Asunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral/diagnóstico por imagen , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Warfarina/uso terapéutico , Adulto , África del Sur del Sahara , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Recién Nacido , Masculino , Válvula Mitral/cirugía , Embarazo , Complicaciones Cardiovasculares del Embarazo/terapia , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/terapia , Trombosis/etiología , Trombosis/terapia , Uganda , UltrasonografíaAsunto(s)
Complejo de Eisenmenger/diagnóstico por imagen , Síndrome de Ellis-Van Creveld/diagnóstico por imagen , Atrios Cardíacos/anomalías , Complejo de Eisenmenger/complicaciones , Síndrome de Ellis-Van Creveld/complicaciones , Femenino , Humanos , Osteoartropatía Hipertrófica Primaria/diagnóstico , Osteoartropatía Hipertrófica Primaria/etiología , Ultrasonografía , Adulto JovenRESUMEN
OBJECTIVE: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. METHODS: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. RESULTS: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. CONCLUSION: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cardiopatías Congénitas/cirugía , Insuficiencia Cardíaca/cirugía , Cardiopatía Reumática/cirugía , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/cirugía , Fibrosis Endomiocárdica/complicaciones , Fibrosis Endomiocárdica/cirugía , Femenino , Cardiopatías Congénitas/complicaciones , Insuficiencia Cardíaca/etiología , Humanos , Hipertensión/complicaciones , Lactante , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Estudios Prospectivos , Cardiopatía Reumática/complicaciones , Centros de Atención Terciaria , Tiempo de Tratamiento , Resultado del Tratamiento , Uganda , Adulto JovenRESUMEN
The cause of endomyocardial fibrosis in Uganda remains unknown in spite of studies dating back to 1948. Herbal decoctions have been used by traditional healers for countless generations to treat many complaints, especially fever. We present evidence - ethnic, geographical, tribal, pathological and distribution by age - that the toxic herbal decoctions taken as medicines in Uganda can cause endomyocardial fibrosis.
