[Percutaneous coronary intervention in the management of acute coronary syndromes in Senegal : Challenges and results]. / Angioplastie coronaire dans la prise en charge des syndromes coronariens Aigus au Sénégal : défis et résultats.

INTRODUCTION: Percutaneous coronary intervention (PCI) remains a major therapeutic tool in the management of acute coronary syndromes (ACS). However, it is not widely practiced in sub-Saharan Africa, particularly for the management of ACS. The availability of a catheterization laboratory for 24-hour management of ACS in Dakar is an important step in improving the prognosis of patients. The objective of our study was to evaluate the clinical and prognostic profile of patients presenting an ACS and treated by PCI. PATIENTS AND METHODS: This is a retrospective study that included all patients who underwent PCI for ACS at hospital principal Dakar during the period from January 2019 to December 2020. RESULTS: Our study included 112 patients with a mean age of 60 years (extremes 31-96 years) and a male predominance (sex ratio 4.09). Cardiovascular risk factors were dominated by hypertension (47.3%) and smoking (39.3%). Chest pain was present in 97% of patients. Left ventricular systolic function was impaired in 56 patients with a mean of 50% and extremes of 20 and 78%. Thrombolysis with streptokinase was used in 13 patients with STEMI. The majority of coronary angiogram (95%) were performed between 8 am and 5 pm. The radial route was the most commonly used (85.7%). Double vessel coronary artery disease was predominant (39,3%) and the left anterior descending artery was the most affected (60.7%). The PCI was performed in all patients and in more than half of the cases (55%) within 12 hours of delay. The PCI success rate was 96.4%. Sixty-seven patients (59.8%) underwent balloon predilation. PCI was performed with a drug-eluting stent in the majority of patients (92.8%). The outcome was favorable in 96.4% of the patients, but there were 3 deaths (2.7%). CONCLUSION: Treatment of ACS by PCI is a reality in Senegal with a considerable success rate. However, intervention delays remain one of the major challenges of this management.

Myocardial tissue changes detected by cardiac MRI in a patient with suspected systemic sarcoidosis.

BACKGROUND: The role of cardiac magnetic resonance imaging in the early management of chronic cardiac inflammatory conditions is growing. Our case enlightens the benefit of quantitative mapping in the monitoring and treatment guidance in systemic sarcoidosis. CASE PRESENTATION: We report about a 29-year-old man with an ongoing dyspnea and bihilar lymphadenopathy, suggesting sarcoidosis. Cardiac magnetic resonance showed high mapping values, but no scarring. In follow-ups, cardiac remodeling was noted; cardioprotective treatment normalized cardiac function and mapping markers. Definitive diagnosis was achieved in extracardiac lymphatic tissue during a relapse. CONCLUSION: This case shows the role that mapping markers can play in the detection and treatment at early stage of systemic sarcoidosis.

Long-term cardiac pathology in individuals with mild initial COVID-19 illness.

Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.

Acute coronary syndrome complicated by cardiogenic shock in a young adult: a case report from Dakar, Senegal.

Coronary artery disease is the leading cause of cardiovascular deaths worldwide. It is becoming a major concern in developing countries, partly due to the adoption of Western lifestyles. It affects young adults as well as older patients over 45 years of age. In this report, we present a case of cardiogenic shock related to myocardial infarction in a young adult. He completed cardiac rehabilitation after the surgery. The outcome was favourable at the six-month follow up.

Sudden Cardiac Death Following Thrombolysis in a Young Woman with Spontaneous Coronary Artery Dissection: A Case Report.

BACKGROUND Spontaneous coronary artery dissection (SCAD) is a well-known cause of acute coronary syndrome. ST-segment elevation myocardial infarction (STEMI) is the most common presentation of SCAD, which can be complicated by sudden cardiac death (SCD). Conservative management is the cornerstone of treatment except in case of ongoing ischemia or large myocardial compromise. CASE REPORT A 34-year-old woman presented with an anterior STEMI, diagnosed by the Emergency Medical Service (EMS) team, which performed fibrinolysis. SCD resulting from ventricular fibrillation occurred soon after thrombolysis was started. Her pulsed was palpable following defibrillation, and she was immediately intubated. A coronary angiogram (CA) showed total occlusion with dye staining contrast of the proximal left anterior descending (LAD) coronary artery. Echocardiogram showed a severe drop in the left ventricular ejection fraction (LVEF 20%). She was treated with dobutamine and intra-aortic balloon pump implantation because of her poor hemodynamic status. Rescue angioplasty was performed with a drug-eluting stent implanted from the left main stem toward the proximal LAD. However, she developed hemorrhagic shock due to active liver bleeding that was surgically treated. At 3 months, she was asymptomatic, her LVEF had improved (45%), and elective CA showed quite normal coronary arteries. Optical coherence tomography showed residual hematoma as "lunar crescent" and stent under-expansion. The latter was fixed by post-dilatations. CONCLUSIONS Our case adds to the evidence that thrombolysis leads to poor outcomes in patients with SCAD, as reported in numerous reports. OCT was used to confirm, a posteriori, the diagnosis of SCAD. Rescue angioplasty was necessary in our patient due to poor hemodynamic status following unsuccessful fibrinolysis.