Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases.

BACKGROUND: Coronary heart disease remains the leading cause of death in developed countries. In Africa, the disease continues to rise with varying rates of progression in different countries. At present, there is little available work on its juvenile forms. The objective of this work was to study the epidemiological, clinical and evolutionary aspects of acute coronary syndrome in young Sub-Saharan Africans. METHODS: This was a prospective multicenter study done at the different departments of cardiology in Dakar. We included all patients of age 40 years and below, and who were admitted for acute coronary syndrome between January 1st, 2005 and July 31st, 2007. We collected and analyzed the epidemiological, clinical, paraclinical and evolutionary data of the patients. RESULTS: Hospital prevalence of acute coronary syndrome in young people was 0.45% (21/4627) which represented 6.8% of all cases of acute coronary syndrome admitted during the same period. There was a strong male predominance with a sex-ratio (M:F) of 6. The mean age of patients was 34 ± 1.9 years (range of 24 and 40 years). The main risk factor was smoking, found in 52.4% of cases and the most common presenting symptom was chest pain found in 95.2% of patients. The average time delay before medical care was 14.5 hours. Diagnosis of ST-elevation myocardial infarction in 85.7% of patients and non-ST-elevation myocardial infarction in 14.3% was made by the combination electrocardiographic features and troponin assay. Echocardiography found a decreased left ventricular systolic function in 37.5% of the patients and intraventricular thrombus in 20% of them. Thrombolysis using streptokinase was done in 44.4% of the patients with ST-elevation myocardial infarction. Hospital mortality was 14.3%. CONCLUSION: Acute coronary syndrome is present in young Sub-Saharan Africans. The main risk factor found was smoking.

[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.

Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.

BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. RESULTS: The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. CONCLUSION: Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.

Right-heart infective endocarditis: a propos of 10 cases.

The prevalence and characteristics of right heart endocarditis in Africa are not well known. The aim of this study was to describe the epidemiological, clinical and laboratory profiles of patients with right-heart infective endocarditis. This was a 10-year retrospective study conducted in 2 cardiology departments in Dakar, Senegal. All patients who met the diagnosis of right heart infective endocarditis according to the Duke's criteria were included. We studied the epidemiological, clinical as well as their laboratory profiles. There were 10 cases of right-heart infective endocarditis representing 3.04% of cases of infective endocarditis. There was a valvulopathy in 3 patients, an atrial septal defect in 1 patient, parturiency in 2 patients and the presence of a pacemaker in one patient. Anaemia was present in 9 patients whilst leukocytosis in 6 patients. The port of entry was found to be oral in three cases, ENT in one case and urogenital in two cases. Apart from one patient with vegetations in the tricuspid and pulmonary valves, the rest had localized vegetation only at the tricuspid valve. However, blood culture was positive in only three patients. There was a favorable outcome after antibiotic treatment in 4 patients with others having complications; three cases of renal impairment, two cases of heart failure and one case of pulmonary embolism. There was one mortality. Right heart infective endocarditis is rare but associated with potentially fatal complications.

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads.

Routine implantation of pacemakers and implantable cardioverter defibrillators is not commonly associated with complications. However, in some cases we see misplacement of pacemaker leads which is most often related to the presence of underlying cardiac anomalies. We report the case of misplacement of a pacemaker lead into the left ventricle of a 56-year-old patient paced in VVI/R mode and with a tined type pacemaker lead because of a symptomatic complete atrioventricular block. Electrocardiogram showed a pacemaker-generated rhythm with a right bundle branch block pattern. Chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm. Echocardiography visualized the pacemaker lead in the left heart chambers (atrium and ventricle), hence confirming its aberrant course. Further, the defect causing its passage to the left heart chambers was a sinus venosus atrial septal defect. The patient reported no complication related to the misplacement of the lead. After a brief period of oral anticoagulation, the lead was inserted into the right ventricle by percutaneous technique.

Fatal evolution of a huge right atrial free-floating thrombus.

KEY CLINICAL MESSAGE: Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.

Combination of left ventricular noncompaction and partial atrioventricular canal defect in a 21-year-old male: a case report.

INTRODUCTION: Left ventricular noncompaction (LVNC) is classified as a genetic cardiomyopathy characterized by a progressive systolic dysfunction. It may occur alone or in association with congenital cardiac anomalies. The combination of left ventricular noncompaction with partial atrioventricular canal defect is rare and has not, to our knowledge, been described previously. CASE PRESENTATION: A 21-year-old male who traveled to our center from a neighboring country presented with signs of heart failure. Transthorarcic echocardiography showed prominent trabeculations in the left ventricle predominantly in the left ventricle involving the apical lateral and mid anterolateral segments associated with a partial atrioventricular canal defect. There was a biventricular systolic dysfunction. There was good response to medical treatment. CONCLUSION: This case stresses the importance of maintaining a high degree of suspicion for this rare cardiomyopathy and the need to systematically look for other associated anomalies in order to institute proper short- and long-term managements.

Profil des patients admis en unité de soins intensifs dans un service de cardiologie de Dakar

Introduction : L'unité de soins intensifs cardiologiques ou USIC est une unité hospitalière de prise en charge intensive des urgences cardio-vasculaires. Notre objectif était de déterminer les principaux motifs d'admission dans une USIC de Dakar, d'apprécier l'évolution des patients et d'identifier les facteurs pronostiques.Méthodologie :C'est une étude transversale descriptive incluant tous les patients admis en USIC à la clinique cardiologique du centre hospitalier universitaire Aristide Le Dantec de Mars à Octobre 2014.Résultats : Au total, 128 sujets ont été inclus. L'âge moyen était de 59,4 ans avec une prédominance masculine. Les patients étaient souvent adressés de la consultation externe du service (40,60%). Les motifs d'admission étaient dominés par les syndromes coronariens aigus (21,9%), les blocs auriculo-ventriculaires complets (19,5%) et l'insuffisance circulatoire aiguë (13,3%). La durée d'hospitalisation moyenne était de 4±3 jours. L'évolution était favorable chez 75% des patients, émaillée de complications dans 6,2 % des cas. Les complications étaient à type d'insuffisance circulatoire aiguë, de déplacement de sonde et d'infections. La mortalité hospitalière était de 18,8%. Les principaux facteurs pronostiques étaient les dysfonctions systoliques des ventricules droit (p=0,022) et gauche (p=0,019), l'insuffisance circulatoire aiguë septique (p=0,001) ainsi que l'anémie (p=0,034).Conclusion : Les urgences cardio-vasculaires à Dakar sont variées, dominées par les syndromes coronaires aigus et les troubles de la conduction

Pregnancy in women with heart disease in sub-Saharan Africa.

BACKGROUND: Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa. METHODS: We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period. RESULTS: Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P=0.03); severe tricuspid regurgitation (P=0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P<0.001). A favourable maternal outcome was associated with: prior cardiac events (P<0.001); prior surgical valve replacement (P=0.03); cardiac prosthetic valve (P=0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28weeks (range, 8-38weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%). CONCLUSIONS: Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis.

Endocardite infectieuse en milieu cardiographique Dakarois : etude descriptive a propos de 39 cas

L'endocardite infectieuse est une complication frequente des cardiopathies rhumatismales. L'objectif de ce travail etait de faire une etude descriptive de l'endocardite infectieuse; en milieu hospitalier Dakarois.Il s'agit d'une etude retrospective; descriptive; realisee a la clinique cardiologique de l'hopital Aristide Le Dantec; durant la periode allant de Janvier 2004 a Decembre 2008. Etaient inclus tous les patients hospitalises et traites pour endocardite infectieuse certaine ou probable; selon les criteres de Durack. Nous avons etudie les parametres epidemiologiques; cliniques; biologiques et echocardiographiques.Le nombre total d'admissions dans le service durant la periode d'etude etait de 3746 patients; dont 870 pour valvulopathies rhumatismales. Nous avions enregistre 39 cas d'endocardite infectieuse soit une prevalence de 1;04et 4;48valvulopathies rhumatismales. L'age moyen de nos patients etait de 24 plus ou moins 11;5 ans avec des extremes de 6 et 52 ans. Plus de la moitie des patients soit 58;9(23 patients) avaient moins de 25 ans. On notait une legere predominance feminine avec un sex-ratio homes/femmes de 0;95. La porte d'entree etait essentiellement bucco-dentaire 40. L'anemie etait constante avec un taux d'hemoglobine moyen a 8;4g/dl. Les hemocultures etaient positives chez 6 patients et le Staphylococcus Aureus etait le germe le plus retrouve. L'electrocardiogramme avait montre des troubles du rythme et de la conduction respectivement dans 69;2 et 10;2des cas. L'echographie cardiaque mettait en evidence des vegetations chez tous les patients; une rupture de cordage dans 6 cas et un abces chez trois patients.L'endocardite infectieuse constitue encore une realite dans nos regions. Elle survient habituellement sur cardiopathie rhumatismale. Son diagnostic repose sur les hemocultures et l'echocardiographie