and Salisu et al may be used in the assessment of PEF of individuals in this environment; however, further studies with larger sample size may be needed.