A. Mbaye

Pregnancy in women with heart disease in sub-Saharan Africa

BACKGROUND Although 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. METHODS We 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. RESULTS Rheumatic 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<0.001). A favourable maternal outcome was associated with: prior cardiac events (P<0.001); prior surgical valve replacement (P=0.03); cardiac prosthetic valve (P=0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28weeks (range, 8-38weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%). CONCLUSIONS Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis.

Prevalence and determinants of hypertension and associated cardiovascular risk factors: data from a population-based, cross-sectional survey in Saint Louis, 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.

Vascular complications of infective endocarditis

UNLABELLED 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.

Infections secondary to pacemaker implantation : a synopsis of six cases : case report - online article

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 pneumonia (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.

Importance of Electrocardiogram for Detection of Preclinical Abnormalities in Patients with Rheumatoid Arthritis without Cardiovascular Events

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

Dépistage de l’ischémie myocardique par l’échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal

INTRODUCTION Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal. METHODOLOGY We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases. RESULTS Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8±11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria (p=0.0001), inactivity (p=0.0001), dyslipidemia (p=0.0002), arterial hypertension (p=0.001), smoking (0.003) and male sex (p=0.004). CONCLUSION In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.

Combination of Left Ventricular Noncompaction and Partial Atrioventricular Canal Defect in a 21-Year-Old Male: A Case Report:

Introduction Left ventricular noncompaction (LVNC) is classified as a genetic cardiomyopathy characterized by a progressive systolic dysfunction. It may occur alone or in association with congenital cardiac anomalies. The combination of left ventricular noncompaction with partial atrioventricular canal defect is rare and has not, to our knowledge, been described previously. Case presentation A 21-year-old male who traveled to our center from a neighboring country presented with signs of heart failure. Transthorarcic echocardiography showed prominent trabeculations in the left ventricle predominantly in the left ventricle involving the apical lateral and mid anterolateral segments associated with a partial atrioventricular canal defect. There was a biventricular systolic dysfunction. There was good response to medical treatment. Conclusion This case stresses the importance of maintaining a high degree of suspicion for this rare cardiomyopathy and the need to systematically look for other associated anomalies in order to institute proper short- and long-term managements.

Fatal evolution of a huge right atrial free-floating thrombus.

Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.

Prévalence et facteurs liés à l’observance thérapeutique chez des patients noirs africains coronariens stables, suivis en ambulatoire en service de cardiologie de Dakar au Sénégal

INTRODUCTION The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease. METHODOLOGY We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence. RESULTS We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014). CONCLUSION Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

Syndrome cardio-rénal: Aspects épidémiologiques, à propos de 36 cas dans un service de cardiologie de Dakar

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.