|Year : 2014 | Volume
| Issue : 2 | Page : 164-175
|Date of Web Publication||3-Oct-2014|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Poster Presentation. Nig J Cardiol 2014;11:164-75
PP-01: Endomyocardial fibrosis in Ile-Ife, Nigeria: A report of three cases
S. A. Ogunyemi, A. O. Akintomide, R. A. Adebayo, O. E. Ajayi, A. O. Ajibare, O. A. Oketona,
M. O. Balogun
Department of Medicine, Cardiology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Background: Endomyocardial fibrosis (EMF) is a progressive restrictive cardiomyopathy which affects the right and/or the left ventricle with its attendant clinical and psychological sequelae. The specific etiology and definitive treatment are still elusive despite increasing diagnostic modalities such as Echocardiography.
Objectives: To highlight the clinical and echocardiographic features of three patients with EMF and the symptomatic management offered them.
Case Report: A case series of three male patients, all in their third decade of life, with clinical and echocardiographic diagnosis of EMF were managed conservatively at the cardiology unit of Obafemi Awolowo University Teaching Hospital Ile-Ife. Their clinical states improved with symptomatic treatment and were discharged home despite non availability of definitive treatment.
Conclusion: The prevalence of this hitherto common tropical disease had been noted to be decreasing however the few patients still presenting with EMF needs definitive care.
PP-02: Dobutamine and low dose dopamine infusion with prophylactic amiodarone use in end-stage heart failure: A case report
O. E. Ajayi, A. O. Akintomide, M. O. Balogun,
A. O. Ajibare
Department of Medicine, Cardiology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
Background: Heart failure (HF) is a chronic inflammatory disease associated with high morbidity and mortality. End stage HF has adverse prognosis compared to early stages and therefore needs specialized interventions. Inotropes can be lifesaving, especially when signs of end organ hypoperfusion occur. Dopamine and dobutamine are both proarrhythmogenic but the proarrhythmic side-effect can be counteracted by the prophylactic use of amiodarone.
Objectives: To present a case of refractory HF successfully managed in our center with inotropes.
Case Report: A 65 years old poorly controlled hypertensive with repeated hospital admissions for congestive HF who presented with features of refractory HF and cardiogenic shock. He was grossly edematous, had bilateral fine crepitations at lung bases and his blood pressure was unrecordably low. He was managed in the Intensive Care Unit with low dose dopamine (2 ug/kg/min) and dobutamine (5 ug/kg/min) infusion via a central venous line with infusion pump and upward review of doses were done accordingly. In addition, patient had continuous intravenous frusemide 200 mg over 24 h via syringe pump as well as oral amiodarone 400 mg twice daily for a week and 200 mg daily thereafter. He improved markedly over a period of 2 weeks and was weaned off the inotropes. He was later discharged home on conventional anti-failure medications.
Conclusion: The combination of low dose dopamine and dobutamine infusion is useful in patients with severe HF unresponsive to conventional oral medications. Pro-arrhythmic side effect could be prevented with the use of oral amiodarone.
PP-03: Use of inotropes in intensive care unit
Department of Nursing, Intensive Care Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
Background: Inotropes are class of drugs used in emergency cardiac care. When there is acute cardiovascular (CV) collapse, inotropes help to maintain cardiac contractility and blood pressure thereby improving cardiac output which ultimately maintains organs and tissues perfusion. They do not substitute for the treatment of the underlying cause of the sudden CV collapse rather they support the CV system while the investigation and treatment of the underlying cause is in progress failing which the victim might die out of tissue deprivation of oxygen. In order words, they are a form of pharmacological life support. Examples are epinephrine (adrenaline), norepinephrine (noradrenaline), dopamine. The outcome in the patient's clinical condition is requiring inotropes in the critical care stems from proper knowledge of the care givers involved in the management of the critically-ill patients. Knowledge on the proper use and side-effects of the inotropic drugs is the responsibility of all nursing staff involved in the critical care. Marked differences and lack of standardization have been observed in the use of inotropic agents in the treatment of critically-ill patients among a diverse group of hospitals in Nigeria. Wrong application of iontropes undoubtedly contributes to both morbidity and mortality of the patients requiring them. International guideline recommendations abound for the use of inotropes in the critically-ill patients. The variability observed indicates an urgent need to define the appropriate use of these medications. This motivated me to author a book titled - use of inotropic in Intensive Care Unit.
Objectives: The aim of the book is to provide a resource for nurses, nursing and medical students and other clinicians wishing to further their understanding of inotropic drugs use in critical care.
Materials and Methods: Control of intravascular volume, vascular tone, heart rate and myocardial contractility are a number of CV normal homeostatic mechanisms that maintain organ and tissue perfusion. Pathological conditions interfere with these mechanisms on different levels leading to impaired end-organ perfusion. Pharmacological hemodynamic intervention is aimed at restoration and maintenance of adequate oxygen delivery to vital organs through the manipulation of circulating volume, cardiac output and perfusion pressure. Inotropes have pharmacodynamic properties distinct from other drugs. Inotropes have an extremely short half-life. They have rapid onset, and rapid offset. The most popular group of inotropes - sympathomimetics, mediate their CV actions through activation of various receptor sites. At various receptor sites the efficacy and potency varies. This variability is heightened with changes in dosages. For example, adrenaline does achieve increased contractility (beta-1 receptor) but, particularly at higher doses, also stimulates the alpha receptors and cause peripheral vasoconstriction. They have desirable and undesirable effects that close monitoring of the patients is paramount with a bedside titration of the drug. Every clinician should be vigilant to guide against the undesirable effects such as tachyarrhythmia and hypertension. They are most often given by continuous infusion and at very minute dosage (mcg/kg/min) to maintain a consistent blood level of the drug that is enhanced by the use of a volume controlled device. Since inotropes have very small pharmaceutical window (easily lose effects or give adverse effects) they must be administered with care and control, including the calculations of the drugs are done with extreme accuracy to avert untoward effects.
Conclusion: An evidence-based approach to administering inotropes is necessary to optimize short- and long-term outcomes in the critically-ill patients. "Use of iontropes in Intensive Care Unit" a book that provides the best-practice guide is recommended for use by all nurses, nursing and medical students, nurse educators, and other practitioners involved in the critical care.
PP-04: Prevalence of snoring and high risk for obstructive sleep apnoea among University workers in Nigeria: Association with Cardiovascular risk factors
A. A. Akintunde, A. A. Salawu 1 , O. G. Opadijo
Departments of Medicine and 1 Chemical Pathology, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
Background: Snoring remains underdiagnosed in the general population. It however has significant morbidity and mortality risks with effect on the cardiovascular (CV) system. The Berlin questionnaire is a worldwide validated instrument to identify those at risk for obstructive sleep apnea.
Materials and Methods: Two hundred and six workers of LAUTECH were invited to participate in the study. The Berlin questionnaire was used for this study. It was a cross sectional study. Sociodemographic and clinical data were taken with a data form. SPSS 17.0 was used for statistical analysis. P < 0.05 was taken as statistically significant.
Results: The study participants consisted of 96 males (46.6%) and 110 (53.4%) females. The mean age was 45.3 7.9 years. The mean body mass index was 28.5 6.0 kg/m 2 . The frequency of occurrence of snoring was 91 (44.2%) with 50 males (54.9%) and 41 females (37.3%, P < 0.05). Using the Berlin score, 63 (30.6%) including 34 females (30.9%) was assessed to be at high risk for obstructive sleep apnea. Snorers were more likely to be at higher risk of obstructive sleep apnea compared to nonsmokers odd risk 113.8, Relative risk 3.313. Snoring was most likely to be significantly associated with obesity, elevated blood pressure and male gender in this study.
Conclusion: We concluded that snoring and high risk for sleep apnea are common among this unselected University population, and they are closely related to many conventional CV risk factors. Appropriate interventional strategies are indicated to reduce the burden of the increased morbidity and mortality associated with sleep apnea in our population.
PP-05: Challenges of managing ventricular tachycardia-storm in a multidisciplinary intensive care unit
V. M. Uhegbu, C. U. Onwurah, V. Okeke, H. Osim,
C. Akpan, E. Chukwudike, V. O. Ansa, C. Odigwe
Department of Medicine, Cardiology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
Background: Ventricular tachycardia (VT) storm represents 3 or more episodes of VT over 24 h, the tachycardia may become incessant. Haemodynamic compromise, ventricular fibrillation and sudden cardiac death occur. Care in a specialized cardiac Intensive Care Unit (ICU) is recommended.
Objectives: To highlight the challenges of managing VT in a multi-disciplinary ICU; a case report is presented.
Case Report: A 67-year-old male presented at the emergency room with a few hours history of palpitations, chest pain, shortness of breath and altered sensorium with history of recurrent palpitations. Not hypertensive or diabetic. His pulse was 200 beats/min, regular and small volume, blood pressure (BP) 90/60 mmHg and respiratory rate of 32 cycles/min. electrocardiogram showed polymorphic VT. He developed cardiac arrest before treatment could be commenced. He was resuscitated with CPR but VT persisted and chemical cardioversion was initiated using IV lidocaine with subsequent reversal to normal sinus rhythm and stabilization of the BP. Following the initial resuscitative measures, he had several episodes of VT and was transferred to the ICU where a continuous infusion of lidocaine was commenced with bolus doses given PRN. Electrical cardioversion was not accessible and alternative medications for cardioversion were not available. Improvement was sustained and oral Amiodarone was introduced and lidocaine infusion tapered off. He remained arrhythmia free and clinically stable and was referred for coronary angiography.
Conclusion: In view of the conflicting interests in managing cases in a multidisciplinary ICU there is urgent need to have dedicated cardiac ICU headed by the cardiologists.
PP-06: Nocturnal non dipping blood pressure profile in normotensives predicts cardiac target organ damage
Godsent Isiguzo 1 , Geofery Nwuruku 1 , Dainia Baugh 1],[2 , Ernest Madu 1],[2
1 Department of Medicine, DOCS Heart Center, Enugu State, Nigeria, 2 Heart Institute of the Caribbean, Kingston, Jamaica
Background: Non-dipping pattern of nocturnal blood pressure (BP) has been identified as a key predictor of cardiac target organ damage among hypertensives. The significance of the absence of nocturnal dipping in individuals with normal BP is uncertain. We studied a group of unselected patients with normal BP to determine if the absence of nocturnal dip in BP is associated with objective evidence of cardiovascular (CV) target organ damage.
Materials and Methods: Our study population consisted of normotensives patients without documented coronary artery disease who were seen at Hearth Institute of Caribbean Kingston Jamaica in 2013. After giving consent for the study, biodata were obtained, and cohort's weight and height were measured; then using an oscillometric BP device, GE Dinamap ProCare 400 Monitor, office BP (OBP) was taken in both arms in sitting a position, and patient's BP recorded as the one with higher reading. ABP was then checked for a minimum of 24 h using GE Tonoport V (GE CS V6 71) on each cohort, followed by two-dimensional echocardiogram and Doppler imaging in accordance with American Society of Echocardiography protocol. ABP data was analyzed with GE CardioSoft software and interpreted following the British medical council guideline, and all the data analyzed with Epi Info 3.5.3.
Results: The mean age of the cohort was 52 15 years; females were 27/40 (67.5%). There were no statistically significant differences between the groups with respect to age, gender, weight, height, body mass index, OBP or clinical profiles. There was statistically significant difference in sleeping BP between dippers and nondippers, 112 7/64 2 mmHg versus 117 3/69 2 mmHg (P - 0.004). Non-dipping cohort showed more CV target damage as shown in the [Table 1], and left ventricular geometry among cohorts with nondipping pattern also showed more likelihood of concentric remodeling, concentric hypertrophy and eccentric hypertrophy.
Conclusion: Non-dipping BP pattern was predictive of CV target organ damage among this cohort of normotensives, similar to what has already been established in hypertensives. Nocturnal nondipping of BP may be an early marker of subsequent hypertension and may identify those individuals at risk for future target organ damage for whom closer observation may be warranted.
PP-07: Left atrial myxoma: An institutional experience
Adiuku-Brown Uzodinma, Aghaji Mac
Cardiac Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
Introduction: Left atrial myxomas are thought to be rare tumors. It is frequently misdiagnosed, and its symptoms missed. It manifests with obstructive, embolic and constitutional symptoms. Surgical excision is the only definitive management.
Materials and Methods: A retrospective review of left atrial myxomas seen managed at the University of Nigeria teaching Hospital Enugu from 1992 to 2014. The presentation, operative details and management, outcomes and follow up were reported.
Results: Five patients with left atrial myxomas were seen during the period. One patient with severe symptoms died before surgery was done. The other four patients had surgical excision. All the patients were symptomatic at presentation. Symptoms suggestive of mitral valve obstruction was common. Diagnosis was by echocardiography. All four underwent excision through a median sternotomy with cardiopulmonary bypass. In all cases, the tumor was attached to the interatrial septum. There was no incident of intra-operative embolization or early operative mortality. On the follow-up, with a duration ranging from 3 months to 19 years there was remarkable clinical improvement and complete relief of symptoms. There has been no recurrence so far.
Conclusion: We conclude that patients who undergo complete excision of left atrial myxomas now have an excellent prognosis, with minimal risk of the intraoperative embolization and late recurrence. We also conclude that for diagnosis, a high index of suspicion must be maintained in the event of syncope, embolic phenomena and other cardiovascular symptoms in a patient without a previous history of cardiac disease.
PP-08: "Left ventricular dysfunction in type 2 diabetics without overt cardiac symptoms"
Ganiyu A. Amusa, Solomon S. Danbauchi,
Basil N. Okeahialam
Department of Internal Medicine, Jos University Teaching Hospital, Jos Plateau State, Nigeria
Mode of Presentation: Poster
Background: Diabetes mellitus (DM) is approaching epidemic proportions in Africa. It is a chronic disease with a high rate of cardiovascular (CV) morbidity and mortality. Significant myocardial injury before overt CV disease in patients with diabetes can be identified early using echocardiography thereby promoting early intervention.
Objectives: This study was aimed at evaluating left ventricular dysfunction and associated factors in patients with type 2 DM (T2DM) without overt cardiac symptoms.
Materials and Methods: One hundred adults with type 2 diabetes (50 with diabetes and hypertension) were recruited with 100 age and sex-matched controls (50 with hypertension). Those with overt cardiac symptoms and diseases which may affect cardiac function were excluded. Participants were evaluated clinically; biochemical workup and electrocardiograms were also obtained. Echocardiograms were obtained according to the American Society of Echocardiography recommendations.
Results: The prevalence of left ventricular dysfunction in the subjects was 47.0% as compared to 22.0% in the control group (χ2 = 13.829, P < 0.001). It was 56.0% in diabetes with hypertension and 38.0% in the diabetes only sub-groups (χ2 = 6.503, P = 0.011). Left ventricular dysfunction was found to be predominantly diastolic in the subjects, but it tended to be worse in the hypertensive diabetic.
The factors associated with left ventricular dysfunction in the diabetes group were found to be the duration of diabetes, fasting plasma glucose and left atrial diameter. It was additionally found to be the duration of hypertension in the diabetes with hypertension sub-group. Fasting blood sugar and the duration of diabetes were found to be significant correlates of left ventricular systolic function parameters (ejection fraction and fractional shortening) in the subject groups.
Conclusion: There is a high prevalence of left ventricular dysfunction in patients with T2DM without overt cardiac symptoms. This suggests early cardiac involvement and hypertension was found to worsen this. It is suggested that cardiac assessment using echocardiography should be part of routine evaluation of patients with DM.
PP-09: First prosthetic mitral valve replacement in Nigeria - 26 years follow up and challenges
A. V. Okwulehie, M. A. C. Aghaji
Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
Objectives: To report the challenges encountered during the long term follow of the first patient to receive a mechanical prosthetic mitral valve in Nigeria.
Methodology: Case report and literature review.
Background: In Nigeria, mitral valve disease is usually a sequela of rheumatic heart disease and usually affects the younger age group. Many patients do not seek medical treatment mainly because of poverty and ignorance. Patients that are affluent or have sponsorship usually travel abroad for surgical treatment. Prior to 1986, the only surgical treatment offered to patients with this condition in our center was closed mitral commissurotomy-for patients with mitral valve stenosis - without regurgitation. We present the first case of mitral valve replacement in Nigeria and discuss the challenges we encountered in the course of managing her from 16 th December 1986-2012 - after which she was lost to follow up.
Case Report: On December 16, 1986, the first prosthetic mitral valve replacement was carried out in Nigeria on a 17-year-old girl. She had rheumatic mitral valve disease with grade 4 mitral regurgitation, pulmonary hypertension and heart failure. She was in New York Heart Association class 11. The mitral valve was replaced with a size 29 Starr-Edwards valve. The aortic cross clamp time was 62 min and bypass time was 2 h 7 min. She was in the Intensive Care Unit for 5 days and spent a total of 17 days in the hospital. She was anticoagulated with warfarin. Subsequently, she got married and had a baby. Her second pregnancy was unsuccessful.
Conclusion: Rheumatic valvular heart disease is prevalent in our society and most patients will present with advanced disease. Often, there is extensive destruction and calcification of the valves and we are usually compelled to use mechanical valves for replacement-because of the issue of longevity of the implanted valve. Patients that undergo valve repair or tissue valve replacement will ultimately require reoperations. The use of mechanical valves obviates the need for reoperations which many of these patients cannot afford. Patients can be managed on anticoagulant therapy for a long time in this sub region-and the females can manage pregnancy-using our protocol. Re-operations that come with implantation of tissue valves are not feasible or affordable.
PP-10: Economic burden of heart failure: Investigating outpatient and inpatient costs in Abeokuta, southwest Nigeria
Okechukwu S. Ogah 1],[2 , Simon Stewart 2],[3 , Obinna E. Onwujekwe 4 , Ayodele O. Falase 1 , Saheed Adebayo 5 , Taiwo Olunuga 5 , Karen Sliwa 2],[6
1 Department of Medicine, Division of cardiology, University College Hospital, PMB 5116, Ibadan, Nigeria, 2 Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 3Q05, Parktown, 2193, Johannesburg, 6 Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Private Bag X3, Observatory 7935 Cape Town, South Africa, 4 Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, 5 Department of Medicine, Federal Medical Centre, PMB 3031, Abeokuta, Nigeria, 3 NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
Mode of Presentation: Poster
Background: Heart failure (HF) is a deadly, disabling and often costly syndrome world-wide. Unfortunately, there is a paucity of data describing its economic impact in sub-Saharan Africa; a region in which the number of relatively younger cases will inevitably rise.
Objectives: The aim of the study is therefore to determine the consumption of medical resources for the treatment of HF in Abeokuta, Nigeria and to estimate the healthcare cost. Estimation of the economic impact of HF in the city will provide information for health care policy formulation for informed decision and ensure efficient use of resources.
Materials and Methods: Heath economic data were extracted from a prospective HF registry in a tertiary hospital situated in Abeokuta, southwest Nigeria. Outpatient and inpatient costs were computed from a cohort of 239 HF cases including personnel, diagnostic and treatment resources used for their management over a 12-month period. Indirect costs were also calculated. The annual cost per person were then calculated and then extrapolated to the region (as an annual cost).
Results: Mean age of the cohort was 58.0 15.1 years and 53.1% were men. The total computed cost of care of HF in Abeokuta was 76, 288,845 Naira (US$508, 595) translating to 319,200 Naira (US$2,128 US Dollars) per patient per year. Inpatient and out-patient care contributed 46% and 54% of the total cost respectively. The high cost of outpatient care was largely due to cost of transportation for monthly follow up visits. Payments were mostly made through out-of-pocket spending.
Conclusion: The economic burden of HF in the study setting is high considering the minimum wage of 18,000 Naira (120 US dollars) per month in the country. This calls for financing reforms for the control of the disease, which may include a reduction or waiver of user fees in government hospitals, scaling up of financial risk protection pre-payment mechanisms such as health insurance and use of primary healthcare centers for follow-up visits for mild cases. The development and adequate funding of community HF care programs in the country is also a possible panacea.
PP-11: Contemporary profile of acute heart failure in Southern Nigeria: Data from the Abeokuta heart failure clinical registry
Okechukwu S. Ogah 1],[2 , Simon Stewart 3 , Ayodele O. Falase 1 , Joshua O. Akinyemi 4 , Gail D. Adegbite 5 , Albert A. Alabi 5 ,
T. O. Olunuga 6 , Akinlolu A. Ajani 6 ,
Julius O. Adesina, 6 Amina Durodola 6 , Karen Sliwa 2],[7
1 Department of Medicine, Division of Cardiology, University College Hospital, PMB 5116, Ibadan, Nigeria, 2 Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 3Q05, 7 York Road, Parktown, 2193, Johannesburg, South Africa, 3 NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia, 4 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, 5 Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, 6 Department of Medicine, Federal Medical Centre, PMB 3031, Abeokuta, Nigeria, 7 Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Private Bag X3, Observatory 7935 Cape Town, South Africa
Mode of Presentation: Poster
Background: There is limited data on the current burden and characteristics of acute heart failure (AHF) in Nigerian Africans.
Objectives: This study sought to determine the contemporary profile, clinical characteristics and intra-hospital outcome of AHF in an African urban community.
Materials and Methods: We prospectively collected comprehensive and detailed clinical and socio-demographic data from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population 3.2 million) over a 2 year period.
Results: Mean age was 56.6 15.3 years (57.3 13.4 for men, 55.7 17.1 for women) and 204 (45.1%) were women. Overall, 415 (91.8%) subjects presented with de novo AHF. The most common risk factor for HF was hypertension (pre-existing in 64.3% of cases). Type 2 diabetes mellitus was present in 41 (10.0%). Hypertensive HF was the commonest etiological cause of HF being responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor-pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%) and ischemic heart disease were less common (0.4%) causes. The majority (71.2%) of subjects presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9% 9.0%) with valvular dysfunction and abnormal LV geometry frequently documented. Mean duration of hospital stay was 11.4 9.1 days and intra-hospital mortality was 3.8%.
Conclusions: Compared to high income countries, individuals presenting with AHF in Abeokuta, Nigeria are relatively younger and still of a working age. It is also commoner in men and associated with severe symptoms because of late presentation. Intra-hospital mortality is similar to other parts of the world.
PP-12: Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach
Ikechi G. Okpechi,
Innocent I. Chukwuonye 1 , Nicki Tiffin 2 , Okechukwu O. Madukwe 3 , Ugochukwu U. Onyeonoro 4 , Theophilus I. Umeizudike 5 , Okechukwu S. Ogah 5],[6
Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, 2 South African National Bioinformatics Institute/MRC Unit for Bioinformatics Capacity Development, University of the Western Cape, Cape Town, South Africa, 1 Department of Medicine, Division of Nephrology, Federal Medical Centre, 3 Ministry of Health, Nnamdi Azikiwe Secretariat, PMB 7215, 4 Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, 5 Department of Medicine, Nephrology Unit, Lagos State University Teaching Hospital, Ikeja Lagos, 6 Department of Medicine, Division of Cardiovascular Medicine, University College Hospital, PMB 5116, Dugbe GPO, Ibadan, Oyo State, Nigeria
Mode of Presentation: Poster
Background: Developing countries of sub-Saharan Africa face a double burden of non-communicable diseases (NCDs) and communicable diseases.
Objectives: As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria.
Materials and Methods: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a population-based cross-sectional survey in Abia State, Nigeria from August 2011 to March 2012. Data collected at various steps included: Demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3).
Results: Of the 2983 subjects with complete data for analysis, 52.1% were females, and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (P < 0.05); while low income, lack of any formal education and use of smokeless tobacco were seen more frequently in rural dwellers than in those living in urban areas (P < 0.05). The frequency of selected CV risk factors increased as BP was graded from optimal, normal to hypertension; and high BP correlated with age, gender, smokeless tobacco, overweight or obesity, annual income and level of education.
Conclusion: Given the high prevalence of hypertension in this part of Nigeria, there is an urgent need to focus on the reduction of preventable CV risk factors we have observed to be associated with hypertension, in order to effectively reduce the burden of NCDs in Africa.
PP-13: Forty successful open heart surgeries at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu: The theatre nurse's perspective
I. I. Obi-Okonkwo, V. Ngoka, A. Azih,
N. B. Okonkwo, C. O. Nwodoh
Department of Nursing Services, Nursing Services Division, Cardiothoracic Theatre, National Cardiothoracic Centre of Excellence, University of Nigeria Teaching Hospital, Enugu, Nigeria
Background: Open heart surgery was first done in 1974 at the University of Nigeria Teaching Hospital (UNTH) then in Enugu urban. It was the first of its kind not only in Nigeria but in the entire sub-Saharan Africa except South Africa. Following that, open heart surgery continued in the Institution hence the designation of UNTH as National Centre of Excellence for Cardiothoracic Surgery in 1986 by the Federal Government of Nigeria. Open heart surgery continued routinely at the Centre with a few years interruption caused by the re-location of the UNTH to her permanent site. With the support of the University of Nigeria and friends of the UNTH (VOOM Foundation in the USA and Save-a-Heart Nigeria in the United Kingdom, open heart operation resumed in March, 2013 and has continued regularly since then.
Objectives: The reason for this presentation is to describe a series of open heart cases carried out at the National Cardiothoracic Centre of Excellence from March, 2013 to March, 2014.
Materials and Methods: Records of patients that under-went open heart operations from March, 2013 to March, 2014 were obtained from the NCTCE by personal the Authors who personally participated.
Results: We present 40 successful open heart surgeries done in one year between March, 2013 and March, 2014. Mitral valve replacement ranked highest in the open heart surgeries - 14 (35%); Aortic valve replacement, double valve replacement and excision of Atrial Myxoma had same occurrence 4 (10%). Atrial septal defect (ASD), Mitral valve repair and tricuspid valve repair occurred 3 times each (7.5%). Ventricular septal defect, tetralogy of Fallot (TOF) and repair of sinus of Valsalva occurred 2 times each (5%) while intra-cardiac repair, BT-shunt and coronary artery bypass graft occurred only once each (2.5%).
The 40 successful surgeries were managed post-operatively in our ultra-modern six bedded cardiac Intensive Care Unit, three bedded step down before going back to their various wards and from the wards to their homes. Follow up on these patients' shows that most of them are doing well and keeping to their treatment regimen.
Conclusion: This number of successful open heart surgery is to the best of our knowledge the highest number done, currently, in Nigeria within the period of study. The high level of success attained was as a result of the Team work and spirit exhibited by the entire members of the cardiac team. The highly skilled cardiothoracic theatre nurses worked closely with the surgeons and other members of the team.
Recommendation: There is need for more Centers to toe the line of the UNTH NCTCE to enable the country meet the needs of Nigerians who have surgically-remediable cardiac ailments and curtail the current medical tourism to other countries.
PP-14: Open heart surgery in patients of Jehovah's witnesses group: The University of Nigeria Teaching Hospital experience
C. Adiuku-Brown Uzodinma, M. A. C. Aghaji
Department of Nursing Services, Cardiac Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
Introduction: The conduct of open heart surgery is associated with frequent use of autologous blood products. The operative management of patients who are Jehovah's Witnesses poses severe challenges to open heart surgery as belief precludes the use of blood products. This article aims to review our experience in the University of Nigeria Teaching Hospital Enugu and compare it with the existing literature on the subject.
Materials and Methods: A retrospective search was made in the database of cardiac service of the University of Nigeria Teaching Hospital Enugu for JW patients who had undergone open heart surgery from 1994 until date. The patient demographics, pathologies, modifications to bypass protocol and operative course and hematological results were reviewed.
Results: Three JW patients had undergone open heart surgery in the period in review. Two had closure of atrial septal defects (one of which was associated with pulmonary stenosis) - these two were elective cases-with normal hemoglobin levels at presentation and we had time to build the HB even higher with hematinic before open heart surgery. The third patient was admitted as an emergency-with obstructive, huge left atrial myxoma. Her hemoglobin before surgery was 8.2 g. All of them had successful open heart surgery and complete resection of left atrial tumors. The patients have been followed up for 3 months to 20 years. There has so far been no late mortality. Techniques employed included pre-operative blood donation in one patient, generous use of hematinic drugs and erythropoietin, the use of a cell saver and meticulous hemostatic techniques. Restricted use of crystalloids and acceptance of the most basic blood pressure level/urine output during the Intensive Care Unit care-are pivotal to the success-especially in the third anemic case. Other techniques are also discussed.
Conclusion: Application of current techniques have improved the safety profile of open heart surgery in Jehovah's Witness patients. Even when they are anemic, open heart surgery can be done safely without blood transfusion. Outcomes for this category of patients in our service have been excellent.
PP-15: Overview of 40 successful open heart surgical cases done at the University of Nigeria Teaching Hospital Enugu in 12 months-recommendations for the future
I. I. Obi-Okonkwo, V. Ngoka, A. Azih,
N. B. Okonkwo, C. O. Nwodoh
Deaprtment of Nursing Services, Nursing Services Division, Cardiothoracic Theatre, National Cardiothoracic Centre of Excellence University of Nigeria Teaching Hospital, Enugu, Nigeria
Background: Open heart surgery in Sub-Saharan Africa, was first done in 1974 at the University of Nigeria Teaching Hospital Enugu. Coming barely 20 years after the first open heart surgery done in the world in the early 1950s in the USA, the operation of 1974 was iconic and innovative. The operation propelled the center into an era of unique and advanced cardiovascular (CV) services in the sub region-prompting appropriate budgeting to upgrade the facilities and appropriate training of manpower in the sector. The impact of the CV services available routinely at the center, prompted the Federal Government of Nigeria - to designate the center as the National Center of Excellence for Nigeria in 1986. Following this, the center carried out the first prosthetic mitral valve implantation in Nigeria-on December 17, 1986, first prosthetic aortic valve replacement on March 9, 1987, first total correction of tetralogy of Fallot (TOF) in 1992, first resection of left atrial tumor in 1995, first double valve replacement-aortic and mitral valve replacements in a patient in 1994, first mitral valve re-replacement-after a failed biologic mitral valve prosthesis in 1992 and so on. Unfortunately, because of the movement of the center to the new University of Nigeria Teaching Hospital (UNTH) site-some 18 km from Enugu town, the cardiac center remained closed for about 8 years-reopening just last year.
Materials and Methods: We present 40 successful open heart surgeries done in 1 year between March 2013 and March 2014.
Mitral valve replacement ranked highest in the open heart surgeries14 (35%); Aortic valve replacement, double valve replacement and excision of Myxoma had same occurrence 4 (10%). atrial septal defect, Mitral valve repair and tricuspid valve repair occurred 3 times each(7.5%). Ventricular septal defect, TOF and repair of sinus of valsava occurred 2times each (5%) while intracardiac repair, BT-shunt and coronary artery bypass graft occurred only once each (2.5%). The 40 successful surgeries were nursed post operatively in our ultra-modern six bedded cardiac Intensive Care Unit, three bedded step down before going back to their various wards and from the wards to their homes. Follow up on these patients shows that most of them are doing well and keeping to their treatment regimen. The two foundations-The VOOM foundation and save a heart Nigeria-we work with continue to show an unbelievable commitment to the program. They bring in consumables like prosthetic heart valves, pacemakers, grafts and cardiac drugs - almost free of charge. The result is that the cost of open heart surgery in UNTH - remains the lowest in the world.
Conclusion: The success would indicate that: Complex cases of CV diseases can be handled safely in Nigeria. The local cardiac team is able to handle emergency heart operations and straightforward cases-while the complex cases are reserved for the quarterly visitors. Looking after the cardiac cases-have impacted positively on the health care delivery of the hospital - serious non-cardiac cases- e.g. trauma cases, patients in septic shock, multiple injured patients, have better chances of surviving at UNTH - since the facilities for ventilation and critical care are freely available and practiced. The Federal government should increase the output-by paying for 200 cases of open heart operations at UNTH per year - while our collaborating Foundations are still with us and helping us peg the cost of open heart operations at 1 million naira for adults and 500,000 naira for children. The Federal government should audit the program-and increase the number to 400 cases a year-within the next year or two. The federal Government should fast track the establishment of universal health care coverage for all Nigerians-to include cardiac care and renal replacement therapy.
PP-16: Pattern of cardiac diseases and diagnostic utility of transthoracic echocardiography in Delta State, Nigeria
E. M. Umuerri 1 , Aigbe F. I. 1 , H. O. Aiwuyo 1 ,
A. O. Obasohan 1],[2
1 Department of Medicine, Delta State University Teaching Hospital, Oghara, 2 Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
Background: Transthoracic echocardiography is a noninvasive tool used to assess cardiac structure and function. Information obtained can guide patient management.
Objectives: To describe cardiac anomalies encountered and the usefulness of transthoracic echocardiography in Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria.
Materials and Methods: Seven hundred and one consecutive echocardiograms of subjects aged 18years and above performed between August 2011 and April 2014 at the echocardiographic laboratory in DELSUTH using Toshiba Xario ultrasound machine were reviewed. 104 reports were excluded due to incomplete data. The data obtained was analyzed for age, sex, clinical indication and echocardiographic findings.
Results: Five hundred and ninety seven echocardiogram reports were reviewed comprising of 343 males (57.5%). The age range was 18-90years (mean = 54.2 16.6 years). The commonest indication for echocardiography was hypertension 289 (48.4%). Others were noncardiac preoperative evaluation 77 (12.9%), chest pain 49 (8.2%), dilated cardiomyopathy (DCM) 37 (6.2%), congestive cardiac failure 33 (5.5%), rheumatic heart disease (RHD) 32 (5.4%), routine medical examination 28 (4.7%) and chronic kidney disease 20 (3.4%). Hypertensive heart disease (HHD) 274 (45.9%) was the commonest echocardiographic diagnosis. Others were DCM 48 (8.0%), RHD 43 (7.2%), cor-pulmonale 18 (3.0%), pericardial diseases 4 (0.7%) and ischemic heart disease 2 (0.3%). Out of the 205 (34.3%) subjects with normal study, 75 were hypertensive. The sensitivity and specificity of clinical diagnosis of HHD, RHD and DCM were 65.4%, 59.4% and 43.2% respectively and 81.5%, 95.8% and 91.4% respectively.
Conclusion: This study reaffirms HHD as the commonest cardiac abnormality among adults in Nigeria. Echocardiography should be an integral part of clinical practice because of its usefulness. Keywords: Echocardiography, Cardiovascular Disease, Nigeria
PP-17: Profile of adult patients evaluated for open heart surgery at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu
B. C. Anisiuba, E. C. Ejim, B. J. C. Onwubere,
P. O. Njoku, R. Anakwue
Department of Medicine, UNTH, Ituku-Ozalla, Enugu, Nigeria
Background: Open heart surgery (OHS) resumed in UNTH about 18 months ago after a few years of inactivity occasioned by the movement to a permanent site. The Cardiology Unit uses a standard protocol to evaluate and recommend patients for OHS.
Objectives: The study aims to review the data and gathered during the preoperative evaluation of adult patients in order to identify the profile of these patients as well as the indications for OHS in UNTH.
Materials and Methods: Data were collected from the medical and echocardiographic records of the patients seen initially by the Cardiology unit, UNTH and who accepted to have OHS. Pediatric patients and patients who were recruited during the period of OHS missions were not included. SPSS version 19 was used for collection and analysis of data.
Results: The data of 43 adult patients were readily available. 21 (48.8%) were males and 22 (51.2%) were females. The majority of the patients (62.8%) had valvular heart disease, mainly rheumatic (mitral regurgitation 34.9%, mitral stenosis 2.3%, aortic valve disease plus either MR or MS 25.61%. Ventricular septal defect was seen in 2 patients (4.7%) while ASD was seen in 5 (11.6%). Atrial tumor was seen 4 patients (9.3%), aortic arch anomalies in 2 (4.7%), coronary artery stenosis in 1 (2.3%) and ruptured sinus of Valsalva aneurysm in 2 (4.7%).
Conclusion: Mitral valve disease constituted the majority of the adult patients presenting at UNTH Enugu for OHS. Rare conditions such as cardiac tumors and ruptured sinus of Valsalva aneurysm were seen also.
PP-18: Femoral vascular access in children-new challenges and best practices-case report and literature review
O. Orakwe, M. Aghaji
Cardiothoracic Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
Background: Arterial cannulation is usually undertaken to facilitate easy blood sampling for required diagnostic investigations and to monitor blood pressure and hemodynamic stability. This may be accomplished through the insertion of indwelling umbilical arterial catheters soon after birth or if unsuccessful, the alternative placement of peripheral arterial lines. The procedure can be associated with serious complications such as vasospasm, thrombosis, embolism, hematoma, infection, peripheral nerve injury, ischemia and tissue necrosis. The profunda femoris artery is poorly developed in about 30% of the population. The risk of ischemic necrosis to the anatomic region is higher in such individual when there is an injury to the superficial femoral artery because of the poorly developed collaterals.
Objectives: To highlight the risks associated with vascular access using the femoral vessels in pediatric patients - for intravenous infusions, blood sampling and placement of central venous lines - and arterial cannulation for pressure monitoring, arterial blood sampling and access for left heart catheterization.
Materials and Methods: Case report and literature review.
Case Report: A full term infant presented with gangrene of the left lower limb extending from the distal half of the thigh to the toes following an injury to the superficial femoral artery. There was a repeated attempt at blood sampling through the left femoral vein. His pregnancy and delivery were uneventful. He later had an above knee amputation.
Conclusion: Risks associated with femoral artery cannulation in children can be minimized by using small sized needles or alternatively using more accessible peripheral vessels. Femoral puncture should be the last resort for vascular access in children- and the procedure needs to be supervised by a senior medical officer who understands the risks associated with the procedure.
PP-19: Serum uric acid and target organ damage in essential hypertension
S. N. Ofori, O. J. Odia
Department of Medicine, Cardiology Unit, University of Port Harcourt, Rivers State, Nigeria
Background: Hypertension is a major risk factor for cardiovascular (CV) mortality. Hyperuricemia increases CV risk in patients with hypertension.
Objectives: to assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy [LVH] and microalbuminuria) in untreated patients with essential hypertension.
Materials and Methods: A cross-sectional study was carried out in one hundred and thirty (85 females, 45 males) newly diagnosed untreated patients with essential hypertension. Sixty-five healthy age and sex matched non-hypertensive individuals served as controls for comparison. LVH was evaluated by cardiac ultrasound scan and microalbuminuria was assessed in an early morning mid-stream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels.
Results: Hyperuricemia was present in 46.9% and 16.9% of cases and controls respectively (P < 0.001). Mean serum uric acid was significantly higher among the patients with hypertension (379.7 109.2 ΅mol/l) compared to controls (296.9 89.8 ΅mol/l; P < 0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P = 0.001). Similarly LVH was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, P = 0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none vs. one vs. two: P = 0.012).
Conclusion: These results indicate that serum uric acid is associated with target organ damage in patients with hypertension even at the time of diagnosis, thus is a reliable marker of CV damage in our patient population.
PP-20: Clinical indices of open heart surgery patients in university of Nigeria Teaching Hospital, Enugu
Ezinne O. Nwosu, Rita N. Ativie, Chinwe P. Obiekwe, Emmanuel C. Chima, Maranatha N. Anudu
University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
Background: Preoperative assessment of patients undergoing open heart surgery has assumed an important position in determining postoperative morbidity and mortality. This is because it reveals abnormalities that may impact on postoperative outcome. In addition, reversible abnormalities can be corrected following preoperative assessment.
Objectives: To assess the clinical outcome of open heart surgery patients with a view to improving rehabilitation after surgery.
Materials and Methods: Case notes of 20 patients who had open heart surgeries between March 2013 and March 2014 were reviewed. Preoperative assessment parameters were age, body mass index (BMI), 6 min walk distance (6MWD), estimated V02 max, metabolic equivalent of task (MET). Postoperative end point measures assessed were length of mechanical ventilation, the oxygen discontinuation time, commencement of stair climbing and length of hospital stay.
Results: Of the 20 patients reviewed, 50% were males while 50% were females. Their mean age was 42 16.2, mean BMI 23.8 5.6. The median of Goldman physical activity was class 2.6 0.5. While the mean 6MWD was 1201 504, mean eVO2 max was 10.6 5, and mean MET 2.9 1. In the postop period the mean Length of ventilation was 10.7 4.5 h, oxygen discontinuation time was 4.3 2.2 days. First day of stair climbing was at a mean of 5.5 2.3 days and length of hospital stay at mean of 11 4.0 days.
Conclusion: This survey showed that our patients had low MET that resulted to longer need for postop supplemental oxygen and longer hospital stay. Pre-operative and post-operative physiotherapy intervention is recommended to shorten these periods.
PP-21: Nonsurgical bleeding after open heart surgery: Management and challenges
I. A. Nwafor, J. C. Eze, N. Ezemba, C. H. Anyanwu, M. N. Nwafor, Okpala, O. C. Nzewi
Department of Surgery, Division of Cardiothoracic Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
Background: Excessive nonsurgical bleeding after open heart surgery is associated with adverse outcomes in other centers including ours, hence a study of the causes, evaluation methods, prevention and treatment strategies is justified.
Objectives: To highlight that nonsurgical bleeding after open heart surgery is not uncommon and poses adverse effects to patients.
Materials and Methods: From March, 2013 to March 2014 (about a year period), Foreign Medical Missions (US and UK) partnered with NCTCE, UNTH, Enugu open heart program. During this period about 37 cases were done with 6 mortalities, some of which were due to excessive nonsurgical bleeding postoperatively. These cases were documented and subsequently analyzed to determine the causes, evaluation procedures, prevention and treatment modalities.
Results: For the year period, a total of 37 cases were done for indications ranging from valve replacement (aortic and mitral) to intracardiac repair for ventricular septal defect, atrial septal defect, TOF including ruptured sinus of Valsava aneurysm and coronary artery bypass graft. 6 (16.2%) mortalities were recorded. There were about 7 (18.9) cases of excessive postoperative bleeding. 3 (42.9%) were attributed to surgery while 4 (57.1) were due to coagulopathy. Of this, 2 (50%) died.
Conclusion: Excessive bleeding in the postperfusion period is not uncommon. The relative importance attributed to inadequate heparin neutralization, thrombocytopaenia, alteration of blood clotting factors and fibrinolysis has varied in different studies. A preoperative assessment that identifies and corrects deficiencies in clotting factors, platelet counts and function, hematocrit and blood volume can substantially reduce the risk of nonsurgical bleeding after open heart surgery.
PP-22: Common civilian vascular injuries in South-Eastern Nigeria: Pattern of presentation and outcome of management
I. A. Nwafor, J. C. Eze, N. Ezemba, C. H. Anyanwu, C. Ngene
Department of Surgery, National cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
Background: The exact incidence of common civilian vascular injuries in Nigeria, especially southeastern Nigeria is unknown on account of under-reporting and uncoordinated management of victims.
Objectives: To determine the pattern and outcome of management of common civilian vascular injuries over a 7-year period in our institution.
Materials and Methods: From January 2007 to December, 2013, all recorded common civilian vascular injuries presenting at our Accident and Emergency and those referred to the outpatient clinics were retrieved and subsequently analyzed.
Results: The age range of 12-75 years were recorded for the total of 26 patients (-^ 4 patients/year). In this spectrum, age range of 21-30 years (19.2%) was the highest while the age range of 61-70 years (0%) and 71-80 years (3.9%) were the lowest. Only a female (3.9%) and 25 males (96.1%) were recorded. In the upper extremity, axillary 1 (3.9%), brachial 6 (23.1%) and radial 3 (11.5%) arteries were affected. In the lower extremity, the femoral 9 (34.6%), popliteal 3 (11.5%) and dorsalis pedis 1 (3.9%) arteries were involved. The pattern of presentation and referral included bleeding at the sites of the injury, usually tied with either bandage or pieces of cloth, hemorrhagic shock, limb ischemia characterized by 6Ps(pain, pulselessness, paraesthesia, paralysis, pallor and poikilothermia, traumatic aneurysm and arteriovenous fistula.
Conclusion: All peripheral and some central vessels are at varying degrees of risk of injury and victims that presented received attention. However, some of the initial attending medical personnel failed to recognize vascular injuries especially in the face of other associated injuries.
PP-23: Masked hypertension in an urban Nigerian community: Result of a pilot study
Augustine N. Odili 1],[2 , Bolaji S. Abdullahi 2 ,
John O. Ogedengbe 3
1 Department of Internal Medicine, College of Health Sciences, University of Abuja, 3 Department of Human Physiology, College of Health Sciences, University of Abuja, Abuja, 2 Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
Background: Outcome studies among populations of different ethnicities have indicated that cardiovascular risk gradually increases from normotension over white coat hypertension (WCH) and masked hypertension (MH) to sustained hypertension. Until now, available data on hypertension from different regions of Nigeria are based on conventional office blood pressure (BP).
Objectives: To determine the prevalence and clinical characteristics of MH in a multi-ethnic urban Nigerian Community.
Materials and Methods: Under the framework of the ongoing Nigerian Population Research on Environment, Gene and Health, BP readings measured five consecutive times with the mercury sphygmomanometer by trained observers were averaged as conventional office BP (CBP). Participants were trained individually after the office examination on the techniques of self-BP monitoring using automated oscillometric device. Each participant obtained 24 readings comprising duplicate morning and evening readings over a 6 day period; the overall average of which is the home BP (HBP). MH is defined as home BP > 135/85 mmHg and CBP < 140/90; WCH is CBP > 140/90 mmHg and Home BP < 135/85 mmHg.
Results: The 275 participants included 128 (46.6%) women, mean age (standard deviation) 40.6 (11.6) years, HBP was significantly higher than CBP; 117.6 mmHg versus 113.4 mmHg (P < 0.0001), and 75.9 versus 73.7 mmHg (P < 0.0001) for systolic and diastolic BP respectively. 75 (27.3%) participants were hypertensive (either previously diagnosed, 57 (20.9%) or newly detected 18 (6.7%). Out of 200 normotensive participants, 14 (7%) had MH. In comparison with normotensive subjects, MH subjects were older; 44 versus 37.1years, P < 0.05 and had higher waist circumference, 97.7 versus 90.8 cm; P < 0.01.
Conclusion: About 7% of adults Nigerians adjudged normotensive by CBP measurement in this cross-sectional study had MH.
PP-24: Management of patients with mechanical heart valve in pregnancy
S. A. Isezuo, U. Hayatu, I. O. Oboirien, M. U. Zagga, G. O. Ibegbulam 1 , A. M. Ndakotsu 1 , B. A. Ekele 2 ,
Y. Ahmed 2 , C. E. Shehu 2 , A. U. Adoke 2 , U. Abubakar 3
Departments of Medicine, 1 Haematology, 2 Obstetrics/Gynaecology and 3 Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Background: Pregnancy in a setting of mechanical heart valve constitutes high risk for thrombosis with implications for fetal-maternal outcomes.
Materials and Methods: Prospective review of 5 pregnancies involving 2 nulliparous women who had mechanical heart valves (St. Jude) and preconception counseling.
Results: The patients who were aged 22 and 42 years had 14 and 21 years duration of mechanical heart valve implantations, respectively. Preconception anticoagulation was with warfarin (5-10 mg daily; INR = 1.7-3.7). The young patient is currently Para 1 + 0 while the older one is Para 4 + 0. Pregnancies were first reported at gestation age ranging from 5 to 12 weeks when the patients were still on warfarin. Warfarin was substituted with subcutaneous unfractionated heparin (UFH) 10,000-15,000 IU 12 hourly (Patient: Control PTTK ratio = 1.8-2.2) during the first trimester. UFH was converted back to warfarin (5-7.5 mg daily; INR = 2.1-3.0) after the first trimester until by 36 weeks of gestation. UFH 12,500-15,000 IU 12 hourly (Patient: Control PTTK ratio = 1.9-2.4) was given from 36 weeks until 24 h postpartum with omission of the dose preceding induction of labor. Warfarin therapy (7.5 mg) was subsequently recommenced. Intra pregnancy abdominal scan revealed no fetal congenital anomaly and all pregnancies were managed by planned vaginal deliveries through induction of labor except one assisted vacuum delivery. Infective endocarditis prophylaxis was given in all deliveries. The new-born were free of congenital anomaly. No maternal morbidity or mechanical valve abnormality was observed.
Conclusion: Management of patients with mechanical heart valves in pregnancy is multidisciplinary and challenging in Africa with culture of large family size.
PP-25: Left atrial myxoma excision in Nigeria-19 years follow-up
Dabs Ngwu, V. Okwulehi, M. A. C. Aghaji
Department of Surgery, Cardiac Unit, UNTH, Enugu State, Nigeria
Background: Atrial myxomas, in both surgical and autopsy series, constitute the majority of cardiac tumors, with over 70% of them arising from the Left Atrium. This report is of a young man who had the first successful excision of an atrial myxoma in Nigeria-with regular checkup for 19 years. The review of the literature is also presented to put the case in the context.
Materials and Methods: The preoperative diagnosis was confirmed using transthoracic echocardiography that revealed a large pedunculated mass arising from the interatrial septum and protruding into the left atrium. The tumor was excised via a median sternotomy under cardiopulmonary bypass, with complete, on-table, direct visualization of the four cardiac chambers; and autologous pericardial patch closure of the iatrogenic atrial septal defect.
Result: Postoperative recovery was uneventful and clinical follow-up with serial transthoracic echocardiography has been going on for 19 years.
Conclusion: Though cardiac tumors in general are rare, atrial myxomas are the most frequently encountered type, presenting diagnostic challenges in many instances but amenable to modern surgical techniques. Patients who develop new cardiac symptoms and signs need immediate screening by a trained echo-cardiographer. Once the diagnosis is missed, the patient will succumb to cardiac death. Once the diagnosis is established, and the tumor completely excised, the patient will live a normal life-but there is a need for long-term follow-up - to ensure that there is no recurrence.
PP-26: Pulmonary hypertension in adults with sickle cell anaemia
V. N. Amadi 1 , M. O. Balogun 1 , N. O. Akinola 2 ,
R. A. Adebayo 1 , A. O. Akintomide 1
Department of Medicine, Cardiology Unit, Obafemi Awolowo University Teaching Hospitals Complex, 1 Department of Haematology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Background: Sickle cell anemia (SCA) is the commonest hemoglobinopathy and is associated with high morbidity and mortality. Pulmonary hypertension is reported to play a significant role in this regard. There is very limited literature on pulmonary hypertension in SCA in this country.
Objectives: To determine the prevalence of pulmonary hypertension in SCA, assess its influence on exercise capacity and determine possible correlates of estimated pulmonary artery pressure.
Materials and Methods: Ninety-two SCA subjects had echocardiography and 6-minute self-paced walking exercise. Pulmonary hypertension was diagnosed on finding a pulmonary arterial systolic pressure of >35 mmHg from the tricuspid regurgitation jet velocity profile, or a right ventricular acceleration time less than 100 m with an acceleration to ejection time ratio <0.30 from assessment of the pulmonary flow jet profile. Mean pulmonary arterial pressure was estimated from a validated regression equation.
Results: Pulmonary hypertension was detected in 38% of SCA subjects. The 6 MWD was significantly lower in SCA subjects with pulmonary hypertension than those without (380.33 + 63.17 m vs .474.28 + 76.74 m; P = 0.014). The mean pulmonary arterial pressure had significant inverse correlation with the 6 MWD (−0.571; P < 0.001), and this remained significant after controlling for confounders. Other significant correlates were: age, hematocrit, left atrial diameter index, and estimated pulmonary capillary wedge pressure (P < 0.05).
Conclusion: Pulmonary hypertension is common in SCA and has significant influence on exercise capacity. Screening for pulmonary hypertension should be encouraged in them to optimize management, and thus improve their quality-of-life and life expectancy.
PP-27: Patient outcomes following after hours and weekend admissions or hospitalization for cardiovascular disease
V. O. Ansa, U. Njideoffor, C. Onwurah, V. Uhegbu, C. O. Odigwe
Department of Medicine, Cardiology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
Background: Studies have shown that admission during weekends and after hours to hospital are associated with an increased risk of death. Delays in the review of patients and in obtaining senior opinion may contribute to avoidable mortality at these times. The concept that patients receive equal care regardless of when they present to the hospital has thus been called to question. There is a paucity of data on patient outcomes following cardiovascular (CV) admissions during weekends and after hours in Nigeria.
Objectives: To demonstrate if a "weekend "or "after hours" effect influences outcome of patients admitted for treatment on account of CV disease including stroke.
Materials and Methods: Data for all CV admissions which included strokes at the University of Calabar Teaching Hospital for 1-year were reviewed and analyzed to determine if outcomes were affected by day and or time of admission.
Results: A total of 225 patients admitted on account of CV disease were reviewed. Mortality was higher in patients admitted during weekends (P = 0.000). However, the time of admission during weekdays did not affect mortality (P = 0.257). Most of the patients were reviewed by consultants within 5 days of admission and this significantly affected outcomes-discharge (P = 0.000) and mortality (P = 0.050).
Conclusion: Mortality was higher in patients admitted during weekends. A "weekend effect" thus probably exists. The reported increased mortality may be attributed to uneven staffing, lack of supervision and fragmented care at these times.
PP-30: Pattern of acquired heart diseases diagnosed on echocardiography
E. E. Ekpe, I. Umoh 1
Departments of Surgery and 1 Medicine, Cardiothoracic Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
Background: Acquired heart diseases are present at both pediatric and adult life and heart diseases have been known to be common in both developed and developing countries of the world, and also to contribute reasonably to noncancer mortality.
Materials and Methods: Retrospective review of the echocardiographic reports of patients done for varying indications in Uyo over a 1-year period was carried out.
Results: One hundred and 63 patients aged 9-72 years (mean = 52) had echocardiography done during the period under review. There were 87 (53.37%) males and 76 (46.63%) females. One hundred and eighty-nine diagnoses were made which means double diagnoses in 26 (15.95%) patients. There were nine types of cardiac pathologies identified in the 163 patients which included hypertensive heart disease in 96 (58.90%) patients, rheumatic heart disease in 51 (31.29%) patients, cardiomyopathy in 23 (14.11%) patients, endomyocardial fibrosis and pericardial diseases in 7 (4.30%) patients each, and other rare cardiac pathologies in the remaining 5 (3.0%) patients. These included cor pulmonale in two patients and left atrial myxoma, degenerative heart disease and pulmonary hypertension in one patient each.
Conclusion: Nine types of acquired heart diseases were discovered in this study and this indicates need for improvement in the cardiovascular medicine and surgery services in the center.
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