Simon Antoine Sarr

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.

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.

Les surdosages aux antivitamines K à Dakar: aspects épidémiologiques, cliniques et évolutifs

Les antivitamines K (AVK) sont largement utilisées dans la prévention et le traitement curatif des accidents thromboemboliques. Les objectifs de ce travail étaient de décrire les aspects épidémiologiques, cliniques et évolutifs des surdosages en AVK et d’en déterminer les facteurs hémorragiques. Il s’agit d’une étude descriptive, transversale monocentrique réalisée à l’Hôpital Principal de Dakar. Tous les patients qui présentaient un INR supérieur à 5 étaient inclus. Etaient étudiés le sexe, l’âge du patient, l’AVK utilisé, l’ancienneté de sa prise, les indications, la valeur de l’INR, les médicaments associés, la présence d’hémorragie, la prise en charge immédiate et l’évolution. Nous avons inclus 154 patients. L’acénocoumarol était l’AVK le plus prescrit. Le sexe ratio était en faveur des femmes. L’âge moyen était de 63 ans. Le surdosage était asymptomatique chez 43% des patients. Les hémorragies étaient représentées principalement par des gingivorragies, épistaxis. Des hémorragies majeures étaient présentes chez 8,6% des patients représentées par des mélénas chez 6 patients (3,9%), un hématome musculaire profond chez 2 patients (1,3%) et des hématomes cérébraux intra-parenchymateux chez 2 autres. Deux patients présentaient un collapsus cardiovasculaire avec déglobulisation. Une prise d’AINS était notée chez 21% des patients. Les AVK ont été transitoirement arrêtés chez tous les patients. La mortalité était de 2% par hémorragie intracrânienne. La réduction des surdosages aux AVK passe par une maitrise par le personnel soignant des facteurs de surdosage et par bonne éducation thérapeutique des patients.

Aspects cliniques, électrocardiographiques et échocardiographiques de l’hypertendu âgé au Sénégal

INTRODUCTION Arterial hypertension (HTA) in the elderly is an independent risk factor for cardiovascular disease. Our study aims to describe the clinical, electrocardiographic and echocardiographic aspects of Arterial hypertension in elderly patients. METHODS We conducted a descriptive, cross-sectional study from January to September 2013. Hypertensive patients =60 years treated in Outpatient Cardiology Department at the Principal Hospital in Dakar were included in the study. Statistical data were analyzed using Epi Info 7 software and a p-value < 0.05 was taken as significant. RESULTS A total of 208 patients were enrolled in the study. The average age was 69.9 years with a female predominance (sex ratio 0.85). Average blood pressure was 162/90 mm Hg. HTA was under control in 13% of cases. The ECG showed evidence of rhythm disturbance (17.78%), left atrial enlargement (45.19%), left ventricular hypertrophy (28.85%) and complete atrioventricular block in 2 cases. Holter ECG revealed non-sustained ventricular tachycardia (Lown class IVb) in 4 cases, paroxysmal atrial fibrillation in 6 cases and paroxysmal atrial flutter in 1 case. Echocardiography performed in 140 patients showed mainly concentric left ventricular hypertrophy in 25 patients, occuring more frequently in males (p=0,04) and dilated left atrium in 56,42% of cases, occuring more frequently in elderly patients (p= 0,01). CONCLUSION Electrocardiographic and echocardiographic aspects in elderly hypertensive population are characterized by concentric left ventricular hypertrophy and by the frequency of arrhythmias sometimes revealed by long-term continuous external electrocardiographic recording.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.

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.

Cardiac MRI: Luxury or Necessity, beyond the Electrocardiogram and Biology in the Management of Acute Coronary Syndrome in Young Patients? About 2 Cases Reports in Sub-Saharan Environment

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.

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.

Prevalence and characteristics of dysfunction of right ventricle in peripartum cardiomyopathy

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