Cardiac pacing challenge in Sub-Saharan Africa environnement: experience of the Cardiology Department of Teaching Hospital Aristide Le Dantec in Dakar.

BACKGROUND: Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. METHODS: We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. RESULTS: In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used ¼ one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. CONCLUSION: Cardiac pacing is a growing activity in Dakar.

Marfan syndrome and cardiovascular complications: results of a family investigation.

BACKGROUND: Cardiovascular complications in Marfan syndrome (MFS) make all its seriousness. Taking as a basis the Ghent criteria, we conducted a family screening from an index case. The objective was to describe the clinical characteristics of MFS anomalies and to detect cardiovascular complications in our patients. CASE PRESENTATION: Six subjects were evaluated. Patients had to be in the same uterine siblings of the index case or be a descendant. The objective was to search for MFS based on the diagnostic criteria of Ghent and, subsequently, detecting cardiovascular damage. The average age was 24 years. The examination revealed three cases of sudden death in a context of chest pain. Five subjects had systemic involvement with a score ≥ 7 that allowed to the diagnosis of MFS. Two patients had simultaneously ectopia lentis and myopia. In terms of cardiovascular damage, there were three cases of dilatation of the aortic root, two cases of aortic dissection of Stanford's type A with severe aortic regurgitation in one case and moderate in the other. There were three patients with moderate mitral regurgitation with a case by valve prolapse. CONCLUSION: The family screening is crucial in Marfan syndrome. It revealed serious cardiovascular complications including sudden death and aortic dissection.

Risk assessment of the occurrence of sudden death related to hypertrophic cardiomyopathy in Dakar.

AIM: The aim of this study was to assess of the risk of sudden death in a population of hypertrophic cardiomyopathy patients in Dakar. METHODS: This was a transverse study at the cardiology clinic of Aristide Le Dantec Hospital from January 2014 to June 2015. We used the European Society of Cardiology risk score to calculate this risk. RESULTS: The average age of patients was 53 years. Unexplained syncope was found in two patients and two others had a family history of sudden death. The septal hypertrophy average was 20.9 mm. Seven patients had left intraventricular obstruction. One patient had a high risk of sudden death, three had intermediate risk and 13 had low risk. Competitive sport was not allowed, 13 patients were under medical treatment, one had an implantable cardioverter defibrillator and two had no treatment. CONCLUSION: Our study highlighted a low and intermediate risk of the occurrence of sudden death at five years. One patient had a high risk of sudden death.

Non-compaction of left ventricular myocardium in sub-Saharan African adults.

BACKGROUND: Non-compaction of the left ventricle (NCLV) is an unclassified cardiomyopathy due to intrauterine arrest of compaction of the loose interwoven meshwork. Only a few studies involving sub-Saharan Africans insmall numbers have been published. The aim of our study was to determine the diagnostic, therapeutic and prognostic aspects as well as the clinical course of NCLV in a black African population. METHODOLOGY: A multicentre retrospective study was carried out between November 2007 and June 2012 in two cardiology departments in Dakar. Patients who met the echocardiographic criteria for NCLV were included in the study. RESULTS: 35patients with the diagnosis of NCLV were evaluated in the study. Their mean age was 47±18.4 years. Heart failure was found in 77.1% of the patients. The most frequent electrocardiographic abnormalities were left ventricular hypertrophy (LVH) (46%) and sinus tachycardia (43%). Mean non-compaction/compaction ratio was 2.84±0.68 with preferential localization in the apex of the left ventricle. The main complications observed were cardiogenic shock (23.5%), pulmonary embolism (6.3%) and ventricular tachycardia (5.9%). Diuretics and ACE inhibitors were the medications most often prescribed. Age >60 years (p=0.04), male gender (p=0.03) and the occurrence of complications during follow-up (p=0.04) were noted to be predictors of poor prognosis. CONCLUSION: Contrary to previous beliefs, NCLV may not be less common in black Africans than in other ethnic subgroups. Clinicians in Africa should be made aware of NCLV so that it can be diagnosed at earlier stages.

Obstructive Primary Cardiac T-Cell Lymphoma: A Case Report from Senegal.

BACKGROUND Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. CASE REPORT Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. CONCLUSIONS The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.

[Epidemiological features of cardiorenal syndrome: a study of 36 cases in the Cardiology Department in Dakar]. / Syndrome cardio-rénal: aspects épidémiologiques, à propos de 36 cas dans un service de cardiologie de Dakar.

INTRODUCTION: Cardiorenal syndrome (CRS) is a pathophysiologic disorder of the heart and the kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. In Africa, particularly in Senegal, the incidence of cardiorenal syndrome is not accurately known. This study aimed to assess the prevalence of CRS in the Cardiology Department. METHODS: We conducted a retrospective study including all patients with heart failure associated with alteration of renal function, hospitalized in the Cardiology Department between April 2010 and April 2011. Data were analyzed with the statistical software Epi-Info 3.5.3. RESULTS: 36 patients were included in the study. The prevalence rate was 3.7% with male predominance (sex-ratio 1.77) and an average age of 56.9 years [30-92]. Patients' medical history was dominated by high blood pressure (52.77%) and diabetes (19.4%). The main etiologies were hypertensive cardiomyopathy (39%) and coronary heart disease (19.44%). The symptomatology was dominated by dyspnoea (69.4%) and edema (50%). 17 patients had anemia. The mean measured clearance (MDRD) was 46 ml/min. Doppler echocardiography showed mainly kinetic disorders (89.3%) and left ventricular systolic dysfunction (71%). The three renal ultrasound examinations were normal. Six deaths (16.7%) were recorded. CONCLUSION: Cardiorenal syndrome is a reality and marks a turning point in the evolution of heart and kidney diseases. In Senegal, its prevalence in the Cardiology Department is low. Prospective multicentric studies should be conducted in order to better evaluate this syndrome in Senegal.

[Clinical, electrocardiographic and echocardiographic aspects in elderly hypertensive patients in Senegal]. / Aspects cliniques, électrocardiographiques et échocardiographiques de l'hypertendu âgé au Sénégal.

INTRODUCTION: Arterial hypertension (HTA) in the elderly is an independent risk factor for cardiovascular disease. Our study aims to describe the clinical, electrocardiographic and echocardiographic aspects of Arterial hypertension in elderly patients. METHODS: We conducted a descriptive, cross-sectional study from January to September 2013. Hypertensive patients =60 years treated in Outpatient Cardiology Department at the Principal Hospital in Dakar were included in the study. Statistical data were analyzed using Epi Info 7 software and a p-value < 0.05 was taken as significant. RESULTS: A total of 208 patients were enrolled in the study. The average age was 69.9 years with a female predominance (sex ratio 0.85). Average blood pressure was 162/90 mm Hg. HTA was under control in 13% of cases. The ECG showed evidence of rhythm disturbance (17.78%), left atrial enlargement (45.19%), left ventricular hypertrophy (28.85%) and complete atrioventricular block in 2 cases. Holter ECG revealed non-sustained ventricular tachycardia (Lown class IVb) in 4 cases, paroxysmal atrial fibrillation in 6 cases and paroxysmal atrial flutter in 1 case. Echocardiography performed in 140 patients showed mainly concentric left ventricular hypertrophy in 25 patients, occuring more frequently in males (p=0,04) and dilated left atrium in 56,42% of cases, occuring more frequently in elderly patients (p= 0,01). CONCLUSION: Electrocardiographic and echocardiographic aspects in elderly hypertensive population are characterized by concentric left ventricular hypertrophy and by the frequency of arrhythmias sometimes revealed by long-term continuous external electrocardiographic recording.