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Despite tremendous advances in the management of cardiovascular diseases and cardiac arrest, there is paucity of information regarding sudden cardiac death in sub-Saharan Africa. We present a two-year review of sudden cardiac death cases among patients managed at a Nigerian tertiary hospital. Patients admitted from January 2012 to December 2013 were prospectively followed-up and cases of sudden cardiac death identified. Diagnosis was based on records of events preceding death, direct interview of attending physician/nurses, and family members/eye witnesses for out-of-hospital sudden cardiac death. Causes of death were obtained from the death certificates for cases of in-hospital events. Three hundred and eighty eight (M:F = 1:1.3) patients with a mean age of 42.22 ± 19.30 years were admitted into the cardiac unit during the period, out of whom 56 (14.4%) died. Twenty three (41.1%) were classified as sudden cardiac death. The predominant etiology was ischemic cardiomyopathy (39.1%), followed by peripartum cardiomyopathy (21.7%) and dilated cardiomyopathy (17.4%). Rheumatic heart disease was diagnosed in 17.4%, while 4.3% had pulmonary hypertension. Nineteen (82.6%) of the subjects had congestive cardiac failure. Hypokalemia and hypocalcaemia were recorded in 2 (8.7%) patients who developed prolongation of the QT interval following commencement of diuretics. Chest-compression-only cardiopulmonary resuscitation was attempted in 12 (52.1%) with a success rate of 8.3%. Sudden cardiac death is common among our patients admitted with cardiovascular diseases. The most common etiology is ischemic cardiomyopathy, followed by peripartum cardiomyopathy. Most of the victims were young, and there were no optimum resuscitative measures.

Pheochromocytoma may be responsible for various cardiac events including cardiac arrhythmias Authors report the case of a young child in whom pheochromocytoma was revealed by a junctional tachycardia The determination of urinary free catecholamines found a very high level of Noradrenaline and the abdominal CT showed a left hilar renal mass

Systemic hypertension is a rapidly growing epidemic in Africa. The role of socioeconomic status on blood pressure control has not been well studied in this part of the world. We, therefore, aimed to quantify the association of socioeconomic status both at the individual and at the country level with blood pressure control in Sub-Saharan Africa. We conducted a cross-sectional survey in urban clinics of 12 countries, both low income and middle income, in Sub-Saharan Africa. Standardized blood pressure measures were made among the hypertensive patients attending the clinics. Blood pressure control was defined as blood pressure P for trend, P for trend, 0.03) and not in middle-income countries ( P for trend, 0.26). In low-income countries, the odds of uncontrolled hypertension increased 1.37-fold (odds ratio, 1.37 [0.99–1.90]) and 1.88-fold (odds ratio, 1.88 [1.10–3.21]) in patients with middle and low individual wealth as compared with high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth ( P for trend

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.

Les tachycardies à QRS large mal tolérées du nourrisson posent le problème de leur diagnostic et de la prise en charge en urgence. Nous rapportons un cas de tachycardie à QRS large chez un nourrisson de 35 jours reçu pour détresse cardio-circulatoire. Le cœur était morphologiquement normal à l’échographie cardiaque Doppler. Un traitement par une dose charge d’Amiodarone n’a pas permis de réduire cette tachycardie. Un retour en rythme sinusal a été obtenu après cardioversion par un défibrillateur externe semi-automatique type Lifeline. Un traitement d’entretien par Amiodarone per os est institué et le patient est en rythme sinusal à 03 mois.

Introduction : Le syndrome cardio-renal (SCR) est un trouble physiopathologique du coeur et des reins dans lequel une dysfonction chronique ou aigue de l’un peut induire une dysfonction chronique ou aigue de l’autre. En Afrique et au Senegal en particulier l’incidence du syndrome cardiorenal est mal connue. L’objectif de cette etude etait d’apprecier la prevalence du SCR en milieu cardiologique. Methodes : Nous avons mene une etude retrospective incluant tous les insuffisants cardiaques ayant une alteration de leur fonction renale et hospitalises entre avril 2010 et avril 2011 au service de cardiologie. Les donnees etaient analysees avec le logiciel statistique Epi-info 3.5.3. Resultats : Nous avons inclus 36 patients. La prevalence etait de 3,7% avec une predominance masculine (sex-ratio a 1,77) et un âge moyen a 56,9 ans [30-92]. Les antecedents etaient domines par l’hypertension arterielle (52,77%) et le diabete (19,4%). Les principales etiologies etaient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie etait dominee par la dyspnee (69,4%) et les oedemes (50%). On notait une anemie (17 patients). La clairance moyenne (MDRD) a 46 ml/min. L’echocardiographie Doppler retrouvait majoritairement des troubles de la cinetique (89,3%), une dysfonction systolique VG (71%). Les 3 echographies renales etaient normales. Six deces (16,7 %) etaient notes. Conclusio n: Le syndrome cardio-renal est une realite et marque un tournant dans l’evolution de toute cardiopathie et nephropathie. Sa prevalence en milieu cardiologique senegalais est faible. Des etudes prospectives et multicentriques sont necessaires pour une meilleure evaluation au Senegal.

Objectives: The objectives of this study were to evaluate the prevalence of the right ventricular infarction and its diagnostic, therapeutic and prognostic characteristics. Patients and methods: A single center retrospective study was carried out between January 2011 and December 2014. Patients who were diagnosed with right ventricular infarction at electrocardiogram and echocardiography were recruited. Outcomes: Among the 159 patients hospitalized for myocardial infarction, 10 had myocardial infarction extended to the right ventricle (6.3%). It occurred on an inferior infarction in 7 cases out of 35 and anterior infarction in 3 cases out of 124. The mean age was 53 years and sex ratio M/F of 2.33. All patients had at least 3 cardiovascular risk factors. Right-sided heart failure was found in 4 patients. Right ventricular infaction was associated with inferior STEMI in 7 patients, and anterior STEMI in 3 patients. Echocardiography showed right ventricular dilatation and impaired right ventricular systolic function in respectively 6 cases. Thrombolysis was performed in 7 patients and rescue angioplasty in 1 case. A regressive cardiogenic collapse was noted in 6 cases and one death in 1 case. Conclusion: Right ventricular infarction is relatively rare and usually related to an extension of an inferior myocardial infarction. Hemodynamic instability is of worse prognosis.

Vasospastic angina is considered rare but its prevalence is probably underestimated, especially in the case of atheromatous coronary lesions. Its diagnosis remains important because of its poor prognosis and its therapeutic features. We report a clinical case illustrating the issue of vasospastic angina’s diagnosis. Diagnostic ways such as coronary spasm challenge tests must be adapted to the evolution of the techniques and the use of coronary angiography nowadays, in particular the preferential use of the radial pathway especially in women with a smaller radial caliber compared to men.

Congenital heart diseases are one of the major cardiovascular diseases in developing countries. Most prevalence studies were based on clinical examination of children with echocardiographic confirmation of suspected cases and underestimate its prevalence. The objective of this study was to investigate the prevalence of congenital heart disease in "daara" (Koranic schools) in the city of Dakar and its suburbs on the basis of clinical examination and Doppler echocardiography in school children. This cross-sectional survey was carried out from 9(th) August to 24(th) December 2011, and included a population of 2019 school children aged 5 to 18 years in 16 selected "daaras" under the Academic Inspectorate of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were recorded in a validated questionnaire. A p < 0.05 was considered to be statistically significant in bivariate analysis. 2 019 school children were included out of which 60.1% were male (sex-ratio: 0.66). The average age was 9.7 years (± 3.3 years). 18 cases of congenital heart diseases were detected being a prevalence of 8.9 per 1 000 (95 % CI: 1.8 to 7.9). This included 6 cases of inter-atrial septal aneurysm, 5 cases of peri-membranous ventricular septal defects, 4 cases of patent ductusarteriosus and 3 cases of tetralogy of Fallot. Factors correlated with the presence of congenital heart disease were ageless than 8 (p

Background : The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods : The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion : This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.

Background : The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. Methods : Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometric measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. Results : The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). Conclusion : We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.

Resume Introduction Les maladies cardiovasculaires deviennent avec leurs facteurs de risque un veritable probleme de sante en Afrique. Les objectifs de cette etude etaient d’evaluer la prevalence des facteurs de risque cardiovasculaire dans la population generale de la ville de Saint-Louis au Senegal. Methodologie Il s’agit d’une etude transversale, descriptive et analytique realisee en mai 2010, chez des senegalais âges d’au moins 15 ans, residant de la ville de Saint-Louis au Senegal. Un sondage aleatoire systematique et stratifie en grappes a ete realise. Les facteurs de risque cardiovasculaire recherches etaient : hypertension arterielle, diabete, dyslipidemie, tabagisme, obesite, sedentarite et syndrome metabolique. Resultats L’enquete a concerne 1424 individus dont 983 femmes (69 %). L’âge moyen etait de 43,4 ± 17,8 ans. La prevalence des facteurs de risque etait : hypertension arterielle (46 %), diabete (10,4 %), hypercholesterolemie totale (36,3 %), hyperLDLcholeserolemie (20,6 %), obesite (indice de masse corporelle superieur ou egal a 30 kg/m 2 ) (23 %), obesite abdominale (48,7 % selon l’International Diabetes Federation et 33,2 % selon National Cholesterol Education Program) sedentarite (64,7 %), tabagisme (5,8 %) et syndrome metabolique (15,7 %). On notait une predominance chez les femmes des facteurs de risque sauf pour le tabagisme et le diabete. Le risque cardiovasculaire global etait eleve dans 24,9 % selon le modele de Framingham, 28,8 % (Societe europeenne d’hypertension) et 6,1 % (SCORE). Conclusion Cette enquete retrouve une forte prevalence des facteurs de risque cardiovasculaire dans une population generale senegalaise, avec une predominance chez les femmes. Cela doit amener a elaborer une meilleure strategie de prevention des affections cardiovasculaires.

Resume Introduction La decouverte d’une ischemie myocardique silencieuse chez un diabetique le place dans une logique de prevention secondaire. Les objectifs de cette etude etaient d’etudier les parametres echocardiographiques des diabetiques de type 2 senegalais a haut risque cardiovasculaire et d’identifier ceux qui seraient predicteurs d’ischemie myocardique silencieuse. Patients et methode Nous avons realise une etude transversale chez 79 diabetiques a haut risque cardiovasculaire. Apres l’examen clinique, nous avons realise un bilan biologique (glycemie, creatininemie, bilan lipidique, hemogramme et ionogramme sanguin), un ECG, une echocardiographie standard et une echocardiographie de stress a la dobutamine a la recherche d’une ischemie myocardique silencieuse. Les donnees ont ete analysees a l’aide du logiciel SPSS 17 et la determination des parametres echocardiographiques predicteurs d’ischemie myocardique silencieuse grâce a une analyse multivariee. Resultats Soixante-dix-neuf diabetiques de type 2 a haut risque cardiovasculaire ont ete evalues dont 56 femmes. L’âge moyen etait de 58,8 ± 11,8 ans (44–72 ans). Les anomalies retrouvees a l’echo-Doppler cardiaque etaient dominees par une dilatation de l’oreillette gauche (72,6 %), une augmentation des pressions de remplissage du ventricule gauche et une augmentation de la masse ventriculaire gauche dans 62,0 % des cas respectivement. A l’echocardiographie de stress, les troubles de la cinetique segmentaire etaient retrouves chez 67,1 % des patients. Ces troubles etaient significativement plus frequents chez les patients qui avaient une dilatation de l’oreillette gauche (p = 0,0001), une augmentation des pressions de remplissage (p = 0,001) et une augmentation de la masse ventriculaire gauche (p = 0,001). Conclusion Chez le diabetique a haut risque cardiovasculaire, l’existence d’une dilation de l’oreillette gauche, d’une hypertrophie ventriculaire gauche ou d’une augmentation des pressions de remplissage du ventricule gauche pourrait temoigner d’une ischemie myocardique silencieuse.

Introduction Le syndrome cardio-rénal (SCR) est un trouble physiopathologique du cœur et des reins dans lequel une dysfonction chronique ou aiguë de l’un peut induire une dysfonction chronique ou aiguë de l’autre. En Afrique et au Sénégal en particulier l’incidence du syndrome cardio-rénal est mal connue. L’objectif de cette étude était d’apprécier la prévalence du SCR en milieu cardiologique. Méthodes Nous avons mené une étude rétrospective incluant tous les insuffisants cardiaques ayant une altération de leur fonction rénale et hospitalisés entre avril 2010 et avril 2011 au service de cardiologie. Les données étaient analysées avec le logiciel statistique Epi-info 3.5.3. Résultats Nous avons inclus 36 patients. La prévalence était de 3,7% avec une prédominance masculine (sex-ratio à 1,77) et un âge moyen à 56,9 ans [30-92]. Les antécédents étaient dominés par l’hypertension artérielle (52,77%) et le diabète (19,4%). Les principales étiologies étaient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie était dominée par la dyspnée (69,4%) et les œdèmes (50%). On notait une anémie (17 patients). La clairance moyenne (MDRD) à 46 ml/min. L’échocardiographie Doppler retrouvait majoritairement des troubles de la cinétique (89,3%), une dysfonction systolique VG (71%). Les 3 échographies rénales étaient normales. Six décès (16,7 %) étaient notés. Conclusion Le syndrome cardio-rénal est une réalité et marque un tournant dans l’évolution de toute cardiopathie et néphropathie. Sa prévalence en milieu cardiologique sénégalais est faible. Des études prospectives et multicentriques sont nécessaires pour une meilleure évaluation au Sénégal.

Introduction L’hypertension artérielle (HTA) du sujet âgé est un facteur indépendant de maladie cardio-vasculaire. Nos objectifs étaient de décrire les aspects cliniques, électrocardiographique et échocardiographiques de l’HTA du sujet âgé. Méthodes Nous avons mené une étude descriptive et transversale de Janvier à Septembre 2013. Etaient inclus les sujets hypertendus âgés d’au moins 60 ans suivis en ambulatoire au service de cardiologie de l’Hôpital Principal de Dakar. Les données statistiques étaient analysées par le logiciel Epi Info 7 et une valeur de p < 0,05 était retenue comme significative. Résultats Au total, 208 patients étaient inclus. L’âge moyen était de 69,9 ans avec une prédominance féminine (sex-ratio de 0,85). La pression artérielle moyenne était de 162/90mmHg. L’HTA était contrôlée dans 13% des cas. A l’électrocardiogramme, on notait un trouble du rythme (17,78%), une hypertrophie auriculaire gauche (45,19%), une hypertrophie ventriculaire gauche (28,85%) et 2 cas de bloc auriculo-ventriculaire complet. Le Holter ECG révélait 4 cas de tachycardie ventriculaire non soutenue (IVb de Lown), 6 cas de fibrillation atriale paroxystique et 1 cas de flutter atrial paroxystique. L’échocardiographie réalisée chez 140 patients retrouvait une HVG à prédominance concentrique chez 25 patients, plus fréquente chez les hommes (p=0,04) et une dilatation de l’oreillette gauche dans 56,42% des cas, plus fréquente chez les patients plus âgés (p= 0,01). Conclusion Les aspects électrocardiographiques et échocardiographiques dans la population hypertendue âgée sont caractérisés par l’hypertrophie ventriculaire gauche notamment concentrique, la fréquence des arythmies révélées quelques fois par l’enregistrement électrocardiographique de longue durée.

Introduction: Systemic lupus erythematosus is a major systemic autoimmune disease of unknown cause. It can affect all organs and especially the heart with different proportions. The aim of this study was to determine the evolving electrocardiographic and echocardiographic features in systemic lupus erythematosus. Methodology: This study was carried out at the cardiology and dermatology Aristide Le Dantec Hospital. This is a descriptive longitudinal study conducted from January 2013 to October 2014. We included SLE patients who had at least two echocardiograms and electrocardiograms performed at least 3 months apart. Anamnestic information, electrocardiographic and echocardiographic features were reported on a pre-established survey form. Data were entered using Epi -info software version 3.5.1. Results: We included 25 patients. It was mentioned a female predominance (88%). The average age of patients was 35.5 years. All patients had dermatological signs of systemic lupus erythematosus. Cardiac events were found on clinical examination in 20% of cases. Sixty four percent (64%) of patients had an abnormal electrocardiogram dominated by left ventricular hypertrophy (24%). During 18 months of follow-up, we noted some electrocardiographic changes in 16% of cases. Ultrasound abnormalities were found in 40% of patients: 8% presented a slight expansion of the OG, a patient had impaired left ventricular function with the presence of a spontaneous contrast intra VG and increased filling pressures. Right ventricular function was impaired in one patient. Other abnormalities were found: 12% of aneurysm of the interatrial septum, 4% of atrial septal defect and 4% of pericardial detachment. Conclusion: Cardiovascular violations are fairly common in SLE patients. A study on a large sample and longterm could better assess cardiovascular complications in SLE patients and how they occurred.

The main etiology of aortic stenosis in Africa is rheumatic fever in middle-age adults. We report the case of an aortic stenosis probably due to familial dyslipidemia. A patient of 24 years, male, was referred by his dermatologist for investigation of exertional dyspnea. Physical examination revealed regular heart sounds with a systolic murmur 4/6 at the aortic valve area and abolition of B2. There was no sign of heart failure. Lipid dosage showed high LDL and total cholesterol levels, 5.42 g/L and 6.23 g/L respectively. Triglyceride and HDL cholesterol levels were normal: 0.70 g/L and 0.62 g/L. Echocardiography found severe aortic stenosis with an aortic valve area of 0.6 cm2; a mean gradient of 68 mmHg and a maximum aortic jet velocity of 5.32 m/s. Coronary angiogram showed slight atheroma but angiographically normal coronary arteries. Dermatological examination showed tuberous xanthomas in pressure areas such as the elbows, knees, and buttocks. Ophthalmologic examination found corneal arcus in both eyes. The patient’s current treatment associated a lipid-lowering diet, statin and diuretics. Although rheumatic heart disease is common in middle-aged adults, aortic stenosis of “atherosclerotic” origin is possible.

Introduction: l’hypertension artérielle (HTA) du sujet âgé est un facteur indépendant de maladie cardio-vasculaire. Nos objectifs étaient de décrire les aspects cliniques, électrocardiographique et échocardiographiques de l’HTA du sujet âgé. Méthodes: nous avons mené une étude descriptive et transversale de Janvier à Septembre 2013. Etaient inclus les sujets hypertendus âgés d’au moins 60 ans suivis en ambulatoire au service de cardiologie de l’Hôpital Principal de Dakar. Les données statistiques étaient analysées par le logiciel Epi Info 7 et une valeur de p < 0,05 était retenue comme significative. Résultats: au total, 208 patients étaient inclus. L’âge moyen était de 69,9 ans avec une prédominance féminine (sex-ratio de 0,85). La pression artérielle moyenne était de 162/90mmHg. L’HTA était contrôlée dans 13% des cas. A l’électrocardiogramme, on notait un trouble du rythme (17,78%), une hypertrophie auriculaire gauche (45,19%), une hypertrophie ventriculaire gauche (28,85%) et 2 cas de bloc auriculo-ventriculaire complet. Le Holter ECG révélait 4 cas de tachycardie ventriculaire non soutenue (IVb de Lown), 6 cas de fibrillation atriale paroxystique et 1 cas de flutter atrial paroxystique. L’échocardiographie réalisée chez 140 patients retrouvait une HVG à prédominance concentrique chez 25 patients, plus fréquente chez les hommes (p=0,04) et une dilatation de l’oreillette gauche dans 56,42% des cas, plus fréquente chez les patients plus âgés (p= 0,01). Conclusion: les aspects électrocardiographiques et échocardiographiques dans la population hypertendue âgée sont caractérisés par l’hypertrophie ventriculaire gauche notamment concentrique, la fréquence des arythmies révélées quelques fois par l’enregistrement électrocardiographique de longue durée.The Pan African Medical Journal 2016;25

L’infection par le virus de l’immunodeficience humaine (VIH) peut provoquer des complications vasculaires. Il s’agit le plus souvent de thrombose veineuse des membres inferieurs. De rares cas d’ischemie des membres revelatrice de l’infection a VIH ont ete decrits. Nous rapportons un cas de thrombose veineuse du membre inferieur gauche et d’une ischemie arterielle bilaterale des membres inferieurs revelant une infection par le VIH 1 chez une patiente de 44 ans. Le taux de CD4 etait de 195/mm3. L’exploration de la coagulation n’a pu etre realisee. La patiente a ete amputee de ses deux membres inferieurs.

Introduction : Permanent cardiac pacing is a technique whose indications have increased in the last 20 years. As with any foreign body, pacemaker implantation is associated with the risk of infection. The objective of this study was to describe the clinical, paraclinical and treatment options of infections secondary to pacemaker implantation at the Cardiology Department of the Aristide le Dantec Teaching Hospital (CHU Aristide le Dantec) in Dakar, Senegal. Methods : We conducted a retrospective study over a period of three years (from January 2005 to December 2007) during which pacemaker implantation was carried out in 107 patients. All patients with local and/or systemic signs of infection were included in our study. Results : The prevalence of infection in patients with pacemakers was 5.6% in our series and infection occurred in three women and three men, with a mean age of 66.2 years (range 23-83). The delay time for the onset of clinical signs of infection was 6.6 months, with a range of eight days to 12 months. The clinical signs were externalisation of the pacemaker with suppuration (five cases), fever (one case) and inflammatory signs (one case). Factors favouring the occurrence of infection were co-morbidity (four cases), pre-operative length of stay (average eight days), use of temporary cardiac pacing (three cases), the number of people in the theatre (average 4.5), postoperative haematoma (one case) and repeating the surgical procedure (three cases). Staphylococcus epidermidis (two cases), Staphylococcus aureus (two cases) and Klebsiella pneumoniae (one case) were the organisms isolated at the local site. Transthoracic echocardiography showed no objective signs of endocarditis. The treatment was antibiotic therapy for an average duration of 50.4 days after debridement of the infected site (six cases). We noted four recurrences at six months and one death from sepsis at 12 months. Conclusion : Infections secondary to pacemaker implantation are rare but serious. Their management is difficult and requires the removal of the implanted material, hence the importance of prevention of infection, or the removal and re-implantation of the pacemaker at another site in cases of infection. This is particularly important in our region where pacemakers are very expensive.

Resume Objectifs Etudier la prevalence de l’arteriopathie des membres inferieurs (AOMI) dans la population âgee de 40 ans ou plus et analyser les facteurs associes aux anomalies de l’index de pression systolique (IPS) dans la population generale de Saint-Louis au Senegal. Methodologie Il s’agit d’une etude transversale, descriptive et analytique realisee du 3 au 30 mai 2010, chez 771 senegalais âges d’au moins 40 ans. Un sondage aleatoire systematique et stratifie en grappes a ete realise. La mesure de l’IPS a ete faite a l’aide d’un doppler de poche de marque DIADOP 50 muni, d’une sonde bifrequence 4 et 8 Hz. L’AOMI etait definie par un IPS inferieur a 0,9 et la mediacalcose par un IPS superieur a 1,3. Resultats Ces sujets (âge moyen 57 ± 11,2 ans, 559 femmes) avaient comme facteurs de risque cardiovasculaire la sedentarite (76,4 %), l’hypertension arterielle (68 %), l’obesite (32,1 %), l’hyperLDL-cholesterolemie (27,8 %), le diabete (18,3 %) et le tabac (6,9 %). Quatre-vingt-treize sujets (12,1 %) avaient une AOMI et 37 (4,8 %) avaient une mediacalcose. L’AOMI etait significativement plus frequente chez les sedentaires ( p = 0,008), les sujets âges ( p = 0,0006) et chez les sujets presentant une coronaropathie ( p = 0,04). En revanche, le tabac n’etait pas fortement associe a l’AOMI. Conclusion L’AOMI est frequente a Saint-Louis et cela du fait de la prevalence elevee des facteurs de risque cardiovasculaire. Des strategies de prevention et de prise en charge correctes de ces facteurs de risque, en particulier la sedentarite, sont necessaires.

The complications of infective endocarditis (IE) are frequent and severe. Our objectives were to analyze the clinical, paraclinical, and prognostic features of IE vascular complications observed in two cardiology units, in Dakar. Patients and methods We retrospectively studied 90 patients presenting with of IE, hospitalized between January 2005 and February 2011. The diagnostic criteria for IE were modified Duke University criteria. We selected in our study population, patients with vascular complications. Results Seventeen patients (18.8%) presented with one or more vascular complications of IE: eight male and nine female patients, with a mean age of 28 years. Infective endocarditis occurred on an abnormal valve in 15 cases. We identified 22 vascular lesions: ten neurological complications, seven arterial complications in the limbs, two myocardial infarctions, two cases of pulmonary embolism, and one splenic infarction. The vascular complication revealed an IE in seven cases. The vascular complication occurred during antibiotic treatment, in 15 cases including seven cases before the 14th day, nine of the 17 patients died. Death was related to vascular complications in six cases, in one case it was related to septic shock. Conclusion Vascular complications of IE are frequent, the most common are neurological. Their prevention requires early and adequate management of IE.

Introduction : Seul ou associe a d’autres facteurs de risque vasculaire, le diabete est responsable d’une lourde morbi-mortalite partout dans le monde. Son expansion prend des allures de pandemie, mais elle reste encore peu documentee en Afrique sub-saharienne. Ce travail fournit quelques aspects epidemiologiques du diabete parmi les autres facteurs de risque vasculaire en milieu urbain a Saint-Louis, au Senegal. Patients et methodes : Il s’agit d’une etude observationnelle, transversale, descriptive, qui s’est deroulee du 3 au 30 mai 2010. Les unites de sondage etaient constituees par les Senegalais habitant la ville de Saint-Louis, âges de 15 ans au moins. L’echantillonnage utilise etait un sondage aleatoire, stratifie en grappes, utilisant comme base de sondage les donnees du recensement general de l’habitat de Saint-Louis. Resultats : L’enquete a concerne 1 424 individus. Le sex-ratio femmes/hommes etait de 2,23. L’âge moyen de la population etait de 43,4 ± 17,8 ans. La prevalence du diabete etait de 10,4 %, incluant 7,8 % de cas connus et 2,6 % de cas nouvellement diagnostiques. Ce diabete etait dit « controle » dans 33,3 % des cas selon les criteres de la Federation internationale du diabete (IDF) et 39,6 % selon ceux de l’Association americaine du diabete (ADA). Le traitement etait medicamenteux dans 74,3 % des cas et par traditherapie dans 54,3 % des cas. Les autres facteurs de risque vasculaire etaient : – la dyslipidemie (64,6 %), connue dans 2,4 % des cas et depistee dans 62,2 % des cas. Seuls 20 % des patients etaient traites par hypolipemiants et 12 % etaient a l’objectif ; – la sedentarite (64,0 %), plus frequente chez les femmes que chez les hommes ( p – l’hypertension arterielle (HTA, 46,0 %), connue de l’individu dans 23,0 % des cas et ignoree chez les 23,0 % restants ; 31,0 % des hypertendus n’etaient pas traites et 30,5 % l’etaient par traditherapie ; – l’obesite (23,0 %), a predominance feminine ; – le tabac (5,8 %) et l’alcool etaient moins frequents. Le diabete etait associe a l’HTA ou a la dyslipidemie dans 87,8 % des cas ; 62,8 % des sujets avaient au moins trois facteurs de risque associes. Sur le plan des complications, 16,6 % des sujets presentaient une insuffisance renale, 17,0 % une arteriopathie des membres inferieurs (indice de pression systolique [IPS] abaisse) et 3,2 % avaient presente un accident vasculaire cerebral. Conclusion : Cette enquete revele des chiffres alarmants sur la prevalence du diabete, ainsi que celle de la dyslipidemie, de l’HTA et meme de l’insuffisance renale dans la population autochtone de la ville de Saint-Louis. Ces facteurs de risque vasculaire sont probablement sous-estimes dans la population generale. Il est necessaire de conduire des enquetes de prevalence a l’echelle nationale afin de mettre en place des politiques de prevention efficaces et perennes.

SummaryBackgroundAlthough 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.MethodsWe 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.ResultsRheumatic 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

Pulmonary embolism remains the major malingerer of acute chest disease. The clinical and electrocardiographic manifestations may deviate to a diagnosis of myocardial infarction. We report a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism. Coronary angiography performed after the second hospitalization was normal.

Resume Introduction Le diabete constitue un facteur de risque majeur de la maladie coronarienne pouvant evoluer de facon insidieuse. Plusieurs methodes non invasives sont utilisees pour la detection de l’ischemie myocardique silencieuse, surtout chez le diabetique a haut risque cardiovasculaire. Notre objectif etait de depister, par l’echocardiographie de stress a la dobutamine, l’ischemie myocardique silencieuse chez des diabetiques de type 2 au Senegal. Methodologie Nous avons recrute au hasard en milieu hospitalier au Senegal des diabetiques de type 2 âges d’au moins 40 ans et une echocardiographie de stress a la dobutamine a ete realisee chez ceux selectionnes selon les criteres de la Societe francaise de cardiologie et de l’Association de langue francaise pour l’etude du diabete et des maladies metaboliques. Resultats L’echocardiographie de stress a la dobutamine etait realisee chez 79 diabetiques a haut risque cardiovasculaire, dont 56 femmes avec un âge moyen de 58,8 ± 11,8 ans. Elle etait positive dans 67,1 % des cas (53/79), avec une predominance des anomalies de la cinetique dans le territoire anterieur (83 %). Les facteurs de risque cardiovasculaire associes a la positivite du test etaient la microalbuminurie (p = 0,0001), la sedentarite (p = 0,0001), la dyslipidemie (p = 0,0002), l’hypertension arterielle (p = 0,001), le tabagisme (0,003) et le sexe masculin (p = 0,004). Conclusion En Afrique, l’echocardiographie de stress a la dobutamine presenterait l’avantage de son accessibilite et de sa faisabilite. La detection precoce de l’ischemie myocardique silencieuse, assez frequente chez les diabetiques a haut risque, permettrait d’optimiser leur prise en charge.

Aims We examined the efficacy and safety of pulmonary vein (PV) isolation, using a cryoballoon catheter. Methods and results We studied 117 consecutive patients presenting with paroxysmal ( n = 92) or persistent ( n = 25) atrial fibrillation (AF), who underwent attempts at isolation of 442 PV with a cryoballoon catheter. They were followed in our ambulatory department for every 3 months, or earlier if they reported symptoms. A 48 h ambulatory electrocardiogram was recorded at the 3-month visit. We analysed the immediate and long-term procedural and clinical outcomes. We isolated 385 of 442 PV (87%) with a single cryoballoon application. In 19 patients (16%), an irrigated-tip radiofrequency (RF) catheter was used to create a supplemental focal lesion. A median of nine applications per procedure (range 6–12) was delivered. The mean, overall procedural duration was 155 ± 43 min (range 75–275), and mean duration of fluoroscopic exposure was 35 ± 15 min (range 12–73). At the end of the procedure, 103 patients (88%) were in sinus rhythm. Over a median period of 9.6 months (range 3–12), 11 patients were lost to follow-up. At 3, 6, 9, and 12 months of follow-up, respectively, 79, 79, 79, and 69% of patients presenting with paroxysmal AF had remained recurrence free, vs. 83, 73, 59, and 45% of patients, respectively, with persistent AF. Phrenic nerve palsy was the most frequent, although reversible complication. Conclusions Pulmonary vein isolation, using a cryoballoon catheter, was completed with a high rate of procedural and long-term success and low rate of minor complications. Supplemented, when needed, by focal RF, cryoballoon ablation was a safe and an effective alternative to a circumferential RF procedure.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 39 - N° 6 - p. 484-489

Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, and death. Oral anticoagulants (OACs) are the cornerstone of AF management and effectively prevent AF-related stroke. As new non-vitamin K antagonist OACs (NOACs) have become available, the landscape of stroke prevention in AF has changed. Data on contemporary treatment patterns and outcomes associated with AF in clinical practice are very limited for patients in sub-Saharan Africa. Methods/design The atrial fibrillation registry in countries of Africa (AFRICA) is a multicenter, prospective, ambulatory-based registry of incident and prevalent AF. The registry will be an international collaboration of health care providers and cardiologists from 25 countries in sub-Saharan Africa. The initial goal of enrolling 5000 patients is to capture a large, representative population of patients with AF in these countries. Enrolled patients will be observed for ≥ 2 years from 2018 to 2022. Because the registry design is adaptive in nature, sample size can be modified during the course of the study to ensure adequacy of the registry to answer targeted research questions. The goal is to describe baseline characteristics, identify specific aspects and characterize treatment and outcomes of patients with AF in sub-Saharan Africa. Conclusion There are considerable gaps between daily clinical practice and current guideline-based recommendations (mainly based on non-African studies) for therapy in many healthcare systems. The atrial fibrillation registry in countries of Africa will provide insights into “real-world” treatment including rate and rhythm control, stroke prevention, transitions to new therapies, and clinical outcomes among patients with AF in sub-Saharan Africa. This would promote better quality of AF care and improved patient outcomes worldwide.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 1 - p. 83-88

To study the prevalence of rheumatic heart disease (RHD) in schools (locally referred to as 'daaras') located in the city of Dakar and its suburbs using both clinical examination and echocardiography.This is a cross-sectional study conducted from 9 August to 24 December 2011 involving 2019 pupils, aged between 5 and 18 years selected from the 16 'daaras' of the Academic Inspectorate (Inspection d'Académie) of the city of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were collected and entered into a questionnaire designed for the study. The World Heart Federation criteria for echocardiographic diagnosis were used to diagnose RHD. p0.05 was considered statistically significant in bivariate analysis.About 60.1% of the pupils were men and the mean age was 9.7±3.3 years. 10 cases of definite RHD were detected, prevalence being 4.96 per 1000 (95% CI 2.4 to 9.1). This prevalence was five times higher with echocardiographic screening compared with clinical screening. 23 cases (11.4 per 1000) of borderline forms were detected. The populations at risk of definite RHD identified in our study were children over 14 years (p0.001), those with recurrent sore throat (p=0.003) and those residing in the suburbs of the city of Dakar (p0.001).Our study shows a relatively high prevalence of RHD. Reducing its prevalence should focus on the implementation of appropriate policies, targeting at-risk populations and focusing on raising awareness and early detection.

Summary 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.

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.

Introduction: In patients with rheumatoid arthritis, cardiovascular involvement is common, may have serious consequences, and can contribute to worsening of patient’s outcome. The realization of systematic electrocardiogram can help to detect earlier cardiac abnormalities and place in a logical secondary prevention. Our purpose of this study was to investigate the electrocardiographic abnormalities in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations. Patients and methods: The study was performed as a cross-sectional study, which included prospectively 73 patients of both sexes aged at least 18 years in the internal medicine department of University Hospital Center Aristide Le Dantec in Dakar, Senegal, fulfilling the criteria for definite or classical rheumatoid arthritis according to the criteria of the American Rheumatism Association. It focused on a sample of following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, Rheumatoid factors, Latex and Waaler Rose, Anti-CCP, antinuclear factors and antibodies anti-ENA), a standard ECG. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables. Results: All patients had normal ECG and no cardiac symptoms or dyspnoea on effort. The study included 73 patients (68 females and 5males) with rheumatoid arthritis without obvious cardiac events meet the criteria of definition of the ACR 1987. The mean age was 44.17 ± 14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93 ± 4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). Electrocardiographic abnormalities found were dominated by left ventricular hypertrophy encountered in 34 patients (46.57%), left atrial enlargement in 32.90% of cases, 16.44% of patients had left axis deviation. The myocardial hyper excitability was present in 8 patients (11.19%), including 6 (8.45%) ventricular premature beats found in patients with active RA. Twenty-six patients had signs consistent with an ischemia and/or myocardial injury is a rate of 35.61%. Conclusion: The realization of the electrocardiogram in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations allows highlighting cardiovascular abnormalities related to the natural course of the disease.

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.

Resume Nous rapportons le cas d’un adenome de Conn chez une femme de 36 ans revele par une impotence fonctionnelle des membres inferieurs. La patiente a presente une hypertension arterielle (HTA) a 170/90 mmHg avec une hypokaliemie a 1,5 mmol/L. Le diagnostic a ete confirme par le dosage hormonal qui a mis en evidence une elevation de l’aldosterone plasmatique et une baisse de l’activite renine plasmatique. L’IRM abdominale a revele un nodule surrenalien gauche de 1,8 cm de diametre prenant le contraste en peripherie pouvant etre compatible avec un adenome surrenalien. Une surrenalectomie gauche totale a ete pratiquee et le resultat anatomopathologique a confirme le diagnostic. Les suites operatoires ont ete simples avec normalisation de la kaliemie et de la tension arterielle.

Introduction : Morbidity and mortality from diabetes are compounded by associated cardiovascular risk factors. For this reason, taking care of these risk factors is a public health goal. In this study we evaluated the level of control of cardiovascular risk factors in black Africans with type 2 diabetes in Senegal. Methods : Between March 2007 and July 2008, we recruited type 2 diabetes patients from outpatient care in a specialised hospital in Senegal. Data were collected on a survey form designed for this purpose. An electrocardiogram and laboratory examinations were also performed. The level of control of diabetes and associated cardiovascular risk factors were assessed, as recommended by the American Diabetes Association (ADA). Results : A total of 318 type 2 diabetes subjects (237 women) were recruited. The average age was 58.2 ± 9.2 years (40-85). The mean duration of diabetes was 6.9 ± 5.9 years. The average glycaemic level was 1.4 ± 0.5 g/l and glycated haemoglobin was 7.6 ± 3.2%. The average length of patient follow up was 6.7 ± 6.1 years with a single annual consultation; 63.2% of the patients were on an insulin + biguanide combination, with good diabetes control (HbA1c < 7%) in 25% of cases. Antihypertensive drugs were prescribed in 28.1% of hypertensive patients. More than half (51.9%) of these hypertensive patients were treated with angiotensin converting enzyme inhibitors. Their blood pressure was well controlled (l 130/85 mmHg) in 5.4% of the hypertensive patients (10/185). The low-density lipoprotein (LDL) cholesterol goal was achieved in 18.5% of cases (5/27). Conclusion : This study shows that the prevalence of cardiovascular risk factors is higher among black Africans suffering from type 2 diabetes. The control of these factors was not optimal in our study. Introduction : La morbidite et la mortalite du diabete sont aggravees par l'association de facteurs de risque cardiovasculaire dont la prise en charge est un objectif de sante publique. Nous evaluons dans cette etude le niveau de controle des facteurs de risque cardio-vasculaire dans une population de diabetiques de type 2 noirs africains au Senegal. Methodologie : Nous avons recrute, entre mars 2007 et juillet 2008, des diabetiques de type 2 suivis en ambulatoire en milieu hospitalier specialise au Senegal. Les donnees ont ete recueillies sur une fiche d'enquete concue a cet effet. Un electrocardiogramme et des examens biologiques ont ete aussi realises. Le niveau de controle du diabete et des facteurs de risque cardio-vasculaire associes a ete evalue selon les recommandations de l'American Diabetes Association (ADA). Resultats : Un total de 318 diabetiques de type 2 (237 femmes) ont ete colliges. L'âge moyen etait de 58.2 ± 9.2 ans (40-85). La duree moyenne d'evolution du diabete etait de 6.9 ± 5.9 ans avec un taux moyen de glycemie de 1.4 ± 0.5 g/l et d'hemoglobine glyquee de 7.6 ± 3.2%. La duree moyenne du suivi des patients etait de 6.7 ± 6.1 ans avec une seule consultation annuelle; 63.2% des patients etaient sous l'association biguanide + insuline avec un bon controle du diabete (HbA1c < 7%) dans 25% des cas. Les antihypertenseurs etaient prescrits chez 28.1% des hypertendus dont plus de la moitie (51.9%) sous inhibiteurs de l'enzyme de conversion de l'angiotensine avec un bon controle de la tension arterielle (l 130/85 mmHg) dans 5.4% des cas (10/185). L'objectif de LDL-cholesterol etait atteint dans 18.5% des cas (5/27). Conclusion : Cette etude montre que la prevalence des facteurs de risque cardio-vasculaire est eleve chez les diabetiques de type 2 noirs africains. Le controle de ces facteurs n'etait pas optimal dans notre etude.

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.

MOTS CLES Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological studies for WolfParkinson-White syndrome, discovered during a medical clearance examination to be a professional soccer referee. This athlete had no medical history, reported no symptoms and his physical examination was normal. A 12-lead electrocardiogram revealed the presence of ventricular pre-excitation, a negative delta wave in leads I and aVL, and right bundle branch-type QRS morphology, consistent with a left lateral accessory pathway (Fig. 1), which persisted during peak exercise. Electrophysiological studies confirmed the presence of a left lateral accessory pathway and the induction of atrial fibrillation by rapid atrial pacing, immediately followed by the development of ventricular fibrillation (Fig. 2a, b), requiring the delivery of two consecutive biphasic 200J DC shocks to restore sinus rhythm (Fig. 3a). The patient

Introduction: According to the WHO, 50% of deaths worldwide (40.1% in developing countries) are due to chronic non-communicable diseases (NCDs). Of these chronic NCDs, cardiovascular diseases remain the leading cause of death and disability in developed countries. The Framingham study has shown the importance of hypercholesterolemia as a primary risk factor. In Senegal, the epidemiology of dyslipidemia and obesity are still poorly understood due to the lack of comprehensive studies on their impact on the general population. This motivated this study to look into the key epidemiologic and socio-demographic determinants of these risk factors. Methods: It was a cross-sectional descriptive epidemiological survey which included 1037 individuals selected by cluster sampling. Data were collected using a questionnaire following the WHO STEPwise approach. Socio-demographic, health and biomedical variables were collected. P value Results: The average age was 48 years with a female predominance (M: F of 0.6). The literacy rate was 65.2% and 44.7% of participants were from rural areas. The prevalence of hypercholesterolemia, hyperLDLemia, hypoHDLemia, hypertriglyceridemia and mixed hyperlipidemia were 56%, 22.5%, 12.4%, 7.11% and 1.9% respectively. One in four was obese (BMI> 30kg/m2) and 34.8% had abdominal obesity. The main factors significantly associated with dyslipidemia were obesity, urban dwelling, physical inactivity and a family history of dyslipidemia. Conclusion: The prevalence of dyslipidemia, obesity and other risk factors in the population was high needing immediate care for those affected and implementation of prevention strategies.Key words: Dyslipidemia, obesity, cardiovascular, risk factors, Saint Louis

Certaines dissections de l`aorte peuvent se compliquer d'hemothorax faisant, evoquer initialement, une pathologie pleuro-pulmomaire. Nous rapportons l'observation d'un patient âge de 67 ans, hypertendu, atteint d`une dissection de l`aorte, presentant un tableau typique, clinique et radiologique d`un syndrome d`epanchement pleural gauche en dehors de tout contexte infectieux et traumatique. Le tableau d`un syndrome pleural gauche a conduit a la realisation d`une ponction pleurale qui a ramene un liquide hemorragique. La tomodensitometrie thoracique a conclu a une dissection aortique type B de Stanford. La prise en charge chirurgicale est indiquee en cas de complication comme ce fut le cas de notre patient.

Summary Background The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as ‘witnessed natural death occurring within one hour of the onset of symptoms’ or ‘unwitnessed natural death within 24 hours of the onset of symptoms’. After appro val from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.

Resume Encore frequente en Afrique, la myocardiopathie idiopathique du peripartum (MIPP) n'a fait l'objet que de tres peu d'etudes prospectives. L'objectif de ce travail prospectif est d'etudier chez 26 femmes atteintes de MIPP les anomalies echocardiographiques et d'en determiner l'evolution et les facteurs pronostiques. Six femmes ont un epanchement pericardique de faible a moyenne abondance. Les anomalies de la cinetique, constamment retrouvees, sont diffuses dans 20 cas (77,1 %) et localisees ou predominant au septum et a la paroi posterieure du ventricule gauche dans les autres cas. Les cavites cardiaques sont dilatees dans 24 cas (92,3 %). L'hypertrophie ventriculaire gauche est notee chez 16 patients (61,5 %). Elle est excentrique dans 15 cas. La dysfonction systolique ventriculaire gauche est constante. Les autres anomalies sont : le trouble de la relaxation ventriculaire gauche (un cas), le bas debit mitral et aortique a l'examen TM (12 cas), l'insuffisance mitrale (21 cas) et tricuspidienne (cinq cas). On note une hypertrophie septale et une dilatation isolee du ventricule droit. Le suivi moyen est de 7,3 ± 1 mois (1–18 mois). Deux patientes sont decedees aux quatrieme et huitieme mois. Parmi les 24 survivants, 11 ont normalise leurs parametres echocardiographiques. Les facteurs associes a l'absence de normalisation sont : la gestite ( p =0,01), la parite ( p =0,01), l'index cardiothoracique ( p =0,04), le diametre telediastolique ventriculaire gauche ( p =0,02), les volumes ventriculaires gauches ( p =0,02) et les parametres de fonction systolique ventriculaire gauche ( p =0,01). L'echocardiographie montre le plus souvent l'aspect de myocardiopathie dilatee hypokinetique, mais plusieurs variantes sont possibles. La majorite des patientes atteintes de MIPP gardent des anomalies echographiques apres un suivi a moyen terme.

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.