|Year : 2013 | Volume
| Issue : 2 | Page : 88-100
Abstract proceedings of the 42 nd Annual General Meeting
|Date of Web Publication||13-Feb-2014|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstract proceedings of the 42 nd Annual General Meeting. Nig J Cardiol 2013;10:88-100
Abstract proceedings of the 42 nd Annual General Meeting and Scientific Conference of the Nigerian Cardiac Society held 18-20 th September 2013 at Kingstone Grand Suites, GRA, Ilorin Kwara State, Nigeria
| Oral Presentation|| |
CVD-O-01: Changing trend in the incidence of myocardial infarction among medical admissions in Ilorin, North-central Nigeria
Philip M. Kolo, Jude A. Fasae, Fredrick I. Aigbe, James A. Ogunmodede, Ayodele B. Omotoso, Bolade F. Dele-Ojo
Cardiology Unit, Department of Medicine, University of Ilorin Teaching Hospital, P.M.B 1459, Ilorin, Nigeria
Presenter: Dr. Dele-Ojo BF
Background and Objective: This study aimed at reviewing cases of myocardial infarction managed between January 2006 and June 2009.
Materials and Methods: Records of all patients managed for acute MI during the period were studied. Diagnosis was based on presence of ischemic type of chest discomfort, serial electrocardiographic (ECG) changes compatible with MI, a rise in troponin I level, and echocardiographic abnormalities.
Results: Fourteen patients consisting of 13 (92.9%) males and 1 (7.1%) female had MI. They were all Nigerians; their ages ranged from 40 to 82 years with a mean of 55.6 ± 12.7 years, and 85.7% of them belonged to social class 1. MI accounted for 0.21% of the total 6647 admissions during the period. Present hospital incidence (0.21%) is significantly higher (Chi2 = 6.8, P = 0.01) than previously reported incidence of 0.075%. Twelve patients had systemic hypertension, 8 had high body mass index, 6 had dyslipidemia, 5 smoked cigarette, and 2 had diabetes mellitus. Three patients died giving a case fatality rate of 21.4%, and another 3 developed chronic left ventricular systolic failure.
Conclusions: Incidence of MI is increasing among hospital admissions in Ilorin, and there is an urgent need for community interventions targeted at early detection and treatment of hypertension, diabetes mellitus, dyslipidemia, and obesity. Campaigns against cigarette smoking should be sustained.
CVD-O-02: Ten-Year coronary artery disease risk assessment in nigerian hypertensive subjects
Dike B. Ojji 1 , Jacob Alfa 1 , Murtala Ngambea 1 , Samuel O. Ajayi 1 , Manmak H. Mamven 1, Ayodele O. Falase Ayodele 2
1 Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, 2 Department of Medicine University College Hospital, Ibadan
Background and Objective: It is well-known that the presence of hypertension doubles the risk of coronary artery disease (CAD). In spite of the high prevalence of hypertension in Nigeria, the prevalence of CAD is relatively uncommon in this population group. It has, however, been projected that with the epidemiological transition in disease pattern being experienced in many parts of sub-Saharan Africa, CAD is likely going to play a more significant role in the disease pattern of Nigerians. To ascertain the future role of CAD in Nigeria, we decided to risk stratify every consecutive norm glycemic hypertensive subject referred to the Cardiology unit of University of Abuja Teaching Hospital from April 2006 to July 2013.
Materials and Methods: One thousand two hundred and fifteen subjects were risk-stratified according to the Framingham 10-year Risk Score.
Results: 52.4% of the 1200 subjects were male while 47.6% were female. The mean age, mean body mass index, and mean arterial pressure of the subjects were 50.9 ± 11.4 years, 28.1 ± 9.4 kg/m 2 and 116.23 ± 13.1 mmHg, respectively. 18.5% of the study population were high-risk individuals, 2.8% were medium risk while 78.7% were low risk individuals.
Conclusions: Although majority of the subjects have a low risk for the development of CAD in the nearest future, a proportion as high as 18.5% in the high-risk category cannot be ignored. Therefore, the need for lifestyle modification to be intensified in this population group cannot be over-emphasized.
CVD-O-03: Public knowledge of heart attack symptoms and prevalence of self-reported cardiovascular risk factors in public servants in Ilorin
Philip M. Kolo, Jude A. Fasae, Fredrick I. Aigbe, James A. Ogunmodede, Ayodele B. Omotoso, Bolade F. Dele-Ojo
Department of Medicine, University of Ilorin, P.M.B 1515, Ilorin, Nigeria, Cardiology Unit, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin Nigeria
Background and Objective: The level of public knowledge on cardinal symptoms of heart attack correlates with the speed the individuals seek medical attention if they experience heart attack. Early thrombolysis or reperfusion improves the outcome of patients with acute coronary syndromes. This study aimed at evaluating knowledge of heart attack and prevalence of self-reported cardiovascular diseases among public servants in Ilorin, Nigeria.
Materials and Methods: A pretested structured questionnaire designed for the purpose of this study was administered by trained field assistants to obtain relevant information from the participants.
Results: Six hundred and one subjects consisting of 312 (51.9%) males and 289 (48.1%) females were interviewed, and their mean age was 31.4 ± 11.1 years. The mean age of the male participants was similar to that of the females (P = 0.7). Although 78% of the respondents have heard about heart attack, only 44.4% could discriminate heart attack from other conditions. Higher proportion of women (50.2%) than men (39.1%) could identify a core symptom of heart attack. However, women reported higher prevalence of hypertension, diabetes, dyslipidemia, obesity, stroke, and probable heart attacks than men. On the other hand, cigarette smoking was fourfold more common in males than in females
Conclusions: There was low knowledge of heart attack symptoms among the participants studied. Women were more knowledgeable about symptoms of heart attack than males, but the former reported a higher prevalence of cardiovascular diseases than the latter. There is need for public education on symptoms of the disease and importance of seeking urgent medical attention in affected persons.
CVD-O-04: Acute myocardial infarction in a patient without modifiable, traditional risk factors
Akins Anya D. Olusegun-Joseph, Olagoke K. Ale, Oluwole A. Kushimo, Sunday A. Agagu, Olamide O. Olowoyo, Jane N. Ajuluchukwu
Lagos University Teaching Hospital, Lagos State, Nigeria
Background and Objective: Acute myocardial infarction (AMI) is often associated with the presence of traditional risk factors. However, there have been reports of cases of AMI in the absence of these risk factors. We report the case of AMI in a 52-year-old Nigerian male, without the traditional risk factors.
Materials and Methods: This is a case report of Mr. A.R, a 52-year-old civil servant from Lagos, South Western part of Nigeria who presented in the emergency department with features in keeping with acute myocardial infarction.
Results: Mr. A.R was admitted via the emergency department with a 13 hr history of retrosternal chest pain of sudden onset. Pain was severe and crushing in nature, radiating to the neck with no significant relieved by sublingual GTN. There was associated diaphoresis, nausea, vomiting, and palpitations. He had a similar but less severe chest pain about 9 years ago. He was not a known hypertensive, diabetic; he does not smoke not drink alcohol. Examination revealed an apprehensive middle-aged man, with a BMI of 23.4 kg/m 2 , with no features of hemodynamic instability. Electrocardiography showed ST elevation in anteroseptal leads. Cardiac troponin T was markedly elevated 2000 ng/L (normal < 50 ng/L). Echocardiography showed regional wall motion abnormalities and myocardial thinning in keeping with anteroseptal infarct, with impaired relaxation, preserved ejection fraction (EF 63%). FBC, E/U/Cr, and lipid profiles were normal. He was discharged after 19 days on admission and has had in the cardiology clinic.
Conclusions: Acute myocardial infarction, though often associated with traditional risk factors, can occur in their absence.
INV-O-01: Stand-alone percutaneous coronary intervention in a Nigerian cardiac catheterization laboratory
Adeyemi Johnson, Bode Falase 1, Kofo Ogunyankin, Ifeoluwa Ajose 1 , Yemi Onabowale 2
First Cardiology Consultants, Ikoyi, Lagos, Nigeria, 1 Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, 2 Reddington Multispecialty Hospital, Victoria Island, Lagos, Nigeria
Background and Objective: There is a rising incidence of non-communicable cardiovascular disease in Nigeria with a resulting increase in the prevalence of ischemic heart disease. There is, however, a paucity of diagnostic and therapeutic facilities in Nigeria to confirm coronary artery disease and to offer appropriate interventional therapy. There is now a private cardiac catheterization laboratory in Lagos, but as there is as yet no sustained open heart surgery programs, percutaneous coronary interventions are currently being performed without surgical backup. This study was designed to assess the results of stand-alone percutaneous coronary intervention (PCI) as currently practiced in Nigeria.
Materials and Methods: The study period was between July 2009 and July 2012. Data was extracted from a prospectively maintained database. Extracted data included patient demographics, Euroscore, indications for PCI, severity of coronary stenoses seen, coronary stenoses that received intervention, type of PCI performed, results of interventions, and complications.
Results: Coronary artery disease was confirmed in 102 (67.1%) of 152 Nigerians referred with a diagnosis of ischemic heart disease. There were 66 males (64.7%) and 36 females (35.3%). The average age was 59.6 ± 10.6 years, and average Euroscore was 4.2 ± 3.1. Of the 102 patients, 77 (75.6%) had significant stenoses and were candidates for revascularization. Distribution of significant stenoses was 1 in 32 patients (41.5%), 2 in 11 patients (14.3%), 3 in 19 patients (24.7%), 4 in 13 patients (16.8%), and 5 in 2 patients (2.6%). PCI was performed in 48 (62.3%) of the patients eligible for revascularization as the coronary anatomy in the remaining patients was not suitable for PCI. The indication for PCI was for myocardial infarction or unstable angina in 39 patients (81.2%). PCI was performed with PTCA plus stenting in 41 patients (85.4%) and with PTCA alone in 7 patients (14.6%) with good angiographic results. Complete revascularization was achieved in 100% of patients with 1 stenosis, 50% of patients with 2 stenoses, 21.4% of patients with 3 stenoses, 20% of patients with 4 stenoses, and none of the patients with 5 stenoses (14.6%). Overall, 29 of the 48 patients (60.4%) had complete revascularization with 72 of 171 significant stenoses (36%) undergoing PCI. Complications of PCI were bleeding that required blood transfusion in 1 patient (2.1%), minor femoral hematoma in 2 patients (4.2%), and a dissection of the right coronary artery in 1 patient (2.1%).
Conclusions: A stand-alone PCI program has been developed in Lagos Nigeria, and both elective and urgent PCIs have been performed with no mortalities and a low complication rate. Complete revascularization rates would, however, be increased with the establishment of open heart surgery programs to provide CABG for more complex lesions not amenable to angioplasty.
INV-O-02: Clinical and angiographic profile of Nigerians with confirmed coronary artery disease
Adeyemi Johnson, Bode Falase 1 , Kofo Ogunyankin, Ifeoluwa Ajose 1 , Yemi Onobowale 2
First Cardiology Consultants, Ikoyi, Lagos, Nigeria, 1 Cardiothoracic Division, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria, 2 Reddington Multispecialty Hospital, Victoria Island, Lagos, Nigeria
Background and Objective: There is an increased incidence of non-communicable diseases in West Africa. This trend has also been noted for coronary artery disease (CAD), but facilities to investigate ischemic heart disease (IHD) have been limited to autopsy findings, electrocardiogram, cardiac enzymes, and transthoracic echocardiogram. Delineation of coronary anatomy and definitive diagnosis by cardiac catheterization has been hitherto lacking. With the recent establishment of a private diagnostic facility (First Cardiology Consultants) as well as a cardiac catheterization facility (Reddington Multispecialty Hospital), this study was designed to elicit information about the clinical profile, modes of presentation, and the coronary angiographic findings of Nigerians with confirmed CAD.
Materials and Methods: The study period was from July 2009 to July 2012. The presence of CAD was detected by coronary artery stenosis noted on coronary angiogram, which was classified as minimal (<50%), moderate (50-69%), and severe (>70%). A diseased coronary vessel was any major epicardial vessel or branch with >50% stenosis. The data was extracted from a prospectively maintained database and included patient demographics, clinical profile, presentation, Euroscore, and angiographic findings.
Results: Out of 2808 patients seen in the study period, CAD was confirmed in 102 (67.1%) of 152 Nigerians referred with IHD, giving a prevalence of CAD of 3.6%. Average age was 59.6 + 10.6 years. Indication for cardiac catheterization was STEMI in 36 patients (35.2%), chronic stable angina in 34 patients (33.3%), unstable angina/NSTEMI in 21 patients (20.6%), congestive cardiac failure in 8 patients (7.8%), non-specific chest pain in 2 patients (2%), and pre-operative workup in 1 patient (1%). Risk factors noted were hypertension in 79 patients (77.5%), hypercholesterolemia in 56 patients (54.9%), diabetes in 31 patients (30.4%), obesity (as defined by BMI > 30) in 20 patients (19.6%), recent smoking history in 13 patients (12.7%), and extra cardiac arteriopathy in 6 patients (5.9%). Average Euroscore was 4.2 ± 3.1. Coronary angiogram showed normal coronary artery or minimal stenosis in 22 patients (21.6%), moderate stenosis in 3 patients (2.9%), and severe stenosis in 77 patients (75.5%). Distribution of patients by diseased coronary vessels was single vessel disease in 26 patients (32.5%), double vessel disease in 23 patients (28.8%), triple vessel disease in 31 patients (38.8%), and associated left main stem disease in 9 patients (11.2%). A total of 210 coronary stenoses were seen with 80 (38.1%) in the left anterior descending coronary artery, 62 (29.5%) in the circumflex coronary artery, 59 (28.1%) in the right coronary artery, and 9 (4.3%) in the left main stem coronary artery. One hundred and seventy-one (81.4%) of the stenoses were significant stenoses, and out of 16 various locations, the commonest locations were proximal LAD 44 (25.7%), Mid LAD 22 (12.8%), proximal RCA 21 (12.3%), and proximal circumfle × 20 (11.7%).
Conclusions: There is a rising prevalence of coronary artery disease in Nigeria. Most patients present with unstable angina or myocardial infarction, and the majority have multiple vessel disease and significant stenoses, most of which are in the LAD territory. This emphasizes the urgency in developing interventional cardiology and coronary bypass services to treat coronary artery disease in Nigeria. The distribution of coronary artery stenoses is similar to other series in the literature.
INV-O-03: Left ventricular structure and functions in the presence of abnormal geometry: An African hypertensive population study
Abiodun M. Adeoye, I.A. Adewoye, O. Oyebowale, Akinyemi Aje, Okechukwu S. Ogah, Adewole A. Adebiyi, Olulola O. Oladapo, Ayodele O. Falase
Division of Cardiology, Department of Medicine, University College Hospital, PMB 5116, Ibadan, Nigeria
Background and Objective: Studies have shown that abnormal LV geometry, especially concentric hypertrophy, is associated with a higher level of cardiovascular morbidity and mortality than normal geometry. Most of the reported literature to date is based on studies conducted among persons of European descent, and limited data exist on populations from sub-Saharan Africa. In this study, we report the effects of abnormal geometry on left ventricular structure and functions in an African population.
Materials and Methods: One hundred and fifty-six consecutive newly presenting hypertensives (73 males and 83 females) with informed consent were recruited for the study. All participants underwent full clinical evaluation, and echocardiographic examination was performed according to the ASE recommendation. One hundred and forty-five subjects with complete echocardiographic parameters were divided into 4 groups using left ventricular mass index and relative wall thickness: Normal (66), concentric remodeling (40), eccentric hypertrophy (25), and concentric hypertrophy (14).
Results: The mean age of the hypertensive subjects was 59.5 (12.3) years. Age, weight, height, body mass index, waist-hip ratio, and systolic blood pressure were similar among the groups. Diastolic blood pressure was lower among the eccentric group when compared with the concentric group (P < 0.019). There was no significant gender influence on the distribution of geometry pattern. Left atrial diameter and left ventricular dimensions except posterior wall thickness at diastole were significantly larger in eccentric hypertrophy when compared with other groups (P < 0.0001). Left ventricular ejection fraction was lowest among subjects with eccentric hypertrophy. Diastolic function parameters were comparable among the groups.
Conclusions: The study showed that slightly more than half of the study subjects had abnormal geometry. Abnormal geometry probably affects LV systolic function more than the diastolic function. Prompt management may alter the prognostic effect of abnormal geometry among the study group.
INV-O-04: Analysis of a five year experience of Permanent Pacemaker Implantation at a Nigerian Teaching Hospital: Need for a National Database
Bode Falase, Michael Sanusi, Adeyemi Johnson 1 , Fola Akinrinlola, Reina Ajayi 2 , David A. Oke 2
Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, 1 First Cardiology Consultants, Ikoyi, Lagos, Nigeria, 2 Cardiology Unit, Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Background and Objective: Permanent pacemaker implantation is available in Nigeria. There is, however, no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution, and the results are analyzed in this study.
Materials and Methods: The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database, which was designed to include the fields of the European pacemaker patient identification code.
Results: Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2 ± 12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%), and dyspnea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%), and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%), and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits, and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker-related deaths (9.8%).
Conclusions: Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry.
CVD-O-05: Successful repair of ruptured sinus of Valsalva aneurysm at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu
Benedict C. Anisiuba, Vincent A. Okwulehie 1 , Suresh Joshi 2 , Collins N. Ugwu, Maduabuchi P. Ufoegbunam 3 , Paschal O. Njoku
Department of Medicine, UNTH, 1 Department of Surgery, UNTH, 2 VOOM Foundation, 3 Department of Anesthesiology, UNTH
Aneurysm of the sinus of Valsalva is a rare abnormality. Incidence of 0.14-0.23% is reported in the West, but a higher incidence (0.46-0.36%) is reported in Asia. A case was reported earlier this year from northern Nigeria, but died suddenly before repair could be done.
We present a 25-year-old female undergraduate who was diagnosed to have VSD soon after birth on account of recurrent fever and cough. Later childhood did not present serious health challenges, except that she was smaller than her siblings. Symptoms worsened at the age of 20 years with exacerbation at 23 years.
Pre-op trans-thoracic and trans-esophageal echocardiogram confirmed a diagnosis of membranous VSD, ruptured right sinus of Valsalva aneurysm, and aortic regurgitation
Under cardiopulmonary bye-pass, the aneurysm of the right sinus of Valsalva was repaired and the membranous VSD patched. The aortic regurgitant jet was tiny with healthy leaflets that did not warrant valve replacement. The whole surgery was monitored with intra-operative trans-esophageal echocardiography. The post-operative period was uneventful, and patient was discharged after 10 days post-op.
To the best of our knowledge, this is the first successful repair of ruptured sinus of Valsalva aneurysm done in Nigeria.
CVD-O-06: Aortic root dilatation in African hypertensives subjects: Frequency of occurrence and associations: A multicenter echocardiographic survey
Adeseye A. Akintunde 1,3 , Ademola A. Aremu 4 , Philip B. Adebayo 1 , Adebayo T. Oyedeji 2, Oladimeji G. Opadijo 1
1 Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, 2 Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, 3 Goshen Heart Clinic, Okinni, Osogbo; 4 Department of Radiology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
Background and Objective: Anecdotal reports suggest that hypertension is associated with an increased predisposition to aortic root dilatation (ARD). Reports on epidemiology of ARD and demographic or clinical associations among African hypertensive subjects are scarce. This study aimed to describe the prevalence of ARD among Nigerian hypertensive subjects.
Materials and Methods: This was a retrospective review analysis of hypertensive subjects who had echocardiography performed. ARD was defined according to 3 criteria using the normograms recently proposed by Devereux et al. SPSS 17.0 was used for statistical analysis.
Results: ARD was present in 34 (7.3%) vs. 10 (2.15%) vs. 12 (2.58%) using the aortic sinus index, pHeight, pBSA, respectively. The frequency of ARD using any of the 3 parameters was 8.37% (39 subjects). ARD was significantly more common among males (31.03% of males vs. 2.84% of females). Compared to hypertensive without ARD, those with ARD were more likely to be older, had a significantly higher systolic blood pressure, left ventricular posterior and interventricular septal thickness in diastole, and left ventricular mass/index. Aortic sinus index and aortic root dimension were well significantly correlated to age, systolic blood pressure, waist circumference, interventricular septal thickness in diastole, posterior wall thickness, left ventricular mass/index, and height.
Conclusions: Males are more likely to have ARD than females among African hypertensive subjects. Age, systolic blood pressure, and echocardiographic parameters are determinants of aortic root dimensions. ARD seems to be associated with a more likely chance of increased cardiovascular risk in African hypertensive subjects.
CVD-O-07: Insights into heart failure with preserved ejection fraction among admitted Nigerian patients
Kamilu M. Karaye, Adeseye A. Akintunde 1
Departments of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria, 1 Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
Background and Objective: The understanding of the epidemiology of heart failure (HF) is mainly based on data from the developed countries of Western Europe and North America, with very little contribution from developing countries, especially those in sub-Saharan Africa. The objective of this report is to provide an insight into the epidemiologic characteristics of HF with preserved ejection fraction (HFPEF) in two teaching hospitals in Nigeria, by assessing the prevalence, characteristics, and outcome of HFPEF in comparison to HF with reduced EF (HFREF) among admitted patients.
Materials and Methods: The study was carried out in the medical wards of Aminu Kano Teaching Hospital, Kano, and Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria. Admitted HF subjects were included if they had HF, were at least 18 years of age, had satisfactory images on trans-thoracic echocardiography, admitted to the medical wards of either of the study centers, and gave informed consent.
Results: One hundred subjects were recruited consecutively and 32% had HFPEF while 68% had HFREF. Mean age of all patients was 47.3 ± 19.5 years. There were no statistically significant differences between subjects with HFPEF and those who had HFREF, in terms of demographic and clinical characteristics. Overall, 53% were females, and <20% of them were >65 years old. Nearly all were bloated up with pedal edema, in New York Heart Association functional classes 3 or 4 and with very high N-terminal B-type natriuretic peptide levels. Fifteen percent were admitted in cardiogenic shock, while 48% had hypotension, 10% had renal dysfunction, and 45% had anemia at presentation. The in-hospital mortality was 14% overall; 19% versus 12% in HFPEF and HFREF, respectively (P = 0.348). Hypertension was the single most important cause of HF in all patients and in the two groups (43%), but the combination of peripartum and dilated cardiomyopathies was as common as hypertension in the HFREF group (42.7% each; 85.4% together), while the causes were relatively more widespread in the HFPEF group.
Conclusions: The patients presented very sick and very late, and the picture of HFPEF certainly looks very different from those seen in developed countries of Western Europe and North America.
CVD-O-08: Troublesome recurrent paroxysms of arrhythmia due to arrhythmogenic right ventricular dysplasia: A case report
Basil N. Okeahialam
Cardiology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
Background and Objective: Cardiac dysrrhythmias could present a devastating experience to the patient, and a nightmare to the clinician ill-equipped to confirm and manage them. As they have various causes, it is vital to define them so as to initiate appropriate action. In our environment lacking in modern diagnostic infrastructure, diagnosis most time is fortuitous; requiring a high level of alertness.
Recently, a young lady presented with palpitations, which worsened over 8 years, and started to interfere with her daily activities. During evaluation, electrocardiograms suggestive of ARVD were recorded. Not being commonly reported in Nigeria as yet and in a female, a gender less commonly afflicted, the need to report this becomes imperative.
Materials and Methods: Case report with illustrative electrocardiograms.
Results: Electrocardiograms showing junctional tachycardia in relation to first episode of palpitation and typical ARVD features with the second. These were: Prolonged QTc interval (449 and 474 msec), T inversion in the antero-septal lead areas, localized QRS prolongation in right praecordial leads >110 msec (120 msec), QRS in V1 through V3 in excess of V6 by >25 msec (40 msec), ratio of QRS in V1+ V2+ V3/V4+ V5+ V6 greater than or equal to 1.2 (1.2).
Conclusions: Such cardiopathies as ARVD may really not be as rare as previously thought in our environment. The need for equipped electrophysiology laboratories to appropriately diagnose cases of palpitation and facilities for interventional cardiology become compelling.
CVD-O-09: The significance of rate pressure product in heart failure patients
Kamilu M. Karaye, Adeseye A. Akintunde 1, Michael Y. Henein 2
Departments of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria, 1 Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria, and 2 University of Umea and Umea Heart Center, Umea, Sweden
Background and Objective: The rate pressure product (RPP) is a strong determinant of myocardial oxygen consumption, and relates strongly to important indices for morbidity and cardiovascular mortality. Its significance in Black-African subjects with heart failure (HF) has, however, not been well described.
The objective of the paper is to assess the significance of RPP among admitted HF patients in 2 Nigerian centers.
Materials and Methods: Admitted HF patients in the 2 centers were serially recruited after satisfying all inclusion criteria. RPP was calculated by multiplying heart rate by systolic blood pressure at admission. Subjects were classified into 2 groups based on RPP <10,000 (log 10 = <4.0) (group 1) or ≥10,000 (group 2), which is a cut-off value, above which there is increased risk of myocardial ischemia.
Results: One hundred subjects were recruited from the 2 centers with a mean age of 47.3 ± 19.5 years, and 53% were females. Thirty-five percent of the subjects were in group 1 while 65% were in group 2. N-Terminal B-type Natriuretic Peptide (NT-BNP), serially measured in only 37 subjects (12 in group 1; 25 in group 2), was significantly higher in group 1 as compared with group 2 (P = 0.016). Group 1 also had thinner interventricular septum (IVST) (P = 0.007) as compared with group 2 subjects. RPP correlated with IVST (r = +0.51, P < 0.001), left ventricular posterior wall thickness (LVPWT) (r = +0.40, P < 0.001), and LV end-diastolic dimension (LVEDD) (r = −0.20, P = 0.045). Independent determinants of increased RPP were IVST (95% confidence interval (CI): 1.061 - 1.528, P = 0.009) and NT-BNP (CI: 0.999 - 1.000, P = 0.026). There was, however, no significant relationship (P > 0.05) between RPP and in-hospital mortality, as well as many morbidity indices including LV ejection fraction.
Conclusions: This study confirms the close relationship that exists between determinants of myocardial oxygen consumption (RPP), and those for LV wall tension (IVST, LVEDD, and NT-BNP), especially the septum, in Black-Africans with HF.
INV-O-05: Atrial Septal Defects: Pattern, clinical profile, interventional techniques, and outcome in Innova Hospital: A 4-year review
Adiele D.K. 1 , Arodiwe I.O. 1 , Chinawa J. 1 , Gouthami V. 2 , Murthy K.S. 2 , Obidike E.O. 1 , Eze J.C. 3 , Ujunwa F. 1
1 Cardiology Division, Department of Pediatrics, 3 Cardiothoracic Unit, Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Nigeria, 2 Innova Children's Heart Hospital, Hyderabad, India
Background and Objective: Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between two compartments of the heart called the left and right atria. It may be asymptomatic, and sometimes may present with heart failure. Surgical repair is definitive
Materials and Methods: From June 2007 to July 2011, 71 patients had ASD device closure at Innova Children's Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. The morphological characteristics of the ASD including its diameter, location, shape, and the width of surrounding septal margins were also evaluated.
Results: From June 2007 to July 2011, 71 consecutive children (29 males, 40 females) with a median age of 9.0 years (range = 3.2-19 years) had ASD device closures in above named center. The median weight was 31.5 kg (range = 7.5-39.0 kg). Five patients (12%) were young children aged 3-5 years old. Forty-four of these children presented with symptoms of heart failure while 47 (70%) cases repaired with device closure were large-sized ASD.
The commonest device type used were Sear care Heart R and Amplatzer technique with the highest success rate obtained in 2010.
Conclusions: Atrial septal defect (ASD) is a common congenital heart disease with a high success rate for device closure in trained hands.
INV-O-06: Transthoracic ligation of the persistent ductus arteriosus in Ile-Ife
Uvie U. Onakpoya, Akinwumi B. Ogunrombi, Olumide A. Aladesuru
Cardiothoracic Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile- Ife, Nigeria
Background and Objective: Patent ductus arteriosus (PDA) ligation is a procedure aimed at improvement in cardiorespiratory function and early prevention of pulmonary hypertension. This is a descriptive retrospective analysis of operated cases of PDA seen in the last 5 years and examines some demographic and clinical parameters observed among the patients.
Materials and Methods: A total of 14 cases of PDA, who had surgical ligation of PDA between April 2009 and May 2013 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, were retrieved from the theater registrar and analyzed.
Results: Mean age was 7 years (range, 4 months - 19 years) with a male: female ratio of 1: 13. Five patients (35.71%) had dyspnea, and 6 (42.86%) had symptoms since birth. Five patients (35.7%) had co-existing anomalies. Triple suture ligation was utilized in all patients. Post-operative ICU stay was 1 day while hospital stay ranged between 3 and 5 days. The most common post-operative complication was chylothorax, which occurred in 2 patients (14.3%).
Conclusions: Surgical closure of the persistent ductus arteriosus is a safe procedure associated with relatively low complications and short post-operative hospital stay.
INV-O-07: Pulmonary arterial hypertension in Nigerian children and adolescents with sickle cell anemia
Benedict C. Anisiuba, Anthony N. Ikefuna 1 , Bartholomew F. Chukwu 1 , Ifeoma J. Emodi 21 , Kenneth D. Adiele 1
Department of Medicine, 1 Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Background and Objective: PAH in sickle cell patients is associated with increased mortality. Tricuspid regurgitant velocity (TRV) on Doppler echocardiography is a useful non-invasive tool to detect PAH. Early detection may lead to interventions that will reduce the excess mortality in these patients. The aim is to use echocardiography to study children and adolescents with sickle cell anemia in order to non-invasively detect the incidence of PAH in these patients.
Materials and Methods: Thirty-two children and adolescents attending the sickle cell clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla (UNTH) were recruited for the study. Thirty two age- and sex-matched subjects without sickle cell anemia were used as controls. All the subjects underwent echocardiography using M-mode, 2-dimensional, color and Doppler modalities. The echocardiogram machines used were Sonoscape (UK) SSI 5000 and Vivid E(Biostadt). TRV ≥250 cm/sec was regarded as PAH.
Results: There were 19 males (59.4%) and 13 females (40.6%) in each group. The age-range of the subjects was 4 to 8 years. There was no significant difference in the age of the patients (mean 10.9 ± 3.46) and the controls (mean 10.65 ± 3.45, P < 0.001). PAH was detected in 4 out of the 32 cases (12.5%) but none in the control group.
Conclusions: PAH occurs in Nigerian children and adolescents with sickle cell anemia.
INV-O-08: Blood transfusion requirements for open heart surgery in Nigeria
Bode Falase, Michael Sanusi, Adetinuwe Majekodunmi 1 , Matthew Zacharias 2 , Ifeoluwa Ajose 1 , Folake Kofo-Idowu, Isla Animashaun
Cardiothoracic Division, Lagos State University College of Medicine, 1 Anesthesia Department, Lagos State University College of Medicine, 2 Department of Community Health, Lagos State University College of Medicine, Lagos, Nigeria
Background and Objective: Open Heart Surgery (OHS) puts demands on blood transfusion services, which can be challenging in a resource-poor environment like Nigeria. As no benchmarks had been established in our environment, workup for OHS included the elective preparation of 4 units of packed cells, 4 units of platelets, 4 units of fresh frozen plasma for each case. The purpose of this study was to determine the actual blood transfusion requirements for OHS.
Materials and Methods: The study period was from August 2004 to December 2011. Only patients requiring cardiopulmonary bypass (CPB) were included. Pre-operative serum hemoglobin was greater than 10 g/dl, INR <1.2, and aspirin or warfarin therapy stopped at least 3 days prior to surgery. Triggers for blood transfusion were serum hemoglobin <6 g/dl during CPB, serum hemoglobin <8 g/dl postoperatively or persistent chest tube drainage >200 ml/hour. Data was extracted from a prospectively maintained database. OHS was categorized based on the requirement for a prosthetic valve as prosthesis surgery (P) or non-prosthesis surgery (NP). Chest tube drainage and transfusion requirements were compared between the two groups using the students T Test for parametric values and the chi-square test for non-parametric values. A P < 0.05 was statistically significant.
Results: Fifty-one patients underwent OHS with an average age of 28.5 ± 15.4 years and average Euroscore of 3.7 ± 1.8. Non-prosthesis surgery (ASD 14, VSD 8, CABG 2, GLENN 2, TOF 2, Myxoma 2) was performed in 30 patients (58.8%) and prosthetic surgery (MVR 16, AVR 5) in 21 patients (41.2%). For the non-prosthesis surgery, CPB time was 150.3 ± 30.7 minutes, and chest tube drainage was 997 ± 859 mls. Packed cells were transfused in 18 NP patients (60%), and packed cell requirements were 3.7 ± 2.7 units. Platelets were transfused in 3 NP patients (10%), and platelet requirements were 3 ± 2.6 units. Fresh frozen plasma was transfused in 8 NP patients (26.7%), and fresh frozen plasma requirements were 2.9 ± 1.4 units. For prosthetic surgery, CPB time was 151.2 ± 26 minutes, and chest tube drainage was 1263.2 ± 1007 mls. Packed cells were transfused in 17 P patients (81%), and packed cells requirements were 4.6 ± 2.9 units. Platelets were transfused in 4 P patients (19.1%), and platelets requirement were 3 ± 2.6 units. Fresh frozen plasma was transfused in 11 P patients (52.4%), and fresh frozen requirements were 3.2 ± 1.5 units. None of the comparisons between the groups reached statistical significance.
Conclusions: Though patients requiring prosthetic valves had more post-operative blood loss and required more transfusion of blood components, this was not statistically significant. The pre-operative preparation of 4 units each of the blood components appears adequate to cover blood transfusion requirements.
INV-O-09: Evaluation of Zaria-made jugulometer
Nathaniel G. George, Vincet Y. Shidali, Yakubu P. Dogo, Isiguzo Godsent 1 , Adesua Monane, Onu James 1 , Solomon S. Danbauchi
Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, 1 Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
Background and Objective: The history of the study of venous blood pressure is as long as the arterial counterpart, particularly the internal jugular venous pressure, which is an indirect assessment of the pressure in the right atrium. Despite the availability of more sophisticated and invasive procedures for central venous pressure measurement, the role of estimating the height (in cm of water) of the IJV at bedside cannot be overemphasized. A handy instrument for this purpose is here being compared with the age long procedure of combining two rulers. The aim of the report is to compare the conventional means of JVP estimation with the use of a new instrument (Jugulometer).
Materials and Methods: Forty one (41) patients with elevated JVP in heart failure were recruited from two (2) centers: ABUTH, Zaria and JUTH, Jos. JVP was estimated by conventional method (using 2 rulers) with patient inclined at 45 o to the horizontal. This was repeated using the jugulometer with and without light source separately. The time taken (in seconds) was noted for each as well as the corresponding height of JVP above the sternal angle (in centimeters). Age, sex, BMI, pulse rate, blood pressure, and cause of heart failure were also noted. Data obtained was analyzed using SPSS statistical software (version 16).
Results: A total of 41 patients consisting of 21 (51.2%) males and 20 (48.8%) females with a mean age of 39.41 years were examined. Heart failure was due to cardiomyopathy (17.1%), hypertension (26.8%), MI (2.4%), rheumatic valvular heart disease (41.5%), peripartum cardiac failure (9.8%), and cor-pulmonale (2.4%). Analysis was done comparing conventional method and instrument without light (pair 1), conventional method and instrument with light (pair 2), and instrument without light and instrument with light (pair 3). There was a significant positive correlation (r = 0.830, 0.830, and 0.954, respectively) in the height of JVP measured (P < 0.000 each). Also, the differences seen in the values of JVP height were not statistically significant (P > 0.174, 0.179, and 1.000). On the other hand, time differences (in seconds) for measuring the JVP were found to be statistically significant (P < 0.004, 0.000, and 0.011) and shorter with the jugulometer.
Conclusions: The Zaria made Jugulometer is faster, less cumbersome, and has comparable accuracy to the conventional way of JVP estimation by the bed side. It is, therefore, recommended for routine patient examination.
CVD-P-01: Civil status and cardiovascular disease risk factors in rural north central Nigeria
B.N. Okeahialam, C. Ogbonna 1 , E.K. Chuhwak, I. Isiguzoro 2 , H.A. Agbo 1
Department of Medicine, 1 Community Health, 2 Medical Laboratory Science, University of Jos, Jos, Nigeria
Background and Objective: Educational status has been shown in previous studies to impact on CVD mortality and so has civil status. Hardly has such studies been reported locally. Since such status will shed light on peculiar risk factors, it is possible to modify them to patients' benefit; improving CVD morbi-mortality indices.
Materials and Methods: Data from our CVD survey in rural north central Nigeria were secondarily analyzed with a view to determining how level of educational attainment or civil status related with some major CVD risk factors. Where significant between group differences emerged, multiple comparison was done to see what exactly predisposed such group.
Results: Educational status turned out not to significantly correlate with the major CVD risk factors unlike the situation in the west. For civil status, there was significant across group correlation with SBP (P = 0.000) and DBP (P = 0.005). On Multiple comparison, the most burdened group (widows) were significantly less active physically in regular occupation (P = 0.000) and leisure activity (P = 0.000). Their BMI was higher but attained significance when compared with the single population (P = 0.04)
Conclusions: Unlike in the west, educational status did not seem to affect CVD risk factor burden. The pervasive unemployment may be responsible since higher attainment gave no socio-economic advantage. Therefore, the risks inherent in life style related to such status were absent. With civil status, the widows as expected were worse off. Apart from the stress (widowhood effect), they were largely sedentary. They should, therefore, be encouraged to be physically active to reduce tendency to obesity and gain physiological benefits of exercise.
CVD-P-02: Anti-hypertensive medication adherence among Nigerian hypertensive subjects: Associations and determinants - A preliminary report
Adeseye A. Akintunde 1,2 , Mathias A. Akinlade 2 , Lookman O. Kareem 2 , Oladimeji G. Opadijo 1,2
1 Departments of Medicine, LAUTECH and 2 LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
Background and Objective: Achieving good blood pressure control in hypertensive subjects is key to reducing the risk of cardiovascular events and mortality. Poor adherence to medications has been linked with increased cardiovascular risk and mortality in many populations. Africans have been shown to have a worse prognosis from hypertension and kidney diseases when compared to Caucasians.
The objective of the study is to determine the level of adherence to anti-hypertensive medications and the factors associated with it among hypertensive subjects attending the GOPD and Cardiology Clinics of LAUTECH Teaching Hospital, Ogbomoso.
Materials and Methods: A cross-sectional study. The 8 parameter Morisky scale was used to assess for adherence to anti-hypertensive medications. Clinical and demographic data were taken. Statistical analysis was done using SPSS 17.0. P <0.05 was taken as statistically significant.
Results: Sixty-four hypertensive subjects were recruited so far consisting of 27 males (42.2%) and 37 females (57.8%). The mean age was 62.7 ± 14.0 years. High adherence, low adherence, and medium adherence as defined by Morisky scale were found in 7 (10.9%), 28 (43.8%), and 29 (45.3%), respectively. There was no relationship between the level of adherence and the number of anti-hypertensive drugs taken or the duration of hypertension. Those with good adherence were likely to be younger, had a higher level of education, and a better quality of life than those with poor adherence.
Conclusions: Poor adherence to medications is very common in the hypertensive Nigerians. Effective health education and regular screening for compliance and adherence is a potential way to reduce cardiovascular risk associated with uncontrolled hypertension.
CVD-P-03: General practitioners' knowledge of heart failure diagnosis and management in two north central Nigerian states
Philip M. Kolo, Emmanuel O. Sanya, Timothy O. Olanrewaju, Ademola E. Fawibe, Ayodele Soladoye 1
Department of Medicine, University of Ilorin, P.M.B 1515, 1 Cardiology Unit, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, 3 Federal Medical Center, Bida Niger State, Nigeria
Background and Objective: Heart failure (HF) has remained a major cause of cardiovascular morbidity and mortality worldwide despite the use of novel therapies in its management. General medical practitioners are the first contact in the care of patients with this condition and, therefore, should be familiar with guidelines on its diagnosis and management, hence this study.
Materials and Methods: A pretested structured questionnaire designed for the purpose of this study was self-administered to obtain relevant information from the participants in Niger and Kwara States of Nigeria.
Results: There were 133 participants consisting of 101 (76.2%) males and 32 (23.8%) females. Only 49 (36.8%) respondents recognized all the major criteria of heart failure diagnosis. Majority (75.6%) of the respondents believed that echocardiography should be done in patients with suspected heart failure. One hundred and two (76.7%) participants always used diuretics, 16.5% digoxin, 15% beta-blockers (BB), 30.1% angiotensin-converting enzyme inhibitors (ACEI), and 7.5% always used angiotensin receptor blockers (ARB's) in HF management.
Conclusions: The demonstrated knowledge of Framingham clinical criteria in diagnosis of HF and guidelines on management was sub-optimal in the study participants. Structured continuing medical education activities are a useful strategy to fill this knowledge gap and ensure better management of these patients.
CVD-P-04: Pyopericardium complicated by tamponade: A case report
Sulaiman A Balarabe, Zira Vandi, Muzammil M. Yakasai, Shehu A. Kana, Umar Abdullahi, Zainab Mahmoud, Nasir A. Ishaq, Jamila A. Yau, Kamilu M. Karaye, Muhammad S. Mijinyawa, Mahmoud U. Sani
Cardiology Unit, Department of Medicine, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria
Pyopericardium is rare entity with high mortality usually described in neonates and children. Fewer than 50 cases have been published in the literature in the last 100 years. The most commonly associated illnesses are pneumonia, chest wall infection, and thoracic operation with up to 75% of cases currently having no underlying primary focus.
We present a 17-year-old woman who presented with a month history of cough, progressive shortness of breath, and fever. She had a spontaneous abortion at 5-month gestation 3 weeks in to the illness. Clinically, she was in congestive cardiac failure and had features of pericardial effusion. Chest X-ray showed globular heart, and echocardiography showed severe pericardial effusion with features of tamponade. She had an emergency pericardiocentesis, and 600 mls of greenish pus was drained. The pus re-accumulated 5 days later warranting a pericardiostomy.
Gram stain of the pus smear showed gram-positive cocci in clusters, but pus cultures were negative. Pericardial tissue histology was suggestive of inflammatory changes with no evidence of tuberculosis or malignancy. Retroviral screening was negative.
The patient did very well on antibiotics and was discharged to follow up in the cardiology clinic. She came for follow up 2 weeks after discharge and had no evidence of heart failure or pericardial fluid re-accumulation.
CVD-P-05: Right-sided endocarditis secondary to prolonged intravenous cannulation: Another dark side of African practice
Godsent C. Isiguzo, Michael O. Iroezindu 1
Department of Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, 1 Department of Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
Infective endocarditis still remains a burden in sub-Saharan Africa, due mainly to varied etiologies chiefs among which are underlying rheumatic valvular heart disease and HIV infection. Another often overlooked but seen risk factor is prolonged I.V canulation. In some cases, these are unnecessary and under unhygienic conditions, predisposing the unfortunate patients to right-sided endocarditis. We present a case of tricuspid valve endocarditis secondary to prolonged I.V canulation.
The index patient was 24-year-old woman with 4 previous pregnancies, on treatment for pulmonary tuberculosis, who erroneously had a diagnosis of ectopic pregnancy following history of amenorrhea, for which laparatomy, with prolonged I.V canulation and later developed features of heart failure and echocardiography, showed massive right-sided endocarditis, but while on evaluation, she had sudden death from most likely pulmonary embolism.
We conclude that there is need to discourage prolonged intravenous access in resource-poor settings while not underplaying the need to strive for best practices. At the same time, there is need for manpower development in cardiovascular disease intervention so as to prevent such sad endings as in the case presented.
CVD-P-06: Cardiac autonomic dysfunction in sickle cell anemia and its correlation with QT parameters
Philip M. Kolo, Emmanuel O. Sanya, Timothy O. Olanrewaju, Ademola E. Fawibe, Ayodele Soladoye 1
Department of medicine, University of Ilorin, P.M.B. 1515, Ilorin Nigeria, 1 Department of Physiology, University of Ilorin, P.M.B. 1515 Ilorin Nigeria
Abnormalities of QT parameters together with cardiac autonomic neuropathy (CAN) confer significant risks of cardiac morbidity and mortality in patients with diabetes mellitus. We questioned whether or not CAN influences occurrence of QT interval prolongation and dispersion in patients with sickle cell anemia (SCA). Forty stable adult sickle cell patients with 44 healthy hemoglobin AA controls were studied. Baseline electrocardiograms were obtained, and cardiovascular autonomic function tests were performed using standard protocols. Mean corrected QT (QTc) in sickle cell patients was significantly higher (P = 0.001) than the mean of controls. Similarly, mean QT dispersion (QTcd) was higher (P = 0.001) in the former than in the latter. Mean QTc in patients with CAN was longer than patients with normal autonomic function (461 ± 26 ms versus 411 ± 23 ms), P = 0.001 (OR of 17.1, CI 3.48 to 83.71). Similarly, QTcd was higher (P = 0.001) in patients with CAN than those with normal cardiac autonomic function. Positive correlations were found between CAN with QTc and QTcd (r = 0.604, P = 0.001, r = 0.523, P = 0.001, respectively). CAN is a risk factor for abnormalities of QT parameters in SCA, and both may be harbinger for cardiac death.
INV-P-01: Knowledge, attitude, and utility of ECG among family medicine residents in Nigeria
Godsent C. Isiguzo, Michael O Iroezindu 1,
Adesua S. Muoneme 2 , Basil N. Okeahialam 2
Department of Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, 1 Department of Medicine, College of Medicine, University of Nigeria Enugu Campus, 2 Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
Background and Objective: The electrocardiogram (ECG) is a simple, readily affordable, and non-invasive tool for the evaluation of cardiac disorders. There is dearth of information on the utility of ECG in general practice in Nigeria. Our aim was to assess the knowledge, attitude, and utility of ECG among Family Medicine residents in Nigeria.
Materials and Methods: A cross-sectional evaluation was conducted between November 2011 and May 2012 in four Family Medicine training centers in Nigeria. A self-administered questionnaire was used to obtain information from the resident doctors regarding their ECG requests, preferred source of interpretation, most common ECG diagnosis, and update of ECG knowledge.
Results: Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31 and 40 years (54.7%) and were predominantly males (73.8%) and senior residents (65.6%). Fifty-four (88.3%) respondents made <5 ECG requests/week, and the most common indication was hypertension (50%). ECG interpretation was either self-reported (41%) by cardiologist (26.5%) or automated reports (21.3%). Self-reporting of ECG was commoner among senior residents (P < 0.01). Left ventricular hypertrophy was the most common ECG diagnosis (55.8%). About 69% of respondents did not update their knowledge of ECG. Most respondents (50%) reported Basic interpretation as the aspect of ECG, for which further learning was desired. Teaching ECG in updates/CME was judged the best way to improve knowledge/utility (61.1%).
Conclusions: The attitude and utility of ECG among Family Medicine residents in Nigeria is poor. Improved knowledge, attitude, and utility of ECG through curriculum revision, hands-on tutorials, and CMEs are highly recommended.
INV-P-02: Initial experience with Echocardiography at the Federal Medical Center, Umuahia, Abia State
Kelechukwu Uwanurochi 1 , Okoroafor Moses 1, Eme Offia 1 , Ogba J Ukpabi 1 , Okechukwu S. Ogah 2,3
1 Department of Medicine, Federal Medical Center, PMB 7001, Aba Road, 2 Ministry of Health, Nnamdi Azikiwe Secretariat, Ogurube Layout, PMB 7215, Umuahia, Abia State, 3 Division of Cardiology, Department of Medicine, University College Hospital, Queen Elizabeth Road, PMB 5116, Ibadan, Oyo State, Nigeria
Background and Objective: Echocardiography commenced at FMC Umuahia on 19 th November 2012 with the use of Vivid-I (General Electric Inc.) echocardiograph equipped with 2.5-5.0 MHz transducer. As at 30 June, 2013, 253 procedures have been performed. We present our initial experience with this procedure in our center. The aim of the paper is to present our initial experience with this procedure in our center and to determine the spectrum of heart diseases.
Materials and Methods: We prospectively collected data on the echocardiographic spectrum of our patients. Baseline clinical and demographic variables were also obtained. Echocardiographic examination was performed in the standard views. Data management and analysis were performed with SPSS software version 15.0.
Results: The mean age for the 253 individuals was 51.49 ± 22.00 years. There were 131 males and 122 females. The common indications for the procedure were congestive cardiac failure 22.5%, hypertensive heart disease 27.5%. The various diagnoses made include: Hypertensive heart disease (42.1%), cardiomyopathy (5.6%), valvular heart disease (6.8%), pericardial disease (7.1%), congenital heart disease (3.4%), ischemic heart disease 1.1%, right heart failure 4.9%, endomyocardial fibrosis 0.4%, and aortic aneurysm 0.4%. Normal echo was recorded in 28.2%.
Conclusions: The presence of this procedure has changed the quality of practice of cardiology in the center as many heart diseases can now be properly classified.
INV-P-03: Electrolyte and Urea profile of children on diuretic for chronic heart failure
Wilson E. Sadoh 1, Osage J. Idemudia 2, Patrick A. Ekpebe 1, Paul Aikhoriojie 2
1 Departments of Child Health and 1 Chemical Pathology, University of Benin Teaching Hospital, Benin City, Nigeria
Background and Objective: Children with congenital heart diseases (CHD) with increased pulmonary blood flow are prone to chronic heart failure (CHF). In the absence of immediate intervention, affected children are on diuretic for CHF. High ceiling diuretic may cause hypokalemia, while CHF may cause low electrolyte levels. The objective of the study is to evaluate the electrolyte profile of children on diuretic for CHF compared to children without CHF.
Materials and Methods: Consecutive children with CHD, who also had CHF and were on diuretics, were recruited for the study. The controls were age- and sex-matched children without CHD and CHF. Subjects either had hydrochlorothiazide or furosemide in combination with spironolactone. They also had captopril/enalapril and sometimes digoxin. Information on biodata was obtained. The electrolyte profiles of both subjects and controls were compared.
Results: A total of 25 subjects and 25 controls were recruited for the study. The subjects consisted of 16 (64.0%) males and 9 (36.0%) females. Their mean age was 24.1 ± 25.5 months. The mean duration of anti-failure therapy was 6.3 ± 6.2 months. The mean levels electrolytes of the subjects and controls were not significantly different, P > 0.05. There were 6 (%) subjects and 2 (%) controls with hyponatremia, P = 0.24. No subject or control had hypokalemia. Mean electrolytes values of subjects on diuretic for <6 months compared to those on therapy for ≥6 months were not significantly different, P > 0.05.
Conclusions: High ceiling diuretics combined with spironolactone prevents most electrolyte imbalances, especially hypokalemia. However, hyponatremia occurs more in children on diuretic and heart failure.
INV-P-04: Nutritional and cardiovascular profiles among children with and without congenital heart diseases in Ibadan, Nigeria
Folusho M. Balogun 1 , Samuel I. Omokhodion 2
1 Institute of Child Health, 1 Department of Pediatrics, University College Hospital/University of Ibadan, Ibadan, Nigeria
Background and Objective: Among the many adverse squeal of congenital heart disease (CHD), malnutrition stands out as one of the major concerns. This study was undertaken to compare the nutritional status, some electrocardiographic and echocardiographic parameters between children with CHD and their apparently healthy controls.
Materials and Methods: Electrocardiographic, echocardiographic, and nutritional status parameters were measured in 100 children with known CHDs and 100 age-, sex-, and social class-matched apparently healthy controls. Associations were tested using student t-test and chi-square test, while conditional regression analysis and partial correlation were used as appropriate. Level of significance was P < 0.05.
Results: There were 54 males with CHD; age range was 1-96 months. The commonest acyanotic CHD was ventricular septal defect (49%) while the commonest cyanotic CHD was Fallot's tetralogy (10%). Children with CHD significantly had lower z scores for weight for height (mean = −1.28 ± 2.01; control mean = −0.05 ± 1.70), height for age (mean = −1.67 ± 2.49; control mean = −0.41 ± 2.64), and weight for age (mean = −1.15 ± 3.50; control mean = −0.23 ± 1.00). They also had lower mid upper arm circumference, triceps, and sub-scapular skinfold thickness. The control group was 4 times likely to have normal weight for age compared with the CHD group. The CHD group also significantly had higher p wave amplitude (mean = 1.85 ± 0.96 mm; control mean = 1.46 ± 0.47 mm), QRS axis (mean = 112.63 ± 89.60°; control mean =58.40 ± 32.39°), and fractional shortening (mean = 41.94 ± 13.21 mm; control mean 37.97 ± 11.25 mm). There was no strong correlation between nutritional indices and ECG or left ventricular function parameters.
Conclusions: Malnutrition can be quite severe in children with CHD if unattended to. Early corrective intervention is necessary to prevent short-term and long-term sequela of malnutrition in these children.
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