Search

Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease. Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes. Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected. The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed. Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28). During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.

Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years; men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%; diabetes was 34.27%; dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel; 28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36; 95% CI, 1.05 - 5.29; p = 0.036); male gender (OR, 1.6; 95% CI, 0.72 - 3.57; p = 0.24); diabetes (OR, 2.14; 95% CI, 0.96 - 4.75; p = 0.06) and necrosis Q waves (4.75; CI, 0.98 - 23.09; p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

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.

Introduction: Rheumatoid arthritis (RA) is associated with increasing of cardiovascular (CV) morbidity and mortality due to accelerated atherosclerosis. Several studies showed also the increasing of the prevalence of subclinical atherosclerosis, but there are little data from sub-Saharan Africa. The aim of our study was to assess the prevalence of cardiovascular risk factors, subclinical carotid atherosclerosis and the ability of the Systematic Coronary Risk Estimation (SCORE) modified by European League Against Rheumatism (EULAR) to predict the high CV risk in our patients. Patients and Method: We conducted a cross sectional study in Senegalese patients with RA. The RA was retained according to 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) criteria. Patients with RA were assessed in a clinical research consultation. Results: We included 50 RA patients. The mean age was 44 years (+/- 12.37) and the sex-ratiowas 0.06. The frequency distribution of traditional cardiovascular risk factors was: hypertension (HT) (30%), diabetes-mellitus (6%), smoking (2%), no-exercise (22%), obesity (16%), metabolic syndrome (8%). Fifty-eight percent of patients were classified at low cardiovascular risk according to mSCORE. 51.7% of patients classified as moderate-risk according to mSCORE, were reclassified as high cardiovascular risk according to carotid ultrasound evaluation (gold-standard). The sensitivity of the mSCORE in the prediction of high CV risk was low at 20%. In the present study, the prevalence of carotid subclinical atherosclerosis was 20%. Age (>45 years) and HT were correlated to subclinical atherosclerosis. Conclusion: In the present study, the prevalence of atherosclerosis in RA patients was higher than expected frequency in comparison with the prevalence in Senegalese general population. We showed that CV risk was underestimated by mSCORE which had a low sensitivity in the prediction of high risk. We showed also the importance of carotid ultrasound for an appropriate stratification of the risk.

Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerosis and increasing cardiovascular risk which is recognized as a major cause of morbidity and death. Whether subclinical atherosclerosis has been evaluated by several methods, there are very limited data about Ankle-Brachial Index (ABI) in patients with systemic lupus erythematosus. The aim of the present study was to compare this index, between SLE patients and controls. We conducted a case-control study in the Department of Internal Medicine of our institution during the period from August 1, 2017 to December 31, 2018. We included 100 subjects, including 50 SLE patients and 50 control cases. This included 44 women and 6 men in patients with an identical distribution in controls. The mean age was 33.5 ± 11.3 years for cases and 33.3 ± 11.3 years (p-value: 0.93) for controls subjects. There was higher frequency of cardiovascular risk factors such as dyslipidemia (p-value at 0.009), low level of serum HDL-cholesterol (p-value 0.001), hypertriglyceridemia (p-value at 0.000) and hyperuricemia (p-value at 0.000) in patients with SLE. Overweight/obesity was higher in controls subjects (p-value at 0.028). There was no statistically significant difference in the frequency of diabetes-mellitus, smoking and high blood pressure. The abnormally ABI was recorded in 19 patients with SLE (38%) and 8 controls (16%) with a p-value: 0.01 and odds ratio: 3.22. Eight patients (16%) and four controls (8%) had low ABI without significant difference (p-value: 0.11 but odds-ratio at 2.98). Eleven patients with SLE (22%) and five controls (10%) had high ABI (p-value: 0.05 and odds-ratio: 3.24). In patients with SLE only disease activity (cSLEDAI) at the inclusion of the study was correlated to abnormal ABI. Conclusion: This study showed an increasing prevalence of abnormal ABI in black African patients with SLE compared to controls with a correlation between disease activity and abnormal ABI.

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.

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.

Background Management of acute coronary syndromes with ST segment elevation (STEMI) is a race again time: time is myocardium». Treatment consist in reperfusion strategy by coronary intervention or thrombolysis. The main objective of this work was to evaluate the time delays of treatment and the extending factors during STEMI. Method It was a prospective, descriptive and analytic study on 6 months including all patients admitted for STEMI. We studied the time delays and the extending factors. Results We included 50 patients. The average age was 58,4 years and the sex ratio M/F was 2,5. Chest pain was typical for 39 patients. Mean time delay between pain onset and first medical contact was 12 h16 min. The first medical contact was a general physician for 33 patients and a cardiologist for 8 patients. The average time delay between the first medical contact and an electrocardiogram was 9 h57 min. The main factor of late diagnosis were unavailability of electrocardiograph and absence of prescription of an electrocardiogram. The average time delay between the diagnosis electrocardiogram and admission in cardiology department was 3 h02 min. The transport was the main extending factor. Aspirin and clopidogrel were used respectively for 17 and 10 patients. Among the patients admitted directly in cardiology, the average time delay for a diagnostic electrocardiogram was 30 min. Thrombolysis was performed in 17 patients within an average delay of 2 h11 min. A rupture of streptokinase was the most common extending factor. Twenty-three patients underwent percutaneous coronary intervention with a main time delay between diagnostic electrocardiogram and cath lab of 2 h42 min. The unavailability of medical team was the first extending factor. Conclusion Factors related to long delay in admission and care are a proof of lack of codified management of STEMI. It is necessary to develop the prehospital emergency medicine, educate population and medical staff.

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.

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.

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.

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.

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

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.

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 prise en charge des coronaropathies a connu des progres remarquables. L’adhesion aux mesures therapeutiques constitue, alors, un defi important pour ameliorer le pronostic a long terme. Nous evaluons dans ce travail les facteurs lies a l’observance therapeutique chez des patients coronariens stables d’origine noire africaine. Methodologie Nous avons realise une enquete entre fevrier et mai 2008 dans trois services de cardiologie de Dakar. Nous avons etudie la regularite des prises medicamenteuses, le respect du regime et des rendez-vous de consultation ainsi que les facteurs lies a l’adhesion therapeutique. Un taux d’observance superieur ou egal a 80 % definissait la bonne adhesion therapeutique et un taux inferieur a 40 % la mauvaise adhesion. Resultats Nous avons inclus 105 patients (61 hommes) avec un âge moyen de 60,67 ± 11,29 ans. Une bonne observance etait notee dans 56,2 % des cas pour le traitement medicamenteux, 42 % pour le regime et 65 % pour le suivi des consultations. Un antecedent d’accident coronarien aigu ( p = 0,04), une bonne connaissance de la maladie ( p = 0,03) et une couverture sanitaire ( p = 0,02) constituaient les facteurs de bonne adhesion au traitement medicamenteux, alors que la myocardiopathie ischemique etait un facteur de mauvaise adhesion ( p = 0,002). La connaissance de la maladie coronaire etait le seul facteur correle a une bonne adhesion au regime ( p = 0,014). Conclusion L’observance therapeutique reste peu satisfaisante chez le coronarien noir africain, d’ou l’importance de l’education des patients pour aider a une bonne adhesion au traitement car la meilleure adhesion therapeutique ameliore le pronostic des coronariens.

Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.

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 Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar. METHODS This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients. RESULTS Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance. CONCLUSIONS Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.

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: 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

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.

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.

Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 30-69 years with uncomplicated hypertension (140-179/90-109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa. ispartof: Blood Pressure vol:20 issue:5 pages:256-266 ispartof: location:England status: published

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.