Solomon Danbauchi

Arrow Injury to the Heart

Arrow injury to the heart is a common cause of penetrating trauma in rural areas of underdeveloped nations. We report such a patient who survived 3 days after such an injury and traveled 1000 km with a pulsating arrow in the chest for treatment. The literature on such injuries is reviewed.

OS 37-02 HYPERTENSION IN HIV-INFECTED ADULTS IN NORTH-CENTRAL NIGERIA: PREVALENCE, ASSOCIATED RISK FACTORS AND ASSESSMENT OF RISK USING THE FRAMINGHAM RISK SCORE.

Objective: To evaluate the prevalence of Hypertension and associated risk factors in HIV+ adults and assessment of these risks using the Framingham risk score ‘FRS’. Design and Method: A cross-sectional analytical study. One hundred and fifty consecutive HIV+ adults presenting at the HIV clinic of Jos University Teaching Hospital (90 on HAART) with 50 HIV- as controls were recruited. Relevant history, physical examination (including blood pressure measured according to standard guidelines), laboratory specimen (fasting plasma sugar and lipids, CD4 count and viral load) and electrocardiogram were obtained from the participants. The prevalence of hypertension and associated risk factors was determined and the FRS for each participant was calculated and interpreted to assess cardiovascular risk. Data was analyzed using Epi info version 7 statistical software; p value < 0.05 was considered significant. Results: There were 94 females and 30 females among the HIV+ and HIV- respectively. The mean ages of HIV+ and HIV- were 41 ± 7 and 40 ± 8 years respectively (p = 0.77). The prevalence of hypertension in the HIV+ and HIV- was 46.0% and 10.0% respectively, p < 0.01. Among the HIV+, 123 (82%) had at least 1 risk factor while 37 (25%) had at least 4 compared to 31 (62%) and 0 (0%) respectively in the HIV-, p < 0.01. The use of HAART was associated with higher prevalence of hypertension, dyslipidaemia, diabetes mellitus and obesity among the HIV+ (Data not shown). The mean FRS of those on HAART (4.8 ± 0.6) and those not on HAART (3.3 ± 0.6) were significantly higher than that of the controls (2.5 ± 1.0); p = 0.04. Furthermore, those on HAART had significantly higher mean FRS compared to those not on HAART, p < 0.01. The use of protease inhibitor based regimen predisposed to higher mean FRS 7.9 ± 2.0 versus 3.2 ± 0.7, p < 0.01. Conclusions: Hypertension and associated risk factors are common in HIV+ persons. Early diagnosis with prompt treatment will significantly reduce morbidity and mortality in these patients.

Determinants of HIV-related cardiac disease among adults in north central Nigeria.

Objective The aim of the present study was to evaluate the determinants of HIV-related cardiac disease (HRCD) among adults in north central Nigeria. This was a hospital-based cross-sectional study recruiting patients who were HIV positive attending the HIV clinic at Jos University teaching Hospital, Nigeria. Methods A total of 200 adults who were HIV positive and aged ≥18 years were consecutively recruited. All patients were administered a questionnaire and underwent clinical examination, laboratory investigation for haemoglobin estimation, CD4 cell count, viral load, serum lipid profile, hepatitis B surface antigen, anti-hepatitis C virus antibody, electrocardiogram and two-dimensional echocardiography Doppler studies. The outcome measure was echocardiography-defined cardiac disease, such as systolic dysfunction, diastolic dysfunction, isolated left ventricular dilatation, right ventricular dysfunction or pulmonary hypertension. Results The mean age of the study population was 38±9 years. The majority (71%) were women and were on average younger than the men (36±8 years vs 47±9 years, p<0.0002). Highly active anti-retroviral therapy (HAART) use was seen in 84.4% of subjects. The median CD4 cell count for the study population was 358 cells/µL; the count was 459 (95% CI 321 to 550) cells/µL for subjects without HRCD and 193 (95% CI 126 to 357) cells/µL for subjects with HRCD (p<0.001). HAART-naive subjects with HRCD had a mean CD4 cell count of 121 cells/µL vs 200 cells/µL for those on HAART (p<0.01). CD4 cell count (OR = 0.25, 95% CI 0.15 to 0.45) and duration of diagnosis (OR=3.88, 95% CI 1.20 to 13.71) were the significant determinants of HRCD on multivariate analysis. Conclusions Duration of HIV diagnosis and degree of immunosuppression were the significant determinants of HRCD. There is therefore a need to reduce cardiovascular morbidity in patients infected with HIV through early diagnosis/sustained use of HAART, early screening for HRCD and prompt intervention.

Hypoplastic left heart syndrome: A case report and review of the literature

This is a case report of a 7-week old boy who presented with clinical features suggestive of transposition of the great arteries with a shunt, but later confirmed to have hypoplastic left heart syndrome (HLHS) on echocardiography. The use of echocardiogram in making an accurate diagnosis of congenital heart defects is discussed. Some important aspects of presentation, management strategies, and current literature on hypoplastic left heart syndrome are highlighted.

Role of pre-eclamptic toxaemia or eclampsia in hypertensive women attending cardiac clinic of Ahmadu Bello University Teaching Hospital Zaria, Nigeria.

BACKGROUND Patients with pre-eclampsia and eclampsia constitute a special high risk group for future hypertension. They require a long term follow up to be able to detect and treat emerging hypertension early enough to prevent complications. Unfortunately, this is not so. This study was undertaken to find out the incidence of history of pre-eclamptic toxaemia (PET) in our female hypertensive patients attending cardiac clinic and to also determine the incidence of complications of hypertension in those with previous history of PET. METHODS Fifty consecutive female hypertensive patients seen in cardiac clinic were recruited. Detailed history including full obstetric and family history was taken. A full clinical examination was done including blood pressure and a search for complications of hypertension. Findings were then analyzed and various frequencies determined. RESULTS Forty-nine patients were studied. The mean age was 47.29 +/- 11.46 years. The mean SBP, DBP and MAP were 143.18 +/- 25.05, 90.49 +/- 14.19 and 108.12 +/- 16.71 mmHg respectively. Between the last child birth and the time of established hypertension in those who had PET ranged from 3-25 years. Sixteen, (32.7%) of the 49 patients had history of PET and 7(43.75%) of these 16 patients had complications of hypertension. CONCLUSION The incidence of history of PET in our female hypertensive patients attending cardiac clinic is significant (32.7%). Also the 43.8% incidence of complications of hypertension seen in those patients with history of PET in this study is high. PET patients, therefore, constitute a special risk group for future hypertension. Therefore collaboration between the Obstetricians and the Cardiologists is important for patients with PET and eclampsia.

PS 11-20 LEFT VENTRICULAR DYSFUNCTION IN HYPERTENSIVE VERSUS NORMOTENSIVE ADULTS WITHOUT CARDIAC SYMPTOMS: PREVALENCE, PATTERNS AND ASSOCIATED FACTORS

Objective: To evaluate the prevalence, patterns and associated factors of left ventricular dysfunction (LVD) in hypertensive versus normotensive adults without cardiac symptoms. Design and Method: A cross-sectional analytical study. Fifty consecutive hypertensive adults (HTN+) and another fifty normotensive, age and sex matched adults (HTN-) were enrolled from the medical clinics of Jos University Teaching Hospital. Relevant history, physical examination (including blood pressure measured according to standard guidelines), laboratory specimen (fasting plasma sugar and lipids, urea, creatinine and haemoglobin concentration) and electrocardiogram were obtained from the participants. Thereafter electrocardiography guided echocardiograph assessment of LV function was performed on each participant. Data was interpreted and subsequently analyzed using Epi info version 7 statistical software; p value < 0.05 was considered significant. Results: There were 27 females and 23 males in each of the two groups. The mean ages were 49 ± 8 and 47 ± 7 years respectively (p=0.48). The comparison of mean values of the systolic and diastolic parameters measured is shown (table 1). The systolic parameters showed statistically significant differences for both genders. The HTN+ group had lower mean values of systolic parameters for both genders. Similarly, the HTN+ group had a higher prevalence of LVD compared to the HTN- group (30% versus 14%, p = 0.05). In addition, the HTN+ group had worse diastolic patterns (figure 1). In the HTN+ group, duration of hypertension and left atrial diameter correlated significantly with the systolic parameters. Both further emerged as independent predictors of LVD on regression analysis. In the HTN- group, older age and left atria diameter correlated significantly with systolic and diastolic parameters. They also emerged as independent predictors on multivariate regression analysis (Data not shown). Conclusions: Left ventricular dysfunction is common in hypertensives without cardiac symptoms. Early diagnosis with prompt treatment will significantly reduce morbidity and mortality in these patients.

PS 14-05 LEFT VENTRICULAR DYSFUNCTION IN ASYMPTOMATIC HYPERTENSIVE PATIENTS WITH AND WITHOUT TYPE 2 DIABETES: PREVALENCE, PATTERNS AND ASSOCIATED FACTORS

Objective: To evaluate the prevalence, patterns and associated factors of left ventricular dysfunction (LVD) in asymptomatic hypertensive patients with and without type 2 diabetes. Design and Method: A cross-sectional analytical study. Fifty consecutive hypertensive adults (HTN+) and another fifty with hypertension and type 2 diabetes mellitus (HTN+/DM+) were enrolled from the cardiology/diabetes clinics of Jos University Teaching Hospital. Relevant history, physical examination (including blood pressure measured according to standard guidelines), laboratory specimen (fasting plasma sugar and lipids, urea, creatinine and haemoglobin concentration) and electrocardiogram were obtained from the participants. Thereafter electrocardiography guided echocardiograph assessment of LV function was performed on each participant. Data was interpreted and subsequently analyzed using Epi info version 7 statistical software; p value < 0.05 was considered significant. Results: There were 27 females and 29 females in the HTN+ and HTN+/DM+ groups respectively. The mean ages were 49 ± 8 and 49 ± 7 years respectively (p = 0.95). The comparison of mean values of the systolic and diastolic parameters measured is shown (table 1). The systolic parameters showed statistically significant differences for both genders. The HTN+/DM+ group had lower mean values of systolic parameters for both genders. Similarly, the HTN+/DM+ group had a higher prevalence of LVD compared to the HTN+ group (56% versus 30%, p < 0.01) and worse diastolic patterns (figure 1). In the HTN+ group, duration of hypertension and left atrial diameter correlated significantly with the systolic parameters. Both further emerged as independent predictors on multivariate regression analysis. In the HTN+/DM+ group, duration of DM correlated significantly with systolic and diastolic parameters while duration of hypertension correlated significantly with systolic parameters. Both further emerged as independent predictor on multivariate regression analysis (Data not shown). Conclusions: Left ventricular dysfunction is common in hypertensives; co-morbid diabetes mellitus worsens it. Early diagnosis with prompt treatment will significantly reduce morbidity and mortality in these patients.

DeBakey type 1 acute aortic dissection presenting as inferior myocardial infarction: A case report and review of literature

Acute dissection of the aorta is one of the most dramatic presentation of cardiovascular emergencies. It has a varying presentation and it is described as deceptive and dangerous. It is reported as rare, and most cases are discovered during autopsies. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections (AoD) present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. We have reported here a 68-year-old man who presented with 18 hours of severe chest pain radiating to the left shoulder and was associated with shortness of breath, palpitations, sweating, and feeling of an impending doom. A diagnosis of inferior myocardial infarction was made based on ST-Segment elevation >2 mm in the Leads II, III and aVF on electrocardiogram (ECG). However, further evaluation with computed tomographic angiogram done revealed DeBakeys type 1 or Stanford type A AoD. He was later referred to a cardiothoracic centre, where he had an aortic root and valve replacement 2 months after the first presentation. He is currently doing fine at 2-year follow-up. Although, AoD is a rare entity and can masquerade in different forms, a high index of suspicion will enhance diagnosis and prompt appropriate intervention.