[Contribution of stress test to the treatment of ischemic heart disease]. / Apport de l'épreuve d'effort dans la prise en charge des cardiopathies ischémiques.

Stress test is a useful diagnostic tool in patients with suspected angina pectoris with low sensitivity but high specificity. It is also very useful in the evaluation of the risk, of the effectiveness of treatment and it is a useful guidance on medical prescriptions after controlling the symptoms of ischemia. This study aims to analyze the contribution of stress test to the treatment of ischemic heart disease in the Department of Cardiology at the University Hospital CHU YO. We conducted a retrospective study of 60 patients who had undergone stress test from January 2012 to December 2013. Stress test was performed using a treadmill according to the modified Bruce protocol. Sixty patients underwent stress test during the study period. The average age of patients was 49± 10.8 years. Sex-ratio was 1.2. All patients underwent treadmill stress test. Twenty-two patients had a history of coronary artery disease. Estimating presence of coronary artery disease was the indication for stress test in 83% of cases. It was detected in 78% of cases. Stress test was stopped when maximal workload was reached in 46 cases (or 77%). Mean exercise duration was 11,7 mn ± 3,2. Ten percent of patients had a positive stress test and 10% a dubious test. Our study will also contribute to transfer knowledge on this diagnostic test which is still little prescribed in our environment and even among cardiologists. However, efforts should be made in order to improve the quality of stress test practice in the management of coronary artery disease in a context of countries with limited resources.

[Contribution of the myocardial scintigraphy to the management of stable angina in Burkina Faso]. / Apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stable au Burkina Faso.

OBJECTIVE: The objective of our work was to analyze the contribution of stress myocardial scintigraphy in the diagnosis of stable angina in the Cardiology Department of CHU YO. METHOD: This was a retrospective study of 47 patients who received a stress myocardial scintigraphy from January 2012 to December 2013 for the diagnosis of stable angina. The scintigraphic sections were made after injection of the radiotracer (MibiTc99m) during the treadmill stress test. RESULTS: Myocardial scintigraphy accounted for 16% of all scintigraphy and stress myocardial scintigraphy for diagnosis of stable angina accounted for 64% of all myocardial scintigraphy. The average age of the patients was 47 ± 10 years. The sex ratio was 1.1. All patients had completed the treadmill stress test. The treadmill stress test was stopped for maximum effort in 42 cases (89%). The average duration of the effort was 12 minutes ± 2.4. Treadmill stress test was positive in three patients. Nineteen percent of patients had a pathologic myocardial scintigraphy. Scintigraphy was pathologic in all patients with a positive treadmill stress test. CONCLUSION: Myocardial scintigraphy remains a sensitive examination for the diagnosis of stable angina. It helps to better stratify risk and adjust patient treatment.

OBJECTIF: L'objectif de notre travail était d'analyser l'apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stabledans le service de Cardiologie du CHU YO. MÉTHODE: Il s'est agi d'une étude rétrospective sur 47 patients ayant bénéficié d'une scintigraphie myocardique d'effort de Janvier 2012 à Décembre 2013 pour le diagnostic d'un angor stable.Les coupes scintigraphiques ont été réalisées après injection du radio-traceur (MibiTc99m) au cours de l'épreuve d'effort. RÉSULTATS: La scintigraphie myocardique représentait 16% des scintigraphies et celle d'effort pour diagnostic d'un angor stable 64% des scintigraphies myocardiques. L'âge moyen des patients était de 47 ± 10 ans.Le sex-ratio était de 1,1. Tous les patients avaient effectué l'épreuve d'effort sur tapis roulant. L'épreuve d'effort était arrêtée pour effort maximal dans 42 cas (soit 89%). La durée moyenne de l'effort était de 12 mn ± 2,4.L'épreuve d'effort était positive chez trois patients. Dix-neuf pour cent des patients avaient eu une scintigraphie myocardique pathologique.La scintigraphie était pathologique chez tous les patients ayant une épreuve d'effort positive. CONCLUSION: la scintigraphie myocardique reste un examen sensible pour le diagnostic l'angor stable. Elle permetde mieux stratifier le risque et ajuster le traitement des patients.

Development of the roadmap for reducing cardiovascular morbidity and mortality through the detection, treatment and control of hypertension in Africa: report of a working group of the PASCAR Hypertension Task Force.

The fourth Pan-African Society of Cardiology (PASCAR) hypertension taskforce meeting was held at the Yaoundé Hilton Hotel on 16 March 2016. Its main goals were to update and facilitate understanding of the PASCAR roadmap for the control of hypertension on the continent, to refine the PASCAR hypertension algorithm, and to discuss the next steps of the PASCAR hypertension policy, including how the PASCAR initiative can be customised at country level. The formation of the PASCAR coalition against hypertension, the writing group and the current status of the PASCAR hypertension policy document as well as the algorithm were presented to delegates representing 12 French-speaking countries. The urgency to finalise the continental policy was recognised and consensus was achieved by discussion on the main points and strategy. Relevant scientific issues were discussed and comments were received on all points, including how the algorithm could be simplified and made more accessible for implementation at primary healthcare centres.

Right ventricular outflow tract tachycardia worsened during pregnancy.

We report the case of a 35 years old woman without underlying heart disease who was diagnosed with a right ventricular outflow tract tachycardia worsened during pregnancy. The diagnosis of ventricular tachycardia was made early in her pregnancy course but the patient had symptoms three months earlier. Her disease course was marked by rhythmic storms during the second trimester of pregnancy that led to three hospitalizations accounting for about two weeks in total. The combination of nadolol 80 mg and flecainide tablets 150 mg improved her rhythmic storms. Radiofrequency allowed a radical cure of this ventricular tachycardia. The patient is now asymptomatic 27 months after radiofrequency treatment.

Hypertension, urbanization, social and spatial disparities: a cross-sectional population-based survey in a West African urban environment (Ouagadougou, Burkina Faso).

Data show that hypertension has become a public health problem in developing countries. Many studies have reported social disparities among the affected populations, but few of them pointed out spatial disparities within towns. We aimed to show that hypertension could be a good indicator of the medical change that occurs unequally in towns. A cross-sectional survey was done in April and October 2004 in Ouagadougou, Burkina Faso, among 2087 adults over 35 years old in different kinds of urban areas. Social and demographic data were collected and blood pressure was measured. Prevalence of hypertension was 40.2%. Age, body mass index, level of equipment, absence of community integration, absence of occupation, duration of residence over 20 years, protein-rich diet and absence of physical activity were identified as risk factors, but there were social and spatial disparities according to location of housing (parcelled-out or non-parcelled-out areas) and to integration within the town. The high rate of hypertension found in Ouagadougou and the heterogeneity of the risk within the population highlights that social and spatial risk factors have to be taken into account for the prevention of the non-transmissible diseases in countries in full process of urbanization and medical change.

Tricuspid aseptic endocarditis revealing right endomyocardial fibrosis during an unrecognized Behçet's disease. A case report.

INTRODUCTION: Aseptic endocarditis or/and endomyocardial fibrosis are rarely reported in Behçet's disease. OBSERVATION: We report on a case of a 21-year-old man living in Algeria, revealed by verrucous tricuspid valvulitis extending to the ventricular endomyocardium and complicated with right heart failure, initially misdiagnosed and treated as infective endocarditis occurring on rheumatic cardiac after-effects. DISCUSSION; We discuss the lack of specificity of Jones criteria and emphasize the need to include cardiac involvement in Behçet's disease in the differential diagnosis of rheumatic fever carditis. This message is notably important in some countries where the prevalence of these two entities are among the highest in the world.

[Validation of a method of blood pressure measurement for a study of hypertension in a black African population]. / Validation de la méthode de mesure de la tension artérielle pour une enquête en population sur l'hypertension artérielle chez le Noir Africain.

Hypertension is a major public health issue in Black Africa. It is also an important factor of cardiovascular risk. To determine the prevalence of hypertension in a large population in Burkina Faso, it is more practicable to use an automatic device for the measurement of BP. Before the start of the study, we tested the reliability of an automatic technique for the measurement of BP in sitting position according to the reference technique. The manometer of reference was a manual, aneroid, and calibrated manometer. The automatic manometer was oscillometric, validated according to the protocol of the British Hypertension Society. The study was held on voluntary healthy persons, or patients hospitalized in the cardiology department of the national university hospital of Ouagadougou (high blood pressure, valvulopathy, cardiac insufficiency). BP measurement was made in a sequential way, with the manual manometer, and with the automatic manometer, by a single observer. Measurement by the manual manometer was based on the auscultation of Korotkoff's murmurs. Systolic blood pressure (SBP) corresponded to phase I, and diastolic blood pressure (DBP) to phase V. Measurement by the automatic manometer was made by reading the BP shown on the device screen. The 10.0 version of the SPSS software was used for data analysis. Statistical tests were concluded with a risk of 0.05. Confidence intervals included 95% of the subjects. The percentage comparison of hypertensive subjects observed in the population by both methods was made with a paired khi2 test. We used Pearson's correlation to quantify the relation between the measures taken using the two methods. In order to quantify the degree of agreement of the two methods, we used the intraclass correlation coefficient (ICC) for quantitative BP measurements, and Kappa's coefficient for qualitative measurements (determination of normotensive or hypertensive subjects). The study was held on 50 black African subjects, with the average age of 38.54 4.83 (18 years-77 years); 55% were male subjects. With the reference method in the sleeping position, the mean SBP and DBP values were respectively 122.60 8.52 and 70.36 5.22 mmHg. The minimal and maximal SBP observed were 80 and 240 mmHg respectively, and the DBP, 30 and 130 mmHg respectively. With the automatic method in the sitting position, the mean values SBP and DBP was 119.88+7.50 and 74.80 4.36 mmHg. SBP minimal was of 75, the maximal of 210 mmHg, and the minimal and maximal DBP was respectively 51 and 121 mmHg. Pearson's correlation coefficients for SBP and DBP between the two methods were statistically different from zero; 0.92 (p<0.001), and of 0.82 (p<0.001) respectively. The ICC was 0.91 for SBP and 0.78 for DBP. Kappa's coefficient was calculated to estimate agreement for the determination of normotensive or hypertensive subjects; among the 50 subjects, 36 were classified normotensive by the two methods, and eight, hypertensive. The differences of classification concerned five hypertensive subjects and one normotensive subject, according to the referenced method. Kappa's coefficient was 0.65. The distribution of the subjects in hypertensive and normotensive did not differ significantly in the two methods (p=0.22). The agreement between the two methods was found very good for the measurement of SBP and DBP; it was good for the determination of an hypertensive or normotensive subject. It is important to test the reliability of a technique of BP measurement before the evaluation of hypertension prevalence in a large population. The reliability of the technique ensures a good estimation of the disease prevalence. It is also important to use statistically adapted tests, to avoid any wrong conclusion as to the reliability of the technique.