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Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited.The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria.This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension 33 mm/mOverall, 45 (18.7%) patients died during follow-up. Maternal age 20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF 25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF 25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study.This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.

Background: Vaginitis, an infection of the lower genital tract in women, is known to be triggered by the overgrowth of the vagina’s naturally occurring microorganisms. Objective: This study looked at the prevalence of Candida spp. and age-related disparities amongst women presenting with vag- initis at the Obstetrics and Gynaecology (O&G) clinic in a tertiary hospital in Port Harcourt, Nigeria. Methods: One hundred high vaginal swabs were collected from pregnant and non-pregnant women and examined microscop- ically and microbiologically. Results: Age-group 20–29 years had the highest incidence of candidal vaginitis. There was a higher occurrence of yeast cells in pregnant than in non-pregnant participants while the non-pregnant women had a greater level of bacterial cells. Forty (40) of the samples contained yeasts of Candida species representing a 40% prevalence. Three species of Candida were identified with C. albicans dominating. Of the 40 samples positive for Candida spp., 30 (75.0%) were confirmed to be C. albicans. The remaining isolates were C. tropicalis (15.0%) and C. parapsilosis (10.0%). Conclusion: The findings in this study would play a role in the future management of Candida-induced vaginitis. Keywords: Candida; epidemiology; prevalence; vaginitis; vulvovaginal candidiasis.

Aims: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. Methods and Results: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. Conclusions: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Aims Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods and results The European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: (i) women without hypertension (PPCM-noHTN); (ii) women with hypertension but without pre-eclampsia (PPCM-HTN); (iii) women with pre-eclampsia (PPCM-PE). Maternal (6-month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end-diastolic diameter (57.4 +/- 6.7 mm vs. 59.8 +/- 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF >= 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66-4.87). Conclusion Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones.This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

Aims: \ud In peripartum cardiomyopathy (PPCM), electrocardiography (ECG) and its relationship to echocardiography have not yet been investigated in large multi-centre and multi-ethnic studies. We aimed to identify ECG abnormalities associated with PPCM, including regional and ethnic differences, and their correlation with echocardiographic features.\ud \ud Methods and results: \ud We studied 411 patients from the EURObservational PPCM registry. Baseline demographic, clinical, and echocardiographic data were collected. ECGs were analysed for rate, rhythm, QRS width and morphology, and QTc interval. The median age was 31 [interquartile range (IQR) 26–35] years. The ECG was abnormal in > 95% of PPCM patients. Sinus tachycardia (heart rate > 100 b.p.m.) was common (51%), but atrial fibrillation was rare (2.27%). Median QRS width was 82 ms [IQR 80–97]. Left bundle branch block (LBBB) was reported in 9.30%. Left ventricular (LV) hypertrophy (LVH), as per ECG criteria, was more prevalent amongst Africans (59.62%) and Asians (23.17%) than Caucasians (7.63%, P < 0.001) but did not correlate with LVH on echocardiography. Median LV end-diastolic diameter (LVEDD) was 60 mm [IQR 55–65] and LV ejection fraction (LVEF) 32.5% [IQR 25–39], with no significant regional or ethnic differences. Sinus tachycardia was associated with an LVEF < 35% (OR 1.85 [95% CI 1.20–2.85], P = 0.006). ECG features that predicted an LVEDD > 55 mm included a QRS complex > 120 ms (OR 11.32 [95% CI 1.52–84.84], P = 0.018), LBBB (OR 4.35 [95% CI 1.30–14.53], P = 0.017), and LVH (OR 2.03 [95% CI 1.13–3.64], P = 0.017).\ud \ud Conclusions: \ud PPCM patients often have ECG abnormalities. Sinus tachycardia predicted poor systolic function, whereas wide QRS, LBBB, and LVH were associated with LV dilatation.

This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non-classified cardiomyopathies, left ventricular non-compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo-/radiotherapy for cancer or haematological malignancies need specific pre-, during and post-pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects. ispartof: EUROPEAN JOURNAL OF HEART FAILURE vol:23 issue:4 pages:527-540 ispartof: location:England status: published

Background: With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD). Cardiovascular disease (CVD) has emerged in recent decades as a major cause of morbidity and mortality worldwide An estimated 17-million deaths globally were due to CVD in 2002, and CVD or stroke are projected to become the worldwide leading cause of morbidity and mortality by 2020. Objective: To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria. Methods: As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria. Results: In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged

Aims The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North‐West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Methods and results Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow‐up, relative to baseline status, were assessed by echocardiography. During median 17 months follow‐up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all‐cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (

Background Peripartum cardiomyopathy (PPCM) seems to have varied epidemiology within and between countries. We recently reported that Kano (North-West Nigeria) has the highest known incidence of PPCM in the world, but the clinical profiles of the patients by regions have not been previously reported. In this study, we aimed to describe the regional differences (if any) in the clinical profiles of patients with PPCM in Nigeria. Methods We consecutively recruited 244 PPCM patients over 9 months from 3 hospitals in Kano (n=199; 81.6%) and from 11 hospitals spread across the North-Central, South-West, South-East and South-South zones (n=45; 18.4%) of Nigeria. Results The baseline characteristics of the patients are summarised in Table 1. 35 (17.6%) patients in Kano and 10 (23.2%) patients in other zones died (p=0.0523) after a median of 17 months. Conclusion PPCM patients in Kano were younger, had lower socio-economic status, presented to hospitals later, were less symptomatic, had larger sizes of cardiac chambers, worse right ventricular systolic function, higher pulmonary artery systolic pressure and were receiving less treatment at enrolment, than those in other zones in Nigeria. This information will be used for advocacy and interactions with healthcare providers. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Dantata Group of Companies (Nigeria). Ammasco International Ltd. (Nigeria). Fortune Oil Mills Nigeria Ltd.

Aims We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

Hypertension and its complications are now responsible for about a quarter of emergency medical admissions in urban hospitals in Nigeria. It is the commonest risk factor for stroke, heart failure, chronic kidney disease, and dementia. Furthermore, high blood pressure is the commonest cause of sudden unexpected natural death in the country. Regrettably, the rate of awareness, treatment, and control is abysmally low in the country and in many parts of the world. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 19 904 individuals with a mean age of 40.9 years, were screened during MMM17. After multiple imputation, 6709 (36.2%) had hypertension. Of individuals not receiving anti-hypertensive medication, 4140 (25.9%) were found to have hypertension. Of individuals receiving anti-hypertensive medication, 1449 (58.8%) had uncontrolled BP. MMM17 was one of the largest BP screening campaigns undertaken in Nigeria. A significant number of the participants were identified with hypertension (but not on any treatment) and uncontrolled BP despite being treated. These results suggest that opportunistic screening can identify significant numbers with raised BP.

Background Cardiac disease remains an important cause of maternal morbidity and mortality globally. Peripartum cardiomyopathy (PPCM), defined as heart failure secondary to left ventricular (LV) systolic dysfunction in previously healthy women towards the end of pregnancy or up to five months following delivery, can result in cardiogenic shock due to severe LV dysfunction or arrhythmias leading to sudden cardiac death. Cardiac electrical activity and its relationship to cardiac dysfunction have not yet been interrogated in large multi-centre studies. Purpose This study aimed to identify the ECG abnormalities associated with PPCM; their relationship with echocardiographic structural and functional abnormalities and explore regional and ethnic differences in ECG features. Methods We included the first 411 patients enrolled into the EURObservational PPCM registry (EORP). Baseline demographic, clinical and echocardiographic data were collected. ECGs were analysed for rate; rhythm; QRS width, axis and morphology; and QTc interval. Results Mean age of the women (from >40 countries) was 30.7±6.4 years. More than two thirds of patients presented with NYHA class III or IV (with no regional differences). The median QRS rate was 102bpm (IQR 87–117). More than half presented with sinus tachycardia (QRS rate >100bpm), whereas atrial fibrillation was rare (2.27%). The mean QRS width was 90.1ms ±21.5, with regional differences (ESC 93.8ms ±21.7 vs. non-ESC 86.8ms ±20.8, P460ms). The median LVEDD was 60mm (IQR 55–65) on echocardiography. Compared with their Asian and Caucasian counterparts, African patients were more likely to have LV dilatation (LVEDD>53mm: 70.11%, 79.31% and 89.42% respectively; P=0.004). The median LV ejection fraction (LVEF) was 32.50% (IQR 25–39) with no significant regional or ethnic differences. Sinus tachycardia predicted poor systolic function (OR 1.85 [95% CI 1.20–2.85], p=0.006). LVEF 53mm (sensitivity 11.15%; specificity 98.46%; PPV 97.14%; NPV 19.10%; OR 8.02 [95% CI 1.08–59.66], p=0.042). Conclusion Patients with PPCM commonly present with sinus tachycardia, LVH, and/or prolonged QTc interval on their ECG. Wide QRS and/or LBBB, were associated with LVEDD>53mm. Sinus tachycardia, however, was associated with LVEF Acknowledgement/Funding Heart Failure Association of the ESC

Background Professional drivers are known to be at high risk for cardiovascular disease (CVD) on account of the higher prevalence co-occurring risk factors they harbour. Chronic kidney disease (CKD) and CVD share similar risk factors. Both impact each other adversely. The renal profile of professional drivers in Nigeria is not well characterised. We decided to study the prevalence of positive CKD screening amongst professional male long distance drivers in Lagos, Southwest Nigeria so as to quantify the burden and its predictors. Methods Two hundred and ninety-three drivers were recruited. Details of their socio-demographic characteristics were obtained. Their anthropometric indices, blood pressure, fasting plasma blood glucose and lipid profile were measured. Serum creatinine was measured and estimated glomerular filtration rate, eGFR, was calculated with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Urinary Albumin Creatinine Ratio (UACR) was determined. A 10 year CVD risk of the subjects was calculated with the Framingham Risk Score (FRS). Results Mean age of the study population was 44.8 + 9.7 years. The prevalence of alcohol use and smoking were 71.0 and 19.5% respectively. One hundred and twenty-one (62.8%) of the subjects were either overweight or obese while 70(24.1%) had abdominal obesity. The prevalence of hypertension and diabetes were 39.7 and 13.9% respectively. Prevalence of CKD by eGFR 30 mg/g was 51.7% (95% CI; 46.0–57.5). The odds for CKD increased with lower HDL-c levels; OR 3.5 (95% CI, 1.1–11.2; p = 0.03) and longer duration of professional driving > 20 years; OR 2.4(95% CI, 1.5–4.0). Conclusion Professional male long distance drivers in addition to having very high prevalence of clustering of both CVD and CKD risk factors have a significant burden of asymptomatic CKD. UACR appears to be an earlier marker of CKD in this population. Health awareness promotion and aggressive risk factor reduction are advocated as ways to reduce this burden.

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress-mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease-specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter-defibrillators, cardiac resynchronization therapy and implanted long-term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.

Nigeria seems to have the highest incidence of Peripartum Cardiomyopathy (PPCM) in the world, but data on outcomes of the disease is limited. In Peripartum Cardiomyopathy in Nigeria (PEACE) registry, we aimed to study the clinical profile, myocardial remodelling and survival of patients with PPCM in

Right ventricular dysfunction is now recognized as an independent predictor of poor outcomes amongst heart failure patients. We therefore evaluated the prevalence of right ventricular systolic dysfunction in a West African academic hospital and its determinants using echocardiography. Heart failure

Background: With globalization and rapid urbanization, demographic and epidemiologic transitions have become important determinants for the emergence of cardiovascular disease (CVD). Objective: To estimate the prevalence of CVD risk factors in adult out-patients attending general practice and non-specialist clinics in urban and rural Nigeria. Methods : As part of the Africa and Middle East Cardiovascular Epidemiological (ACE) study, a cross-sectional epidemiologic study was undertaken for the presence of hypertension, diabetes mellitus, dyslipidemia, obesity, smoking and abdominal obesity in Nigeria. Results : In total, 303 subjects from 8 out-patient general practice clinics were studied, 184 (60.7%) were female and 119 (39.3%) were male. Mean age was 42.7±13.1 years; 51.8% were aged

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long- term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented.

Background Studies in international literature have shown that Community Pharmacists can make considerable impact in controlling cardiovascular disease risk factors, especially hypertension. In Nigeria, there are no studies on the knowledge of CVD risk factors by Community Pharmacists and their practice of primary prevention. Objective To assess the knowledge of CVD risk factors and practice of primary prevention of CVD amongst Nigerian community pharmacists. Setting Community Pharmacists in Lagos, Nigeria. Methods This cross-sectional study involved 168 Community Pharmacists. Their knowledge of CVD risk factors was assessed with the Heart Disease Fact Questionnaire. Their opportunistic screening practices for CVD risk factors (primary prevention) were also assessed. Main outcome measures Knowledge of CVD risk factors and practice of primary CVD prevention. Results The mean age of the participating pharmacists was 41.7 (± 11.2) years and 87 (51.8%) of them were males. The median number of years of practice was 9.0 (3–15) years. Mean knowledge score was 22.1 (± 3.0) with 154 (91.7%) of the subjects scoring above 70%. An average of 95.5% of the participants correctly identified hypertension, smoking, dyslipidaemia, obesity, physical inactivity and diabetes as CVD risk factors. Eighty-one (48.2%) had good practice of primary CVD prevention. Conclusion: This study shows that Community Pharmacists in Nigeria have very good knowledge level of CVD risk factors and almost 50% of them practised primary prevention of CVD.

Background Pulmonary hypertension (PH) is very prevalent among heart failure (HF) subjects and is now recognised as an independent predictor of poor prognosis. There is a paucity of data in our environment about the frequency and correlates of PH in HF. We aimed to determine the frequency of PH in HF patients in an academic hospital and assess its correlates using echocardiography. Methods A total of 219 heart failure patients in NYHA functional class II to IV, and without co-morbidities that could cause PH, were consecutively recruited. Demographic, clinical and echocardiographic data were obtained from all subjects. Results The frequency of PH was 38.8%, using an estimated pulmonary artery systolic pressure (PASP) cut-off value of > 36 mmHg. HF subjects with PH tended to be male with a worse NYHA functional class compared with subjects without PH. HF subjects with PH also had significantly higher left ventricular (LV) filling pressures (higher left atrial volume index and E/e' ratio), more severe mitral regurgitation (MR), poorer LV systolic function, and worse parameters of right ventricular (RV) structure and function compared with those without PH. Echocardiographic variables that correlated significantly with PASP include LV filling pressures (p 0.001). On multivariate analysis, the left atrial volume index and E/e' ratio were independently associated with PASP. Conclusions PH is common among HF subjects in our environment and is associated with higher LV filling pressure, more severe MR, poorer LV systolic function and worse RV remodelling. Routine screening for PH among HF patients is recommended for better risk stratification and management.

This position paper summarises the current knowledge on the epidemiology, diagnosis and management of women of childbearing age with rheumatic heart disease (RHD) in Africa, as well as the available data on their use of reproductive health services. The aim is to provide guidance to health professionals on aspects of sexual and reproductive health in women with RHD. It reviews the diagnosis, management and counselling of women with RHD throughout their reproductive life. Additionally, this publication discusses potential ways of integrating obstetric and cardiovascular care at peripheral levels of the health systems, as a way of improving outcomes and reducing maternal mortality rates related to cardiovascular disease in Africa. Finally, the article proposes responses to fulfil the actual needs for better reproductive health services and improvement in care for women with RHD.

The study investigated the prevalence of Candida species among HIV positive patients in two tertiary hospitals in Rivers State. A total of 300 samples of sputum, throat swab and high vaginal swab samples were obtained from HIV positive patients attending Braithwaite Memorial Specialist Hospital (BMSH) and the University of Port Harcourt Teaching Hospital (UPTH). The Candida species identified from the samples include; C. albicans, C. stellatoidea and C. tropicalis. The mean distribution of C. albicans, C. stellatoidea and C. tropicalis among the study subjects were 179.00 ± 11.36, 7.00 ± 1.00 and 72.33 ± 27.10 respectively. Sputum samples obtained from HIV positive patients had the highest prevalence of Candida species (56.3 %), followed by throat swab sample (30.7 %) and high vaginal swab samples (13.0 %). Prevalence of candidiasis among HIV patients was revealed to be higher among subjects between the ages of 26 - 33 years followed by 18 - 25 years, 34 - 41 years, 42 - 49 years, 50 - 57 years and 58 - 65 years. The compromised immune systems of HIV positive patients permits the multiplication of Candida species leading to infections.

Aims To provide comprehensive information on the access and use of cardiac implantable electronic devices (CIED) and catheter ablation procedures in Africa. Methods and results The Pan-African Society of Cardiology (PASCAR) collected data on invasive management of cardiac arrhythmias from 2011 to 2016 from 31 African countries. A specific template was completed by physicians, and additional information obtained from industry. Information on health care systems, demographics, economics, procedure rates, and specific training programs was collected. Considerable heterogeneity in the access to arrhythmia care was observed across Africa. Eight of the 31 countries surveyed (26%) did not perform pacemaker implantations. The median pacemaker implantation rate was 2.66 per million population per country (range: 0.14–233 per million population). Implantable cardioverter-defibrillator and cardiac resynchronization therapy were performed in 12/31 (39%) and 15/31 (48%) countries respectively, mostly by visiting teams. Electrophysiological studies, including complex catheter ablations were performed in all countries from Maghreb, but only one sub-Saharan African country (South Africa). Marked variation in cost (up to 1000-fold) was observed across countries with an inverse correlation between implant rates and the procedure fees standardized to the gross domestic product per capita. Lack of economic resources and facilities, high cost of procedures, deficiency of trained physicians, and non-existent fellowship programs were the main drivers of under-utilization of interventional cardiac arrhythmia care. Conclusion There is limited access to CIED and ablation procedures in Africa. A quarter of countries did not have pacemaker implantation services, and catheter ablations were only available in one country in sub-Saharan Africa.

AIMS: To evaluate the prevalence of hypertrophic cardiomyopathy (HCM) and its characteristics (clinical, electrocardiographic and echocardiographic) in a hospital population presenting for echocardiography at the Lagos University Teaching Hospital (LUTH). MATERIALS AND METHOD: The echocardiographic records of patients over a two year period (1998-2000) were reviewed. Patients with a diagnosis of HCM were re-evaluated and included if they had a hypertrophied non-dilated left ventricle with maximal interventricular septum thickness ≥ 15mm and interventricular/posterior wall ratio >1.3 in the absence of any known cause of hypertrophy. RESULT: Fourteen (2%) of the 712 patients examined had hypertrophic cardiomyopathy with a male preponderance (M/F 3.7:1) and mean age of 43.14±15.00yrs. The commonest symptoms were chest pain and palpitations in about 50% of the subjects. Giant T wave inversion was present on the electrocardiogram of 42.9% of the subjects. The mean interventricular septum was 23.25±7.86mm (range 16 - 36mm) and the mean posterior wall thickness was 13.66±7.86mm (range 8.3 – 20mm). CONCLUSION: Hypertrophic cardiomyopathy occurs in about 2% of our population referred for echocardiographic examination. Hypertrophic cardiomyopathy should be considered in young males presenting with chest pain in Nigeria.

Background : Prehypertension has been associated withtarget-organ damage. This study sought to determine theimpact of prehypertension (PHT) on QT dispersion and leftventricular hypertrophy (LVH) in adult black Nigerians. Methods : One hundred and one subjects with office blood pressure (BP) < 140/90 mmHg were categorised according to their office BP into normotensive (normal BP < 120/80 mmHg, n = 57) and prehypertensive (prehypertensive BP 120-139/80-89 mmHg, n = 44) groups. Echocardiography and electrocardiography (ECG) were performed on the subjects. Results : Thirty-four males aged 53.65 ± 16.33 years and 67 females aged 52.42 ± 12.00 years were studied. The mean QT interval dispersion (QTd) of the normotensive (38.96 ± 11.06 ms) and prehypertensive (38.41 ± 11.81 ms) groups were similar (p = 0.81). Prehypertensive subjects had higher left ventricular mass (LVM) (165.75 ± 33.21 vs 144.54 ± 35.55 g, p = 0.024), left ventricular mass index 1 (LVMI-1) (91.65 ± 16.84 vs 80.45 ± 18.65 g/m2, p = 0.021) and left ventricular mass index 2 (LVMI-2) (54.96 ± 10.84 vs 47.51 ± 12.00 g/m2.7, p = 0.017). QTd was independent of echocardiographic and electrocardiographic LVH (p > 0.05). Conclusion : Compared with normotension, prehypertension is associated with higher LVM but similar QTd. This suggests that structural remodelling precedes electrical remodelling in prehypertension.

Background: Heart failure (HF) is a common, chronic clinical syndrome with appreciable impact on both prognosis and lifestyle of patients. Two main aims of management include preventing disease progression and improving quality of life (QoL). Not much work has been done in this area in Sub-Saharan Africa and most of the available disease specific instruments were developed using the Caucasian population. Aim: We therefore evaluated the QoL of stable HF patients attending the cardiology clinic of the Lagos University Teaching Hospital using a disease specific instrument, Kansas City Cardiomyopathy Questionnaire (KCCQ) and a generic one, the WHOQOL- BREF. Method: Consenting, stable HF patient were recruited from the cardiology clinic of the Lagos University Teaching Hospital. Relevant clinical data and echocardiographic parameters were retrieved from their clinical notes and the subjects filled out the questionnaires, the KCCQ and the WHOQOL-BREF. The QoL and four main domains in the WHOQOL- BREF were compared with scores on the KCCQ for relationships. Result: Data set of 190 patients was analysed. There were 91 (47.9%) males and 99 (52.1%) females with a mean age 51.90 ± 13.21 yrs. Only 52 (27.4%) had college education and 143 (75.2%) had very poor personal resources. About 104 (54.7%) were paying their medical bills themselves. The mean QoL score using the KCCQ score was 59.61 ± 23.80. With The KCCQ, 6.9% felt their QoL was poor and 20% felt it was fair while 11.6% and 20.5% felt their QoL was poor and fair respectively with the WHOQOL-BREF. There was positive correlation, p

Aims The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries. Methods and results Out of 500 patients with PPCM entered by 31 March 2016, we report on data of the first 411 patients with completed case record forms (from 43 countries) entered into this ongoing registry. There were marked differences in socio-demographic parameters such as Human Development Index, GINI index on inequality, and Health Expenditure in PPCM patients from ESC vs. non-ESC countries (P < 0.001 each). Ethnicity was Caucasian (34%), Black African (25.8%), Asian (21.8%), and Middle Eastern backgrounds (16.4%). Despite the huge disparities in socio-demographic factors and ethnic backgrounds, baseline characteristics are remarkably similar. Drug therapy initiated post-partum included ACE inhibitors/ARBs and mineralocorticoid receptor antagonists with identical frequencies in ESC vs. non-ESC countries. However, in non-ESC countries, there was significantly less use of beta-blockers (70.3% vs. 91.9%) and ivabradine (1.4% vs. 17.1%), but more use of diuretics (91.3% vs. 68.8%), digoxin (37.0% vs. 18.0%), and bromocriptine (32.6% vs. 7.1%) (P < 0.001). More patients in non-ESC vs. ESC countries continued to have symptomatic heart failure after 1 month (92.3% vs. 81.3%, P < 0.001). Venous thrombo-embolic events, arterial embolizations, and cerebrovascular accidents were documented in 28 of 411 patients (6.8%). Neonatal death rate was 3.1%. Conclusion PPCM occurs in women from different ethnic backgrounds globally. Despite marked differences in socio-economic background, mode of presentation was largely similar. Embolic events and persistent heart failure were common within 1 month post-diagnosis and required intensive, multidisciplinary management.

Depression is a major issue in heart failure (HF). Depression is present in about one in five HF patients, with about 48 % of these individuals having significant depression. There is a wide variation in reported prevalences because of differences in the cohorts studied and methodologies. There are shared pathophysiological mechanisms between HF and depression. The adverse effects of depression on the outcomes in HF include reduced quality of life, reduced healthcare use, rehospitalisation and increased mortality. Results from metaanalysis suggest a twofold increase in mortality in HF patients with compared to those without depression. Pharmacological management of depression in HF has not been shown to improve major outcomes. No demonstrable benefits over cognitive behavioural therapy and psychotherapy have been demonstrated.

Background Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. Methods A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. Results There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment ( p =0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. Conclusions These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. Trial Registration ClinicalTrials.gov (NCT02265887).

INTRODUCTION: Cardiovascular abnormalities are common in HIV-infected patients although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naive patients. METHODS: One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities and CD4 count was measured in all patients. RESULTS: The cases comprised 57 females (57.0%) and 43 males (43.0%) while the controls were 28 females (56.0%) and 22 males (44.0%) (chi(2) = 0.01; p = 0.913). The mean age of the cases was 33.2 +/- 7.7 while that of the controls was 31.7 +/- 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000) including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (chi(2) = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation mitral valve prolapse and isolated right heart dilatation and dysfunction. CONCLUSION: Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

INTRODUCTION: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting. METHODS: The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson Ç02 test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis. RESULTS: A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p=0.0001). Age above 65 years, excessive daytime sleepiness, abdominal adiposity, resistant hypertension and high overall cardiovascular risk were independent determinants of a high OSA risk. The magnitude of risk associated with these independent predictors of high risk (Odds ratio) was highest for persons aged above 65 years, those with excessive day time sleepiness, and presence of abdominal adiposity. CONCLUSION: A significant proportion of patients attending our tertiary care center are at high risk of OSA.

Context: Concerns have been expressed about the antihypertensive prescription patterns of nonspecialist physicians who care for the majority of patients with hypertension in developing countries. Aims: The aim of the study was to assess the antihypertensive prescription pattern of nonspecialist general medical practitioners in Lagos, Nigeria. Settings and Design: This was a cross-sectional survey carried out among nonspecialist general medical practitioners within Lagos State, Nigeria. Subjects and Methods: A total of 132 doctors completed questionnaires about their demographics, duration and location of practice, and antihypertensive prescription patterns. Statistical Analysis Used: Continuous variables are presented as means or medians while categorical variables are presented as percentages. Comparison between means was done using the Student's t-test, while comparison between percentages was carried out using Chi-square test. Results: Majority (61.2%) considered thiazide diuretics their first choice antihypertensive. The most frequently prescribed antihypertensives were calcium channel blockers (CCBs) (88.6%), thiazide diuretics (85.6%), and angiotensin converting enzyme inhibitors (ACEIs) (84.8%). These were also the most frequently combined with the CCB-thiazide diuretic combination being the most frequently prescribed (81.1%) followed by the ACEIs - thiazide diuretic combination (65.9%). The most frequently considered factors when prescribing antihypertensive medications were side effects of the medications (92.4%), additional benefits beyond blood pressure (BP) lowering (90.9%), patients' BP at the time of presentation (89.4%), dosage frequency of the drug (87.9%), and available scientific evidence for efficacy in lowering BP (87.1%). Conclusions: The antihypertensive prescription pattern of nonspecialist physicians practicing in Lagos aligns with current hypertension treatment guidelines.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NTproBNP) is useful in the diagnosis and management of adult patients with heart failure. OBJECTIVE: The objective of the study was to determine the usefulness of NT-proBNP in diagnosing congestive heart failure (CHF) in children and its correlation with left ventricular ejection fraction (LVEF) and clinical heart failure score. METHODS: Plasma NT-proBNP was measured in 28 children with CHF and age matched controls. Heart failure assessment was done using modified Ross score and all had echocardiography done. RESULTS: Mean plasma NT-proBNP of children with CHF (377.86±1026.49pg/mL) was significantly higher than that of controls (353.61±328.50 pg/mL) (p0.3). CONCLUSION: Our findings indicate that measuring NT-pro BNP may be useful as a diagnostic tool in congestive cardiac failure in children. The fact that its levels also correlated positively with modified Ross score thereby objectively determining severity of heart failure suggests that this biomarker may also be useful as an evaluation tool in congestive cardiac failure in children. Keywords: NT-pro BNP, Heart failure, children, modified Ross Score, ejection fraction.

As millions of people infected with HIV in Africa are increasingly able to live longer and healthier lives because of access to antiretroviral therapy, concerns have emerged that people might eschew protective practices after their health improves. Extending beyond the notion of sexual “disinhibition,” researchers have begun to analyze the sexual behavior of people in treatment through the perspective of their marital and childbearing aspirations. This article explores the reproductive life projects of HIV-positive men and women in southeastern Nigeria, showing how actions that contradict medical advice are understandable in the context of patients’ socially normative desires for marriage and children. Based on in-depth interviews and observations (June–December 2004; June–July 2006; June–July 2007) of people enrolled in the region’s oldest treatment program, we argue that broadly held social expectations with regard to reproduction are experienced even more acutely by HIV-positive people. This is because in Nigeria the stigma associated with AIDS is closely tied to widespread perceptions of social and moral crisis, such that AIDS itself is seen as both a cause and a symptom of anxiety-producing forms of social change. Specifically, in an era of rapid societal transformation, Nigerians see sexual promiscuity and the alienation of young people from traditional obligations to kin and community as indicative of threatened social reproduction. For people who are HIV-positive, marrying and having children offer not only the opportunity to lead normal lives, but also a means to mitigate the stigma associated with the disease. Four ethnographic case studies are provided to exemplify how and why social and personal life projects can trump or complicate medical and public health priorities. These examples suggest that treatment programs must openly address and proactively support the life projects of people on antiretroviral therapy if the full benefits of expanded access to treatment are to be realized.

Heart failure (HF) is associated with high morbidity and mortality most especially in developing countries including Nigeria. In the country, most patients present late for treatment and with attendant high treatment default. Thus, the study set out to examine the psychosocial correlates of subjects with HF. It was a cross-sectional study of new patients aged 18 years and above that presented with HF in the cardiology clinic of Lagos University Teaching Hospital (LUTH), Lagos. Each subject had echocardiography done to confirm the diagnosis and grade the severity of HF. Furthermore, the socio-demographic profiles of each subject were obtained and they were also assessed with General Health Questionnaire (GHQ-12) and questionnaire to elicit the attitudes and belief of subjects about HF. In all, 55 subjects were studied over a 6-month period, made up of 25 (45.5%) males and 30 (54.5%) females; with mean age of 51.2+14.0 years. According to New York Heart Association (NYHA) classification, over half (50.9%) of subjects had class II severity of HF followed by classes I and III of 20.0% each. The two commonest causes of HF were dilated cardiomyopathy (47.3%) and Hypertensive Heart Disease, HHD (30.9%). Forty three (78.2%) of the subjects had >2 scores on GHQ-12, indicating the likelihood of co-morbid psychopathology. Close to half (47.3%) of the subjects believed HF was caused by psychosocial /spiritual causes; with further 12.7% believing in admixed medical and spiritual causes. However, 35 (63.6%) of the subjects believed orthodox care to be the effective treatment for HF while the rest 20 (36.4%) believed in combination of orthodox medical care and spiritual intervention of prayer and “deliverance from the enemies”. Up to 81.8% of subjects believed HF has detrimental effect on work/income, sexual ability and social life. Over half (54.6%) admitted to past use of psychoactive substance but stopped on account of the HF. Only 2 (3.6%) were current users (alcohol). It is concluded that there is need to establish intensive health education on HF and cardiovascular diseases in the country. Key Words : Heart Failure; Nigeria; Psychosocial; Factors

Purpose: To evaluate the perception of primary care physicians on diagnosis and management of congestive cardiac failure in Lagos, Nigeria Method: A slightly modified questionnaire used in the Euro-F study was distributed to primary care physicians in randomly selected hospitals in randomly selected local government in the Lagos metropolis. Result: Response rate to the questionnaire was 50%. There was poor (25%) record keeping of heart failure patients among the group. The commonest symptoms used by the primary care physicians for diagnosis were pedal swelling (74%). The favored signs were pedal oedema (62%) and basal crepitations (39%). There was poor knowledge of symptoms when these were categorized using the Framingham criteria. Only 32% knew two major criteria and less than 50% knew three minor criteria. Majority of the diagnosis of heart failure was based on symptoms and signs, (62.91± 29.57), with minimal reliance on investigation, (12.58± 20.75). Commonest investigations performed were electrocardiogram, (75%) and chest X-ray (91%). The use of echocardiography was quite low in this study (16%). There was poor knowledge regarding ACE-inhibitor use, (32.82± 37.54) and adequate doses. The knowledge about the beneficial effects of ACE inhibitors on symptom relief (37%) and reduction in mortality (42%) was poor. The knowledge about the use of b-blockers in heart failure was also poor. Majority of the physicians favoured use of diuretics and cardiac glycosides. They had correct knowledge about their effects on symptom relief, diuretics, (80%) and cardiac glycosides (72%). They wrongly asserted that mortality is reduced with diuretics, (61%) and cardiac glycosides (65%). Conclusion: There is poor knowledge among the primary care physicians as regards diagnosis and the management of congestive cardiac failure. Continuing medical education is therefore of paramount importance for these physicians in view of the importance of this disease entity and rapid emergence of new information in all aspects of heart failure. Keywords : Primary care Physicians, Diagnosis, Management, Heart failure. NQJHM Vol. 14 (2) 2004: pp. 130-135

There are conflicting reports about the presence of depression in Black patients with heart failure (HF). We therefore evaluated the pattern of depression among hospitalized and stable HF patients in a homogenous Black population.Patients hospitalized for new or decompensated HF were assessed. The Zung Self-Rating Depression Scale (SDS) questionnaire was administered to the subjects who were subsequently interviewed by a psychiatrist using the Hamilton Depression Rating Scale (HDRS). Stable HF patients at the outpatient clinic were used as controls.There were 123 hospitalized and 82 stable outpatients. Depression was present in 67% of hospitalized patients and 30.50% of the outpatients (P.0001, using the SDS indexed scores). Stratifying the SDS indexed scores showed that 45.50%, 19.60% and 1.80% of the hospitalized patients compared with 26.80%, 3.70% and 0% of the outpatients had mild, moderate and severe depression (P=.007 and P=.001), respectively. The HDRS assessment showed that 63.40% of the hospitalized patients and 28.0% of the stable outpatients had significant depression (P.0001).Depression affects two thirds of hospitalized urban Nigerian HF patients compared to one third of stable outpatients with HF. The prevalence of depression is similar to the prevalence among European and North American samples.

In a 6 month prospective questionnaire study of 101 consecutive newly referred hypertensive patients and 86 normotensive volunteers, the relationship of erectile dysfunction and hypertension in these patients was studied using a modified international index of erectile function (IIEF). The mean age of the hypertensive subjects was 56.2±45 years and controls were 43.5±11.8 years. The erectile function score of the hypertensive group was significantly different from the normotensive control. (17.51±5.92 vs. 20.56±2.61). P< 0.05. 63 patients (62%) of the hypertensive subjects had varying levels of erectile dysfunction as compared to 38 (44%) of the control group. 39 (38.6%) of subjects had mild erectile dysfunction as compared to 36(41.8%) of the control group. 12 (11%) of the hypertensive subjects had moderate erectile dysfunction as compared to 2(0.2%) of the control group. 12 (11%) of the hypertensive subjects had severe erectile dysfunction as compared to none in the control group. There was a significant difference in the number of subjects in the hypertensive group who had erectile dysfunction compared to the normotensive subjects. Erectile dysfunction appeared to be influenced by subject's age and duration of hypertension. This study clearly suggests that erectile dysfunction is commoner in the hypertensive population than the control group. The cause of this may be multifactorial and a national study is needed to fully define the extent of this problem in Nigeria. Key Words: Erectile dysfunction, hypertensive patients Nigerian Medical Practitioner Vol. 45 No 6, 2004 (98-101)

Purpose: To evaluate the clinical, electrocardiographic (ECG) and echocardiograhic features of adult Nigerians presenting with atrial Fibrillation (AF) at the cardiology unit. Method: All consenting patients presenting to the cardiology unit of LUTH from September 2000 to September 2001 with ECG evidence of AF were recruited into the study. Demographic and anthropometric data were obtained. The subjects had a full clinical examination. 2D and M-mode echocardiogram was performed on the subjects. Result. Of the 39 subjects analysed there were 22 females and 17 males with a mean age of 54.49±14.60. The underlying heart disease distribution was as follows: hypertensive heart disease 46.2%; dilated cardiomyopathy 20.8%; rheumatic heart disease 17.9%; thyrotoxic heart disease 7.7%; hypertrophic cardiomyopathy 5.1%, lone 2.6%. About 23% were asymptomatic for the arrhythmia at diagnosis. Congestive cardiac failure was present in 74% of the subjects with a mean NYHA class of about III. Embolic phenomenon was observed in 15% of the subjects; 12.8% cerebral events and 2.6% limb embolism. Abnormal QRS axis was noted in 33.3%. Ectopic ventricular beats were as follows: uniform ectopics 30.8%; multiform ectopics 10.3% and unsustained ventricular tachycardia 7.7%. Abnormal echocardiographic features are as follows: dilated left atrium 33( 84.62%); abnormal thickness of the interventricular septum and posterior wall 12(30.77%) and 19(48.71%) respectively;Increased left ventricular internal diameter in diastole 20(51.3%) and in systole 25(64.10%); reduced fractional shortening 30(76.9%); spontaneous echoes 7(18.0%) and intramural thrombus 2(5.1%) Conclusion: Commonest underlying heart disease for AF in this study was hypertensive heart disease. Congestive cardiac failure was a frequently documented clinical feature and cerebral embolism remains a very common complication. Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 29-33

Purpose: Using the Rose Questionnaire, we aimed to study the characteristics of chronic chest pain in ambulatory care, to find patterns that are consistent with a diagnosis of angina pectoris. Methods: Patients: Consecutive patients, referred to the Cardiac Out-patient clinic with a major complaint of chest pain of more than one month were included. Exclusion criteria consisted of the presence of congestive heart failure, or recent use of digitalis or beta blockers. The questionnaire for this study was that of the World Health Organisation Cardiovascular Survey/ Rose Questionnaire (RQ) with an additional section designed to obtain data on demography, and descriptive characteristics of chest pain. Angina was according to RQ definition. Health professionals trained in the use of the RQ, administered the instrument. Sub-group analysis was based on the presence and absence of angina. Results: There were 214 patients, a male : female ratio of 0.8: 1; an average age of 44 years (age range of 16-70 years); 48% were obese (body mass index [BMI]>27 kg/m2) and 59% were over 40 years. The median duration of chest pain was six (6) months. Characteristic features of angina were present as follows: retrosternal location - 40%; pressure - like/constricting pain: 43%; and chest pain aggravated by exertion – 35%. Angina was diagnosed in 7%, whose pain stopped within 10 minutes of “stopping and resting”. Underlying diseases were hypertension-14.9%, Diabetes: 1%, and hypercholesterolaemia: 5.6%. Electrocardiographic (ECG ) abnormalities were common: left ventricular hypertrophy: 59%, ST elevation –25%, T wave inversion-6.5%. No ST depression was noted. Bundle branch block, prolonged PR interval axis deviation were found in less than 1%. Age, sex, and BMI were comparable in those with and without angina. Features of chest pain without significant association with angina were location, character, duration of single episodes, and aggravation by emotion. However, aggravation by food and exertion distinguished the angina groups (p Discussion and conclusion: Prevalence of RQ – detected angina is 7%, indicating that a majority of patients with chronic chest pain had non-cardiac or atypical chest pain. Presence of underlying diseases, pain characteristics, or ECG features did not distinguish those with and without RQ - angina. Further studies are required to elucidate the causes, and prognosis of RQ- angina, in our environment. Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 60-65

IntroductionPulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy due to a narrowing of the pulmonary vasculature and consecutive right heart failure. Little is known about PH in Africa, but limited reports suggest that PH is more prevalent in Africa compared with developed countries due to the high prevalence of risk factors in the region.Methods and analysisA multinational multicentre registry-type cohort study was established and tailored to resource-constraint settings to describe disease presentation, disease severity and aetiologies of PH, comorbidities, diagnostic and therapeutic management, and the natural course of PH in Africa. PH will be diagnosed by specialist cardiologists using echocardiography (right ventricular systolic pressure >35 mm Hg, absence of pulmonary stenosis and acute right heart failure), usually accompanied by shortness of breath, fatigue, peripheral oedema and other cardiovascular symptoms, ECG and chest X-ray changes in keeping with PH as per guidelines (European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines). Additional investigations such as a CT scan, a ventilation/perfusion scan or right heart catheterisation will be performed at the discretion of the treating physician. Functional tests include a 6 min walk test and the Karnofsky Performance Score. The WHO classification system for PH will be applied to describe the different aetiologies of PH. Several substudies have been implemented within the registry to investigate specific types of PH and their outcome at up to 24 months. Data will be analysed by an independent institution following a data analyse plan.Ethics and disseminationAll local ethics committees of the participating centres approved the protocol. The data will be disseminated through peer-reviewed journals at national and international conferences and public events at local care providers.