Faruk Buba

Spectrum of cardiovascular diseases diagnosed using transthoracic echocardiography: Perspectives from a tertiary hospital in North-Eastern Nigeria

Background: The advent of echocardiography has tremendously improved the diagnosis of cardiovascular diseases. We present a review of cardiovascular disorders diagnosed using transthoracic echocardiography over 3 years. Materials and Methods: Echocardiographic data of patients from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics was used in assessing the occurrence of the different cardiac disorders. Results: One thousand three hundred and two echocardiograms were considered, out of which 1224 (94%) comprising 591 (48.3%) males and 633 (51.7%) females were analyzed. Ages ranged from 4 days to 105 years with a mode of 60 years and a mean of 39.62 ± 20.58 years. The most common indications were hypertensive heart disease (HHD) (28.2%) and congestive cardiac failure (23.4%). HHD was the most common diagnosis (25.1%) followed by cardiomyopathies (23.9%). Idiopathic dilated (29.3%) and peripartum cardiomyopathy (23.1%) were the most common cardiomyopathies. Valvular heart diseases (VHD) were diagnosed in 14.9%, with rheumatic (60.4%), and degenerative (36.4%) being dominant. Congenital heart disease was diagnosed in 7.2%, with 70.5% of the cases in those ≤14 years. Ischemic heart disease was diagnosed in 6.6%. Pericardial diseases were found in 3.2%, while cor pulmonale was documented in 0.8%. Atrial myxoma dissection of the ascending aorta, athletes heart, and amniotic fluid embolism were each observed in <1%. A normal echocardiogram was reported in 13.3%. Conclusion: The most common echocardiographic diagnoses in our center are HHD, cardiomyopathies, and VHD. Congenital and ischemic heart diseases are also prevalent.

Prevalence and Aetiology of Left Ventricular Thrombus in Patients Undergoing Transthoracic Echocardiography at the University of Maiduguri Teaching Hospital

Objectives. We sought to determine the prevalence and aetiology of LVT among patients undergoing echocardiography. Methods. We reviewed case notes and echocardiographic data of patient diagnosed with LVT using noncontrast transthoracic echocardiography. Definition of various conditions was made using standard guidelines. Mean ± SD were derived for continuous variables and comparison was made using Students t-test. Results. Total of 1302 transthoracic echocardiograms were performed out of which 949 adult echocardiograms were considered eligible. Mean age of all subjects with abnormal echocardiograms was 44.73 (16.73) years. Abnormalities associated with LVT were observed in 782/949 (82.40%) subjects among whom 84/782 (8.85%) had LVT. The highest prevalence of 39.29% (33/84) was observed in patients with dilated cardiomyopathy, followed by myocardial infarction with a prevalence of 29.76% (25/84). Peripartum cardiomyopathy accounted for 18/84 (21.43%) cases with some having multiple thrombi, whereas hypertensive heart disease was responsible for 6/84 (7.14%) cases. The lowest prevalence of 2.38% (2/84) was observed in those with rheumatic heart disease. Left ventricular EF of <35% was recorded in 55/84 (65.48%). Conclusions. Left ventricular thrombus is common among patients undergoing echo, with dilated cardiomyopathy being the most common underlying aetiology followed by myocardial infarction. Multiple LVTs were documented in peripartum cardiomyopathy.

Ruptured Left Sinus of Valsalva Aneurysm in a Female Nigerian Septuagenarian

Sinus of Valsalva Aneurysm (SVA) is a rare cardiac condition that is commonly congenital. Acquired SVA is very rare, resulting from infections affecting the aortic wall, degenerative diseases or traumatic injury to the chest. Left SVAs are usually acquired, especially when associated with rupture into the left heart. We present a case of ruptured left SVA in a female Nigerian Septuagenarian who presented with congestive cardiac failure.

Pattern, Precipitants and Short Term Outcome of Heart Failure Patients Managed at Federal Medical Centre Nguru, a Tertiary Health Centre in Yobe State Northeastern Nigeria

Heart Failure (HF) is a syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Clinical studies investigating the aetiological patterns of heart failure in Sub-Saharan Africa (SSA) revealed that hypertension, cardiomyopathy and rheumatic heart disease account for more than two-thirds of cardiac disease cases. The objective of this study therefore is to assess the pattern, precipitating factors and short term outcome of heart failure among patients admitted into our hospital. Method: The study was a prospective cross-sectional type conducted among in patients with heart failure in the medical ward of the hospital. Results: A total of three and fifty four (354) subjects were recruited into the study, comprising one hundred and twenty nine males (36.4%) and two hundred and twenty five (63.4%) females. Majority of the patients were admitted in NYHA functional class IV. This however improved to class II at discharge though few were discharged in NYHA class III. Heart failure secondary to progressive hypertensive heart disease was the most common (39.0%) followed by peripartum cardiomyopathy (22.6%) while idiopathic dilated cardiomyopathy (11.0%) and rheumatic heart disease (7.3%) were the third and fourth causes of heart failure respectively. The most common precipitating factor for heart failure in this study was chest infection (44.9%). In conclusion, the study revealed that progressive hypertensive heart disease was the leading cause of heart failure, followed by peripartum cardiomyopathy while idiopathic dilated cardiomyopathy and rheumatic heart disease were ranked third and fourth causes of heart failure respectively. Though myocardial infarction is on the increase, it was found to be the fifth cause of heart failure. The study also identified the following precipitants of heart failure in decreasing order of occurrence: chest infection, non-adherence to prescription, and urinary tract infection.

Carotid Intima-Media Thickness in Patients with Diabetes Mellitus Attending Tertiary Care Hospital in Nigeria

Objective: Carotid intima-media thickness is a significant and independent predictor of coronary artery disease in patients with diabetes. The aim of our study was to determine carotid intima-media thickness in Nigerians with diabetes.Methods: This was an observational cross-sectional study involving consecutively presenting patients with type 2 diabetes mellitus and healthy age-matched adults. Anthropometric variables were measured, and blood samples collected for fasting blood sugar, cholesterol, and HbA1c. Carotid intima-media thickness was measured using a 2-D scanner. Association of carotid intima-media thickness with other variable was assessed using correlation and multivariable linear regression models.Results: One hundred and fifty two subjects (87 diabetics and 65 healthy adults) were studied. Carotid intimamedia thickness was significantly higher among diabetics. Seventy nine (90.8%) and seventy two (82.8%) patients with diabetes had carotid intima-media thickness greater than 0.9 mm and 1.0 mm respectively. Carotid intimamedia thickness was higher in patients with higher HbA1c, fasting blood sugar, body mass index, total cholesterol and LDL cholesterol, and significantly correlated with HbA1c, age, fasting blood sugar, systolic blood pressure, total cholesterol, LDL-c and HDL-c. Age, HbA1c and duration of hypertension predicted increased carotid intima-media thickness.Conclusion: The prevalence of increased carotid intima-media thickness is extremely high among Nigerians with diabetes, and this significantly correlated with other risk factors for cardiovascular diseases. Assessment of carotid intima-media thickness should be routinely included in evaluation of subjects with diabetes, and assessment of total cardiovascular risk.

Cardiac masses diagnosed on transthoracic echocardiography at Nigerian Tertiary Hospital: A 3-year review

Background: Echocardiography has since its inception, assumed a significant role in evaluation of cardiac masses, supplanting other diagnostic modalities for this purpose. We reviewed the various kinds of cardiac masses detected using transthoracic echocardiography in our center over a period of 3-year. Materials and Methods: Echocardiographic data of patients that underwent transthoracic echocardiography from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including all forms of Doppler modalities where appropriate. Descriptive statistics was used in assessing the proportion of the different cardiac masses observed. Results: One thousand three hundred and two transthoracic echocardiograms were performed over the 3-year period, out of which 1224 comprising 591 (48.3%) males and 633 (51.7%) females were retrieved and reviewed. Their mean age was 39.62 (20.6) years. Cardiac masses were documented in 106 (8.7%) of the subjects. The most common cardiac mass was intracardiac thrombus, observed in 89 (84.0%) followed by vegetation in 10 (9.4%). A presumptive diagnosis of right atrial myxoma was made in 4 (3.8%), whereas 1 (0.9%) had a right atrial mass of uncertain cause. Inferior vena cava mass and metastatic lesion to pericardium were each diagnosed in 1 (0.9%) patient. Most of the cardiac thrombi involved the left ventricle (94.4%), whereas vegetations were mainly on the mitral valve (80%). Conclusion: The dominant causes of cardiac mass observed are cardiac thrombus, commonly involving the left ventricle, and vegetations on mitral valve.

0491: Sudden cardiac death: clinical perspectives from the University of Maiduguri Teaching Hospital, Nigeria

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