Search

Introduction: La coronarographie est une méthode exploratrice et thérapeutique des artères coronaires qui connait depuis quelques années des avancées remarquables, de telle sorte que ses indications peuvent s’étendre à tous les âges en fonction des orientations cliniques. L’objectif de ce travail était de décrire les aspects des artères coronaires chez les patients de moins de 40 ans explorés au CHU Aristide Le Dantec.Patients et Méthodes: Nous avons effectué une étude descriptive qui incluait tous les patients dont l’âge était inférieur ou égal à 40 ans et qui avaient eu une coronarographie suite à un consentement éclairé dans la période du 1er Mai 2014 au 31 Août 2017. Les paramètres étudiés étaient épidémiologiques, cliniques, coronarographique, incluant l’éventuelle angioplastieRésultats: Nous avions inclus 32 patients. L’âge moyen était de 33,84 ± 5,59 ans, avec un minimum de 18 ans. Le genre masculin prédominait avec 27 hommes. Le facteur de risque cardio-vasculaire le plus fréquemment retrouvé était le tabac (28,13%) suivi de la dyslipidémie (25%), de l’hérédité (18,75%) et du surpoids (15,6%). Chez deux patients (6,25%), on a noté une consommation de substance stupéfiante. Les indications de la coronarographie étaient entre autres, le syndrome coronaire aigu (72%) et l’angor d’effort à (19%). La coronarographie était normale chez 11 patients et Pathologique chez les 21 restants, incluant 15 cas (46,87%) avec des lésions serrées. Les atteintes angiographiquement significatives étaient dominées par les atteintes mono-tronculaires dans 50% des cas. L’angioplastie était réalisée avec satisfaction chez 5 patients avec une prédominance de stents nus.Conclusion : Chez le sujet jeune avec syndrome coronarien aigu ou angor d’effort, le facteur de risque le plus fréquent est le tabac et l’atteinte coronaire est le plus souvent mono tronculaire. Introduction: Coronarography have been making remarkable progress in our structure for several years. However, its indications can be extended to all ages depending on the clinicalorientation. The objective of this work was to describe the aspects of the coronary arteries in the young patients explored at Aristide Le Dantec University Hospital.Patients and methods: We performed a retrospective descriptive study that included all patients who were less than or equal to 40 years of age and who had had coronary angiography after informed consent in the period from May 1, 2014 to August 31, 2017. The studied parameters were epidemiological, clinical, coronary as well as angioplasty data including procedure, techniques and results of angioplastyResults: We included 32 patients. The average age was 33.84 years ± 5.59 with a minimum of 18 years. The male gender predominated with 27 men, a sex ratio of 5.4. The most common cardiovascular risk factor was tobacco (28.13%) followed by dyslipidemia (25%) and heredity. (18.75%), overweight was found in 15.6% of cases. In two patients (6.25%) dopant consumption was noted. Indications for coronary angiography included 72% acute coronary syndrome and 19% effort angina. Coronarography was normal in 11 patients and pathological in the remaining 21. The tight lesions were in front of the chart, 15 cases (46.87%). Angiographically significant lesions were dominated by mono-truncal involvement in 50% of cases. Angioplasty was performed satisfactorily in 5 patients with a predominance of elude stents.Conclusion: Coronarography of the young subject is increasingly considered in our countries because of indications that are no longer limited to acute coronary syndrome although it is the first. In this age group the most frequent risk factor is tobacco and the mono-truncal involvement is the most recorded.

Introduction: Cardiovascular risk is increased in systemic lupus erythematosus. Cardiovascular events are the first cause of death in lupus after five years duration. Prevention of cardiovascular events needs a good evaluation of the risk. In this work, we tried to evaluate the performance of conventional and adjusted forms of cardiovascular risk equations to predict high risk in lupus patients, in comparison with carotid ultrasound. Method: We realized a cross-sectional study during the period from 24 August 2017 to 22 November 2018. Consenting patient meeting the 1997 American college of Rheumatology criteria of systemic lupus erythematosus were recruited. The clinical characteristics and the treatment data were informed. Traditional cardiovascular risk factors were also investigated, and the assessment of cardiovascular risk was performed by Framingham and SCORE equations and their modified forms (multiplication by a factor of 1.5). Carotid ultrasound was used to detect atherosclerosis by measuring intima media thickness and searching for carotid plaques. In last, we compared cardiovascular risk levels by equations to results of carotid ultrasound. Statistical analysis and data collection were performed using SPSS 23.0 software. Results: Forty-nine patients with a sex ratio of 0.13 and a mean age of 33.5 (±11.3) years were enrolled. More than half of patients had dyslipidemia. More than 80% of the population were at low cardiovascular risk according to the equations. However, 16% of cases had carotid atherosclerosis. Between 50% and 100% of patients having atherosclerosis were considered at low or moderate risk by equations. The best sensitivity to predict cardiovascular risk was given by modified Framingham (50%). Conclusion: In our study, conventional and modified risk equations had a bad performance to predict cardiovascular risk in systemic lupus erythematosus.

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.

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

Aneurysm of the sinus of Valsalva starts at the base of one of the 3 sinuses of Valsalva; then it extends towards the cardiac chambers. This is a rare disease which diagnosis is most of the time made at the stage of rupture. This work, report a case of ruptured aneurysm of Valsalva’s sinus into the right ventricle (RV) in a 54-year-old male patient. Our intention is to emphasize the role of Trans Thoracic Echocardiogram (TTE) in the diagnosis of this pathology.

Introduction: La survenue de l’hypertension artérielle pulmonaire (HTAP) est un tournant dans l’évolution de la sclérodermie. L’objectif de cette étude est de décrire les aspects épidémiologiques et évolutifs de l’HTAP au cours de la sclérodermie systémique.Méthodes: Nous avons réalisé une étude descriptive concernant des patients suivis pour sclérodermie systémique, au service de Dermatologie de l’hôpital Aristide Le Dantec entre Janvier 2000 et Août 2009. Ces patients étaient inclus dans l’étude après exploration cardio-vasculaire (ECG, échocardiographie-Doppler). Nous avons étudié les paramètres épidémiologiques, cliniques, paracliniques et évolutifs des patients. Résultats: Nous avons enregistré 12 cas d’hypertension artérielle pulmonaire parmi les 83 patients atteints de sclérodermie systémique soit une prévalence de 14,45%. L’âge moyen des patients était de 43,58 ans ± 12,5 ans et le sex-ratio (H/F) de 0,33. Sur le plan clinique, la dyspnée était quasi constante (75%) et la douleur thoracique présente dans 25% des cas. Le syndrome de Raynaud était observé chez 8 patients soit 66,67% de nos patients. L’électrocardiogramme montrait des signes de surcharge droite chez 4 malades (33,33%) et la radiographie thoracique en faveur d’une fibrose pulmonaire chez 4 patients. L’échocardiographie-Doppler notait une insuffisance tricuspide importante dans 58, 33% des cas (7 patients), une pression artérielle pulmonaire systolique (PAPs) en moyenne de 66,25 ± 29,3 mmHg, une dilatation des cavités cardiaques droites dans 5 cas et un mouvement paradoxal du septum interventriculaire chez 3 malades (33,33%). Il était également noté 3 cas (25%) d’épanchement péricardique. Nous avons déploré 4 décès (33,33%).Conclusion: L’hypertension artérielle pulmonaire est une complication fréquente et grave de la sclérodermie. Son dépistage, grâce à l’échocardiographie- Doppler systématique, constitue une étape fondamentale de la prise en charge.