M. Dioum

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.

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.

Left Valsalva Sinus Aneurysm on Infection Tuberculous

Sinus of Valsalva Aneurysm (SVA) is a localized dilatation of the aortic wall, forming a sacral ectasia, located just above the aortic cusps between the valve and the sino-tubular junction [1-3]. It is a rare condition that is congenital or acquired and whose frequency is less than 1% according to the literature [1]. The aneurysm most often involves the right coronary sinus (65-85% of cases), more rarely the posterior sinus (10-30%) and exceptionally the left coronary sinus (<5%) [4]. we report a case of an unruptured left SVA in an 18-year-old patient in a context of disseminated tuberculosis associated with rheumatic valvulopathy.

A Rare Case of Junctional Tachycardia Revealing a Paraganglioma

Authors report the case of eleven years old boy named CAN who complained moderate atypical abdominal pain without irradiation, without increasing or decreasing factors, accompanied by palpitations lasting during two days with abrupt beginning following a dispute. He had also hypersudation and dyspnea at rest. The past medical history revealed that he was correctly vaccinated, with a good psychomotor development. No parental consanguinity was found or similar symptoms in the pedigree. Two years ago, he were admitted in hospital for systemic inflammatory response syndrome and reversible left ventricular dysfunction, which would have been attributed to a myocarditis; for which he had benefited from treatment with angiotensin converting enzyme inhibitor and diuretic.

The Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in Senegal

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare malformation that represents less than 0.5% of the congenital heart diseases. The common clinical feature is congestive heart failure. The treatment is strictly a surgical repair. The authors report the first 3 cases of ALCAPA diagnosed in Senegal in infants under the age of 1 year old. Two were successfully treated by surgical repair; the 3rd child is still waiting for surgical repair to be performed abroad.

L’hypertrophie ventriculaire gauche chez le sujet noir Africain hypertendu : résultats d’une enquête transversale, réalisée en milieu semi-rural au Sénégal

OBJECTIVES To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. PATIENTS AND METHODS According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05. RESULTS We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003). CONCLUSION Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

Right Ventricular Infarction: Prevalence, Diagnostic and TherapeuticCharacteristics, and Prognosis about 10 Cases

Objectives: The objectives of this study were to evaluate the prevalence of the right ventricular infarction and its diagnostic, therapeutic and prognostic characteristics. Patients and methods: A single center retrospective study was carried out between January 2011 and December 2014. Patients who were diagnosed with right ventricular infarction at electrocardiogram and echocardiography were recruited. Outcomes: Among the 159 patients hospitalized for myocardial infarction, 10 had myocardial infarction extended to the right ventricle (6.3%). It occurred on an inferior infarction in 7 cases out of 35 and anterior infarction in 3 cases out of 124. The mean age was 53 years and sex ratio M/F of 2.33. All patients had at least 3 cardiovascular risk factors. Right-sided heart failure was found in 4 patients. Right ventricular infaction was associated with inferior STEMI in 7 patients, and anterior STEMI in 3 patients. Echocardiography showed right ventricular dilatation and impaired right ventricular systolic function in respectively 6 cases. Thrombolysis was performed in 7 patients and rescue angioplasty in 1 case. A regressive cardiogenic collapse was noted in 6 cases and one death in 1 case. Conclusion: Right ventricular infarction is relatively rare and usually related to an extension of an inferior myocardial infarction. Hemodynamic instability is of worse prognosis.

Evolutionary Aspects of Electrocardiographic and Echocardiographic Manifestations in Systemic Lupus Erythematosus: Descriptive Longitudinal Study about 25 Cases in 18-Month Monitoring

Introduction: Systemic lupus erythematosus is a major systemic autoimmune disease of unknown cause. It can affect all organs and especially the heart with different proportions. The aim of this study was to determine the evolving electrocardiographic and echocardiographic features in systemic lupus erythematosus. Methodology: This study was carried out at the cardiology and dermatology Aristide Le Dantec Hospital. This is a descriptive longitudinal study conducted from January 2013 to October 2014. We included SLE patients who had at least two echocardiograms and electrocardiograms performed at least 3 months apart. Anamnestic information, electrocardiographic and echocardiographic features were reported on a pre-established survey form. Data were entered using Epi -info software version 3.5.1. Results: We included 25 patients. It was mentioned a female predominance (88%). The average age of patients was 35.5 years. All patients had dermatological signs of systemic lupus erythematosus. Cardiac events were found on clinical examination in 20% of cases. Sixty four percent (64%) of patients had an abnormal electrocardiogram dominated by left ventricular hypertrophy (24%). During 18 months of follow-up, we noted some electrocardiographic changes in 16% of cases. Ultrasound abnormalities were found in 40% of patients: 8% presented a slight expansion of the OG, a patient had impaired left ventricular function with the presence of a spontaneous contrast intra VG and increased filling pressures. Right ventricular function was impaired in one patient. Other abnormalities were found: 12% of aneurysm of the interatrial septum, 4% of atrial septal defect and 4% of pericardial detachment. Conclusion: Cardiovascular violations are fairly common in SLE patients. A study on a large sample and longterm could better assess cardiovascular complications in SLE patients and how they occurred.

Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas@@@Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases

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

Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas

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