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Introduction: Infectious endocarditis is a transplant of microorganisms in healthy endocardium, in injured endocardium or intracardiac material. The modes of revelation can be multiple and varied, the skin manifestations of an infectious although classical endocarditis, are rare. Observation: This was a young 20-year-old patient, admitted in our cardiac unit for the exploration of a cardiac murmur in a context of long-term fever evolving for nearly 3 weeks associated with a skin rash. The examination found fever at 39°C and tachycardia at 115 beats/min. The cardiac auscultation revealed tachycardia with a systolic breath apexian mitral insufficiency. The skin examination revealed Osler’s nodules, an erythema of Janeway on the soles of the feet and on the palms of the hands. In biology, there was a non-specific biological inflammatory syndrome. Blood cultures from three series of samples did not isolate a germ. The transthoracic echography showed large vegetations in the anterior and posterior leaflets of mitral valve associated with severe mitral regurgitation. In this context, the diagnosis of mitral endocarditis is retained according to the Duke criteria. A double intravenous antibiotic therapy based on ceftriaxone and gentamycin was administrated. The evolution was favorable with stable apyrexia, disappearance of skin signs, regression of non-specific biological inflammatory syndrome. A replacement surgery of mitral valve was proposed. Conclusion: Infectious endocarditis is a disease with multiple and varied modes of revelation. Although skin manifestations are rare, they are still a determining factor in the diagnosis of infectious endocarditis.

Brugada syndrome is a channelopathy that can be familial or sporadic. It is a major cause of sudden death in young people with no obvious heart structural abnormality. The electrocardiogram can be dynamic over time with sometimes normalization. Several pathophysiological conditions are known to induce the electrocardiographic expression of the syndrome. We report here the case of a 65-year-old hypertensive man, without syncope or family sudden death history who was hospitalized for shigella gastroenteritis. Electrocardiogram during fever showed an incomplete block and ST segment elevation with negative T waves in V1 and V2 suggested type 1 Brugada syndrome. Troponin was negative. Electrocardiogram after fever recovered an incomplete right block and normalization of the ST segment. Electrocardiogram should be performed in patients admitted to the emergency unit for infectious syndrome in our countries. This may reveal a number of patients with Brugada syndrome abnormalities.

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Summary Background Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. Aims To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. Methods We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. Results Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03–1.72), medication (OR 1.56, 95% CI 1.25–1.93) or both (OR 1.91 1.39–2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04–2.22), 1.8-fold (95% CI 1.22–2.65) and 3.08-fold (95% CI 2.02–4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. Conclusions High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.

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Aim The aim of this study was to assess of the risk of sudden death in a population of hypertrophic cardiomyopathy patients in Dakar. Methods This was a transverse study at the cardiology clinic of Aristide Le Dantec Hospital from January 2014 to June 2015. We used the European Society of Cardiology risk score to calculate this risk. Results The average age of patients was 53 years. Unexplained syncope was found in two patients and two others had a family history of sudden death. The septal hypertrophy average was 20.9 mm. Seven patients had left intraventricular obstruction. One patient had a high risk of sudden death, three had intermediate risk and 13 had low risk. Competitive sport was not allowed, 13 patients were under medical treatment, one had an implantable cardioverter defibrillator and two had no treatment. Conclusion Our study highlighted a low and intermediate risk of the occurrence of sudden death at five years. One patient had a high risk of sudden death.

Despite the growing interest in athlete’s right ventricle and various work carried out, many uncertainties are remaining. The interest of this work resides in the determination of the particularity in right heart of the black athlete subject. We conducted a prospective study from August to October 2016 in the cardiology department of Aristide Le Dantec University Hospital in Dakar. The included patients were divided according to the sporting practice as enduring, resistant and non-athletes. The parameters studied were electrocardiographic (atrial or ventricular hypertrophies), echocardiographic: dimensions of the right cavities, systolic and diastolic functions of the right ventricle. We included 58 subjects: 38 athletes including 28 endurance and 10 resistance and 20 non-athletes. The average age of the endurance athletes was 21.9 ± 3, 75 years, 26.30 ± 4.64 in resistance ones and 24.10 ± 1.89 in the non-athletic group. Two cases of first-degree atrioventricular block were recorded in athletes. On the echocardiographic point, the atrium surfaces, as well as the transverse diameter, were greater in athletes, especially in the endurance group. The mean diameters of the admission chamber and those of the right ventricular flush chamber were larger in the group of endurance athletes. It was the same for the annular and sagittal basal mean diameters of the RV as well as the RV/LV ratio. The anterior wall of the right ventricle was larger in athletes compared to non-athletes. The vena cava was greater in athletes, the pulmonary arterial pressure higher in resistance ones.

Introduction: Precordial pain is a common reason for admission in cardiology, and has many causes. Acute myocarditis in its pseudo-infarctoid form is sometimes difficult to differentiate from myocardial infarction. Cardiac magnetic resonance imaging (MRI) helps to differentiate these two disease entities. We report the respective cases of two young patients, one presenting with myocarditis whilst the other with myocardial infarction. Case Report: We present the cases of two patients. The first who had a recent history of febrile syndrome is a 23-year-old who stopped smoking 3 months prior to presentation whilst the second is a 22-year-old professional footballer with a history of stress with no other cardiovascular risk factors. They were respectively admitted in our emergency department for a constrictive, intense chest pain. Physical examination was normal. The chest pain in both patients was associated with elevated cardiac markers, primary repolarisation abnormalities on ECG, wall motion abnormalities as well as left ventricular systolic dysfunction on transthoracic echocardiography. Coronary angiograms were normal in both patients. In the first patient, MRI concluded with an acute myocarditis with apical akinesia extending to the anterior wall, a T2 hypersignal indicative of myocardial edema, and uptake of a nodular heterogeneous contrast without affecting the sub-endocardial layers on the late enhancement sequences. In the second patient, MRI showed an appearance consistent with acute extensive infarction in the antero-apical region with severe hypokinesia and late quasi-transmural enhancement, impairment of the anterior papillary muscle of the mitral valve and a reduced left ventricular ejection fraction at 33%. In addition to analgesics, the first patient was treated with perindopril and bisoprolol, and the second patient received antithrombotic and anticoagulant treatment. There was clinical improvement in both patients. Conclusion: Cardiac MRI is a useful diagnostic tool for the precise diagnosis of precordial pain with elevated cardiac enzymes, especially in young patients.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Resume Introduction Les cardiopathies congenitales de l’adulte regroupent les malformations traitees dans l’enfance qui decompensent secondairement et celles qui, asymptomatiques a la naissance, se revelent tardivement. Les objectifs de ce travail etaient d’identifier les cardiopathies congenitales de l’adulte dans un service de cardiologie generale du Senegal et d’etudier les presentations cliniques, les traitements et l’evolution. Methodologie Nous avons mene une etude transversale, descriptive, portant sur les dossiers de patients âges d’au moins 16 ans, suivis pour une cardiopathie congenitale dans le service de cardiologie de l’Hopital General de Grand-Yoff de Dakar entre mai 2003 et mars 2015. Le diagnostic de la cardiopathie etait base sur l’echocardiographie. Resultats Nous avons collige 50 dossiers de patients soit une prevalence de 0,75 %, avec une predominance feminine (64 %). L’âge moyen des patients etait de 36,16 ± 18,4 ans (16–79 ans) et 29,76 ± 22,58 ans au moment du diagnostic. La dyspnee etait le principal signe revelateur (60 %). Les principales malformations etaient la communication inter-auriculaire (38 %), la stenose pulmonaire (14 %), la communication inter-ventriculaire (12 %) et la persistance du canal arteriel (10 %). Selon la classification de Bethesda, la cardiopathie etait de complexite simple (42 %), intermediaire (58 %) ou severe (10 %). Le traitement etait medical chez 43 patients et chirurgical chez 7 patients. Les principales complications etaient l’endocardite infectieuse (10 %), la fibrillation atriale (12 %), l’insuffisance cardiaque (24 %) et l’hypertension arterielle pulmonaire (50 %). Conclusion Les cardiopathies congenitales de l’adulte semblent sous-estimees dans nos regions et la correction chirurgicale y est rare. Il incombe d’assurer une bonne gestion de la transition entre l’âge pediatrique et adulte.

Resume Objectifs Evaluer la prevalence de l’hypertrophie ventriculaire gauche (HVG) electrocardiographique et echographique ainsi que ses corollaires dans une population d’hypertendus vivant en milieu semi-rural au Senegal. Patients et methode Selon l’approche STEPS de l’organisation mondiale de la sante, nous avons mene, en novembre 2012, une enquete transversale et exhaustive chez les sujets âges d’au moins 35 ans et vivant depuis au moins 6 mois, dans la zone semi-rurale de Gueoul. Les facteurs de risque cardiovasculaire ont ete depistes et l’hypertrophie ventriculaire gauche recherchee a l’electrocardiogramme et a l’echocardiographie chez les hypertendus. Les donnees etaient analysees grâce au logiciel SPSS 18.0 et le seuil de significativite fixe pour une valeur de p Resultats Nous avons examine 1411 sujets âges en moyenne de 48,5 ± 12,7 ans. Au total, 654 sujets etaient hypertendus et une hypertrophie ventriculaire gauche a ete la recherche chez 515 sujets parmi eux. Selon l’indice de Sokolow-Lyon, 86 sujets (16,7 %) presentaient une HVG electrocardiographique, plus frequemment chez les hommes (p = 0,002). Selon l’indice de Cornell et le produit de Cornell, elle etait retrouvee respectivement chez 66 (12,8 %) et 52 sujets (10,1 %), avec une predominant feminine (p = 0,0001 ; p = 0,004). Elle etait plus frequente chez les hypertendus en grade 3 quel que soit l’indice. A l’echocardiographie, la prevalence de l’HVG selon la masse ventriculaire gauche etait de 2,5 % (13 cas), de 9,3 % (48 cas) selon la masse ventriculaire gauche indexee a la surface corporelle et de 8,2 % (42 cas) selon la masse ventriculaire gauche indexee a la taille2,7. L’HVG selon la masse ventriculaire gauche indexee a la surface corporelle etait significativement correlee a l’HVG electrocardiographique selon l’indice de Sokolow-Lyon (p Conclusion Bien que rare chez l’hypertendu senegalais vivant en milieu semi-rural, l’hypertrophie ventriculaire gauche est correlee a la severite de l’hypertension arterielle. Un depistage par l’electrocardiogramme permettra un meilleur suivi de ces hypertendus.

Patient: Female, 32 Final Diagnosis: Obstructive primary cardiac T-cell lymphoma Symptoms: Right heart failure Medication: — Clinical Procedure: None Specialty: Cardiology Objective: Rare disease Background: Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. Case Report: Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. Conclusions: The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.

Les troubles du rythme cardiaque mal tolérés du nouveau-né sont une véritable urgence nécessitant une prise en charge rapide et adéquate. Nous rapportons le cas d'un nouveau-né de 15 jours présentant une tachycardie atriale en défaillance cardiaque aiguë ayant nécessité une cardioversion électrique.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

Aims Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. Methods and results Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. Conclusion The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

Resume Introduction Notre objectif etait d’etudier la prevalence des personnes porteuses de plaques d’atherome carotidiennes en population semi-rurale de Gueoul au Senegal et d’analyser les correlations avec les facteurs de risque et les atteintes vasculaires. Patients et methode Enquete transversale, descriptive durant 1 mois incluant les Senegalais âges d’au moins 35 ans residant depuis plus de 6 mois a Gueoul. La mesure etait faite avec un appareil d’echocardiographie Doppler portable. La plaque carotidienne etait definie notamment par une epaisseur intima media > 1,5 mm. Un seuil de significativite etait retenu pour une valeur de p Resultats Au total, 1411 sujets etaient inclus avec un sex-ratio femmes/hommes de 2,93 et un âge moyen de 48,5 ans. Les facteurs de risque cardiovasculaire etaient la dyslipidemie (61,1 %), la sedentarite (56,2 %), l’obesite abdominale (53,9 %), l’hypertension arterielle (46,4 %), l’obesite (12 %), le diabete (7,2 %) et le tabagisme (2,5 %). La prevalence des plaques d’atherome carotidiennes etait de 6,8 % dont 42,7 % avaient des plaques bilaterales. L’âge avance ( p = 0,001), l’hypertension arterielle ( p = 0,0001), le diabete ( p = 0,004) et le syndrome metabolique ( p = 0,008) etaient significativement correles a ces plaques. Concernant les atteintes vasculaires, 5,2 % des patients porteurs d’atherome carotidien avaient eu un accident vasculaire cerebral ( p = 0,01), 27,1 % avaient eu un infarctus du myocarde ( p = 0,02) et 31,2 % avaient une arteriopathie des membres inferieurs ( p = 0,5). Conclusion La prevalence des porteurs de plaques d’atherome carotidiennes semble faible. Cependant, l’association avec les facteurs de risque cardiovasculaire est a souligner, justifiant l’importance des strategies de prevention des maladies cardiovasculaires.

Resume Introduction Les facteurs de risque cardio-vasculaire sont en nette augmentation dans les pays en voie de developpement. Parmi ces facteurs, la dyslipidemie est souvent retrouvee, cela liee aux changements des habitudes comportementales et alimentaires (OMS, 2006). La dyslipidemie est une « modification pathologique primitive ou secondaire des lipides seriques », c’est une anomalie metabolique et chronique caracterisee par une elevation persistante des TG, du LDL-c et une diminution du HDL (Attias et al., 2013–2014). L’objectif de cette etude etait de determiner la prevalence de la dyslipidemie et de donner le profil lipidique de la population de Gueoul. Patients et methode Nous avons effectue une etude observationnelle, transversale, descriptive exhaustive sur les Senegalais ayant 35 ans ou plus, residant a Gueoul depuis au moins 6 mois. Le bilan lipidique (cholesterolemie totale, triglyceridemie, HDL-cholesterol, LDL-cholesterol) etait systematique. Le prelevement etait fait apres 12 heures de jeune. Resultats La dyslipidemie etait retrouvee dans 61,3 % des cas avec 50 % d’hypercholesterolemie pure ( n = 705). Seuls 20 sujets (2,3 % = 20/864) savaient qu’ils avaient une dyslipidemie. Le taux de depistage etait de 59,8 % ( n = 844). Le type le plus represente etait l’hypoHDLemie (45,6 %) suivie de l’hyperLDLemie (28,8 %). Les triglycerides etaient augmentes dans seulement 2,8 % des cas. Conclusion La prevalence de la dyslipidemie est tres elevee dans nos regions. Elle est souvent associee au genre feminin, a l’HTA, au diabete et a l’obesite. Ses principales causes sont la sedentarite, le changement des habitudes de vie et de comportement alimentaire. Elle est souvent meconnue et sa prise en charge est limitee dans la majorite des cas au regime hypocalorique.

Resume Introduction La recherche de l’atteinte cardiaque chez les patients atteints de polyarthrite rhumatoide permet de prevenir les complications et les place dans une logique de prevention secondaire. L’objectif de cette etude etait d’etudier les parametres electrocardiographiques et echocardiographiques dans une population de patients senegalais atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Patients et methode Nous avons realise une etude transversale descriptive, ayant inclus de facon prospective des patients suivis en ambulatoire dans le service de medecine interne du centre hospitalo-universitaire Aristide Le Dantec de Dakar au Senegal, avec un diagnostic de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire. Elle a porte sur un echantillon de 73 patients des deux sexes âges d’au moins 18 ans. Apres l’examen clinique, nous avons realise un bilan biologique (CRP, fibrinogene, la VS, les facteurs rhumatoides : Latex et Waaler-Rose, les anti-CCP, les facteurs antinucleaires et les anticorps anti-ENA), un ECG, une echocardiographie standard. Les donnees ont ete analysees selon une etude descriptive des differentes variables avec le calcul des proportions pour les variables categorielles et les parametres de position et de dispersion pour les variables quantitatives. Resultats Au total, 73 patients atteints de polyarthrite rhumatoide sans manifestations cardiaques evidentes remplissant les criteres de definition de l’ACR 1987 ont ete inclus dans l’etude. L’âge moyen etait de 44,17 ± 14,43 ans avec des extremes de 18 et 75 ans. La duree moyenne d’evolution de la PR etait de 5,93 ± 4,78 ans. La notion de rhumatisme inflammatoire familial etait rapportee dans 35,60 % des cas et quasiment un patient sur six presentait au moins un facteur de risque cardiovasculaire (16,96 %). Les anomalies retrouvees a l’echo-doppler cardiaque etaient dominees par une dysfonction diastolique du VG (42,46 %), une augmentation de la masse ventriculaire gauche dans 35,61 %. Des fuites valvulaires de grades variables ont ete mises en evidence touchant tous les orifices mais rarement significatives. Conclusion La realisation de l’echocardiographie chez des patients atteints de polyarthrite rhumatoide asymptomatique au plan cardiovasculaire permet de mettre en evidence des anomalies cardiovasculaires liees a l’evolution naturelle de la maladie.

Introduction: Systemic hypertension is a rapidly growing epidemic in Sub-Saharan Africa. Adequacy of blood pressure(BP) control and the factors influencing it, especially the role of socio-economic status(SES) have not been well studied in this part of the world. Hypothesis: We therefore aimed to quantify the association of SES both at the individual and at the country level with BP control in Sub-Saharan Africa. Methods: We conducted a cross-sectional survey in urban clinics of twelve countries, both low-income and middle-income, in Sub-Saharan Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP Results: A total of 2198 hypertensive patients (58.4±11.8years; 39.9% male) were included, of whom 1017(46.3%) were from low-income and 1181(53.7%) from middle-income countries. Individual wealth level was low, mid and high in 376(17.6%), 1053(49.2%) and 713(33.3%) patients respectively. Uncontrolled hypertension was present in 1692 patients(77.4%) including 1044(47.7%) with ≥grade 2 hypertension. The proportion of uncontrolled hypertension progressively increased with decreasing level of patient individual wealth, respectively 72.8%, 79.3% and 81.8%(p for trend Conclusions: Low individual wealth was significantly associated with poor hypertension control, especially in low-income countries. Strategies for hypertension control in Sub-Saharan Africa should especially focus on people in the lowest individual wealth groups who also reside in low-income countries.

Pulmonary embolism and acute aortic dissection are two formidable cardio-vascular emergencies. Their association, although exceptional, is burdened with a heavy mortality in the absence of an early and adapted surgery. We report a case of Standford acute type A aortic dissection associated with fatal pulmonary embolism. This is a 66-years old man with a notion of a long trip received for prolonged chest pain since 3 days, of sudden onset, maximal intensity, tearing, transfixing, migratory, radiating towards the back and the loins, exacerbated by breathing. The examination noted 120 bpm tachycardia, 70% SaO2 desaturation, asymetric blood pressure and asymetric pulse, aortic insufficiency murmur and bilateral crackling rettles at lungs. The chest X-ray showed an enlargement of the upper mediastinum with double-contoured image. The electrocardiogram recorded a regular sinus tachycardia at 132 cycles/min, a lateral sub epicardial ischemia in lateral leads. CT scan revealed total thrombosis of the right branch of the pulmonary artery extending to part of the trunk and an intimal flap from the aortic arch to the abdominal aorta. The evolution was brutally lethal two days after hospitalization. The dissection of the aorta and the pulmonary embolism are medical emergencies whose association poses more difficulties as well on the diagnosis plan but especially therapeutic.

Introduction: Pulmonary Embolism (PE) is the most severe form of venous thromboembolic disease. This is a serious condition not only because of its mortality but also its sequelae. Methodology: The aim of this study is to evaluate the prognosis of patients who had an episode of PE, hospitalized in the cardiology department of the Aristide Le Dantec University Hospital in Dakar. We performed a cohort study that included all patients admitted for pulmonary embolism during the period of May 1, 2011 to February 29, 2016. Subjects were contacted for a re-evaluation during the period of August 1st to September 1st 2016. We evaluated the status of patients (death or alive), to look for signs of chronic pulmonary heart based on the electrocardiogram (right atrial and ventricular hypertrophies, aspect S1S2S3, right bundle branch) and especially on the echocardiogram (right cavitary and parietal dimensions, measurement of the PASP). Results: A total of 77 pulmonary embolism cases were counted during the study period; 70 files were retained. It was a predominantly female population, with an average age of 51.2. Low risk forms (PESI I-II) accounted for 85.7% of the sample, versus 14.3% of PESI III-IV-V forms. At the re-evaluation, we counted 18 deaths (25.7%); twenty-two patients were lost to follow up. No recurrence was noted since hospitalization. Two patients had bilateral, noninflammatory edema. Dyspnea was found in 3 patients. No patient had any sign of right heart failure. Doppler echocardiography showed dilatation of the right ventricle along parasternal long axis in 6 cases and along apical section in 5 cases respectively. Right ventricular wall hypertrophy was noted in 6 patients. The systolic function of the right ventricle was normal in all cases. The right atrium was dilated in 5 cases. Pulmonary hypertension and increased pulmonary vascular resistance were noted in 7 cases, respectively. The overall mortality factors were acute circular insufficiency, right ventricular systolic dysfunction, PESI score of at least 1, tachycardia, PASP value greater than 50 mmHg, right heart failure and dilatation of the right atrium. Conclusion: Wall dilatation and hypertrophy of the right ventricle as well as pulmonary hypertension are frequent sequelae. The parameters of the hemodynamic impact of pulmonary embolism constitute the main prognostic factors.

Resume Le faux anevrisme du ventricule gauche est une complication tardive peu frequente de l’infarctus du myocarde. Des formes dites non coronaires ont ete decrites chez le sujet jeune. Dans ce cadre, nous rapportons trois observations. Monsieur M.B., 20 ans, a consulte pour des precordialgies associees a des palpitations. L’examen cardiovasculaire retrouvait une voussure precordiale battante expansive et un souffle systolo-diastolique mesocardiaque. On notait un rythme sinusal avec des extrasystoles ventriculaires a l’ECG. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale de l’arc inferieur gauche. L’echocardiographie-Doppler montrait un volumineux faux anevrisme apical ventriculaire gauche. Mme O.B., 23 ans, a ete admise pour une insuffisance cardiaque globale chez qui l’examen retrouvait un souffle systolique apexien. L’ECG inscrivait une tachycardie sinusale reguliere, une hypertrophie auriculaire gauche et ventriculaire gauche. La radiographie thoracique de face montrait une cardiomegalie et une deformation anevrismale des arcs moyen et inferieur gauches. L’echocardiographie-Doppler revelait un volumineux faux anevrisme apical du ventricule gauche. Monsieur I.S., âge de 24 ans, admis pour la prise en charge d’une insuffisance cardiaque globale. Le patient avait un syndrome inflammatoire non specifique a la biologie, une tachycardie sinusale et des extrasystoles a l’ECG. La radiographie du thorax de face montrait une solution de continuite au niveau de l’arc posterieur de la sixieme cote, une cardiomegalie et une dilatation anevrismale de l’arc inferieur gauche. A l’echocardiographie-Doppler, on notait un volumineux faux anevrisme du ventricule gauche de siege apical.