The indications for implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death have rapidly expanded over the past 15 years. Clinical trial data have quickly been implemented into guidelines. Ventricular arrhythmias still account for significant proportion of mortality observed in patients discharged after an acute myocardial infarction, in spite of massive developments in revascularization strategy and adjuvant medical management. At present, we have the results of clinical trials that show ICD use is associated with improved survival in this group of patients with left ventricular dysfunction and either demonstrated or anticipated risk for arrhythmic death. Despite the fact that there are few interventions that in multiple trials settings have consistently produced a 20–30% reduction in total mortality, ICD treatment is largely underutilized. Keeping in mind, in fact that devices fail, and in unpredictable subsets, especially in patients who get inappropriate shocks, quality of life is decreased, we need to use this powerful tool in the most appropriate manner based on the guidelines that resulted from the trials.

Background: Functional and structural consequences of hypertension on the right ventricle (RV) have received scarce attention due to the complex shape and orientation. The aim of the current study is to study the RV systolic and diastolic function in untreated hypertensive patients using two-dimensional speckle tracking analysis and correlating the findings with the morphological and functional changes of the left ventricle. Methods: This cross-sectional study involved 80 patients with mild to moderate untreated systemic hypertension and 40 healthy controls. M-mode echocardiography measurements of the right ventricular wall (RVW) diastolic thickness, tricuspid annular plane systolic excursion, left ventricular (LV) dimensions, and systolic function were performed. Pulsed Doppler echocardiography was used to measure peak early (TE) and peak atrium (TA) right ventricular diastolic filling velocities. Similar parameters of the LV diastolic filling were recorded. Tissue Doppler imaging (TDI) was done to determine the left and right myocardial annular velocities. Mean pulmonary artery pressure (MPAP) was measured noninvasively by the estimation of pulmonary artery acceleration time (AT). Apical 4-chamber images were acquired at high frame rate to extract RV peak systolic strains. Results: The current study revealed significantly thicker RVW in hypertensive group (5.3 vs. 2.8 mm in controls, P < 0.001). The RV diastolic dysfunction (RVDD) defined as tricuspid E/A ratio <0.8 was recorded in 60% of the hypertensive group. Significant positive correlation was found between tricuspid and mitral E/A ratio. Pulmonary AT was significantly reduced in hypertensive group (128.1 ± 5.4 vs. 143.6 ± 1.8 ms in healthy group, P < 0.001). Pulmonary artery systolic pressure (PASP) was significantly elevated in untreated hypertensive group 39.3 ± 7.8 mm Hg. The RV diameter was 2.2 and 2.1 cm in controls and hypertensive group (P = 0.011). Global RV systolic strain values were remarkably reduced in hypertensive group (−19.6 ± 1.4 vs. −24.1 ± 2.2% in controls, P < 0.001). Conclusions: The RV diastolic and systolic dysfunction was found in 60% and 30%, respectively, in the hypertensive group. Body mass index is a predictor of RVDD while several variables were found to be significantly (P < 0.001) associated with RV systolic dysfunction. These variables were left atrium dimensions, systolic blood pressure, and PASP. Possible causes of these structural and functional changes in the RV are translation of the increased LV filling pressure in the pulmonary circulation and interaction of the right and left ventricle.

Background: The previous studies in Western countries have suggested that subjects with prehypertension have a higher risk of developing cardiovascular disease and mortality, increased left ventricular mass (LVM), and abnormal LV geometry, than those with normal blood pressure (BP). The aim of this study was to determine the pattern of LV geometry in Nigerian prehypertensives and compared with those of hypertensives and normotensives. Methods: This was a cross-sectional comparative study conducted at Aminu Kano Teaching Hospital, Kano, Nigeria. Clinical evaluation and full echocardiographic examination were performed among selected patients with normal BP (group 1), prehypertension (group 2), and hypertension (group 3). Results: A total of 300 subjects were studied, 100 in each group. The mean age of subjects in group 1 was 27.86 ± 8.60 years, and 60% were female, while that of group 2 was 34.04 ± 6.25 years, and 53% were female, and that for group 3 was 52.62 ± 11.8 years, and 56% were female. About 86% of group 1 had normal geometry (NG) while 12% had concentric LV remodeling concentric remodeling (CR) and 2% had eccentric hypertrophy (EH). Among subjects in group 2, NG was found in 72%, CR in 14%, EH in 12% and concentric hypertrophy (CH), in 2%. In group 3, NG was found in only 21% while 13% of them had CR, 28% CH, and 38% had EH. There was a progressive increase in LVM index from normal BP (30.13 ± 8.53 g/Ht^2.7) to prehypertension (33.26 ± 8.95 g/Ht^2.7) and to hypertension (48.41 ± 12.4 g/Ht^2.7) (P = 0.001). Conclusion: This study has shown a higher prevalence of abnormal LV geometric patterns and higher LVM among subjects with prehypertension compared with normotensives. Such findings could carry prognostic implication and require further population survey involving a larger group.

Background: Thyroid dysfunction may affect the heart. Conflicting evidence exists regarding cardiac involvement in subclinical hypothyroid. Objective: Aim of the study is to investigate left ventricular dysfunction in subclinical hypothyroidism. Materials and Methods: This is a case–control study including 51 subclinical hypothyroid patients and 55 age, sex, and body surface area matched control. After meeting inclusion and exclusion criteria, the study population was selected and evaluated with two-dimension, M-mode, and pulse Doppler echocardiography. The following parameters were measured - left ventricular end-diastolic diameter, left ventricular end-systolic diameters, posterior wall thickness, interventricular septal thickness, fractional shortening, left ventricular ejection fraction, left ventricular mass index, diastolic transmitral peak velocity (E and A wave), E/A ratio, deceleration time of mitral E wave, and Tei index. Student's t-test for independent sample with calculation of P value (two-tailed) was applied for statistical analysis using SPSS software (version 17.0). Results: There was significant left ventricular diastolic dysfunction as measured by increased mitral peak A velocity (66.3 ± 8.4 mm/s in case vs. 52.4 ± 4.8 mm/s in control, P < 0.001), decreased E/A ratio (0.90 ± 0.08 in case vs. 1.31 ± 0.36 in control, P < 0.001), prolonged isovolumetric relaxation time (120 ± 13 ms in case vs. 76 ± 9 ms in control, P = 0.035), increased Tei index (0.29 ± 0.13 in case vs. 0.22 ± 0.10 in control, P = 0.015). Left ventricular systolic function as measured by other parameters was similar in both groups with no significant change. Conclusion: Subclinical hypothyroidism is significantly associated with left ventricular diastolic dysfunction.

Background: The ankle-brachial index (ABI) is a ratio of Doppler recorded ankle and brachial systolic blood pressure. ABI value of <0.9 is diagnostic of peripheral arterial disease (PAD) and is associated with increased risk of cardiovascular morbidity and mortality. ABI is a simple and noninvasive tool that can be used in primary care as part of cardiovascular risk assessment. Objectives: To determine the pattern of ABI, the prevalence of PAD, and the risk factors for low ABI. Subjects and Methods: Four hundred subjects aged 50 years and above were selected by systematic random sampling. Their demographic data and cardiovascular risk factors were assessed, and their ABI was measured. ABI value of ≤0.9 was taken as low ABI indicating PAD while a value >1.3 was taken as high ABI indicating arterial calcification. Results: Two hundred and eighty-eight (72.0%) of the participants had normal ABI, 99 (24.8%) had low ABI indicating PAD, and 13 (3.3%) had high ABI. The prevalence of low ABI increased from 4.9% between 50 and 59 years to 25.3% and 58.7% between 60 and 69 and ≥70 years, respectively. The risk factors for low ABI were age (P = 0.00), history of hypertension (P = 0.03), and diabetes mellitus (DM) (P = 0.00). Conclusion: 24.8% of the participants had low ABI indicating PAD. The prevalence of PAD increases by 5–10 folds after the fifth decade of life. Low ABI was associated with advancing age, DM, and hypertension.

Context: Ambulatory blood pressure monitoring (ABPM) is superior to office blood pressure (OBP) in predicting hypertension control/outcome. Despite the growing burden of hypertension in Africa, ABPM use remains rudimentary. Aims: To report our initial ABPM experience in Nigeria. Setting and Design: Ongoing prospective descriptive study, involving consecutive recruitment of consenting patients' ≥18 years, presenting at DOCS Heart Centre Enugu Nigeria. Methods: The study involved 78 hypertensive patients attending the clinic from May, 2013. OBP was taken in sitting position, using oscillometric BP device. Each patient was then monitored over 24 h with a Tonoport V (GE CS V6 71[21]), interpreted using GE Cardiosoft^TM ABPM software in accordance with British Medical Council guidelines. Statistical Analysis: Data were analyzed using EPI Info (version 3.3.5). Continuous variables were expressed as means ± standard deviation. Differences between group means were tested using two-tailed Student's t-test. Proportions were reported as percentages and compared between groups with Chi-square. Results: The study involved 78 adult hypertensive patients; mean age of the patients was 53 ± 13 years and body mass index 30.0 kg/m², 53.8% were males. Control on OBP was 17.9%, on ABPM 24.4%. The mean 24-h BP was 144 ± 16/88 ± 10 mmHg; daytime BP, 146/90 ± 17/11 mmHg; night-time BP, 139/81 ± 17/9 mmHg; and waking BP 149/88 ± 20/14 mmHg. Borderline hypertension was seen in 4.5%, sustained hypertension in 36.4%, white coat hypertension in 13.6%, and nocturnal hypertension in 22.7%. The majority of patients had abnormal dipping pattern, with enormous BP load, 89.2% having a high load. Conclusion: BP control was better represented by ABPM more than OBP in the patients; showing that to optimize management, greater use of ABPM is a more pragmatic approach to mitigate the adverse outcomes among hypertensive patients.

Background: The advent of echocardiography has tremendously improved the diagnosis of cardiovascular diseases. We present a review of cardiovascular disorders diagnosed using transthoracic echocardiography over 3 years. Materials and Methods: Echocardiographic data of patients from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics was used in assessing the occurrence of the different cardiac disorders. Results: One thousand three hundred and two echocardiograms were considered, out of which 1224 (94%) comprising 591 (48.3%) males and 633 (51.7%) females were analyzed. Ages ranged from 4 days to 105 years with a mode of 60 years and a mean of 39.62 ± 20.58 years. The most common indications were hypertensive heart disease (HHD) (28.2%) and congestive cardiac failure (23.4%). HHD was the most common diagnosis (25.1%) followed by cardiomyopathies (23.9%). Idiopathic dilated (29.3%) and peripartum cardiomyopathy (23.1%) were the most common cardiomyopathies. Valvular heart diseases (VHD) were diagnosed in 14.9%, with rheumatic (60.4%), and degenerative (36.4%) being dominant. Congenital heart disease was diagnosed in 7.2%, with 70.5% of the cases in those ≤14 years. Ischemic heart disease was diagnosed in 6.6%. Pericardial diseases were found in 3.2%, while cor pulmonale was documented in 0.8%. Atrial myxoma dissection of the ascending aorta, athlete's heart, and amniotic fluid embolism were each observed in <1%. A normal echocardiogram was reported in 13.3%. Conclusion: The most common echocardiographic diagnoses in our center are HHD, cardiomyopathies, and VHD. Congenital and ischemic heart diseases are also prevalent.

Background: Echocardiography has since its inception, assumed a significant role in evaluation of cardiac masses, supplanting other diagnostic modalities for this purpose. We reviewed the various kinds of cardiac masses detected using transthoracic echocardiography in our center over a period of 3-year. Materials and Methods: Echocardiographic data of patients that underwent transthoracic echocardiography from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including all forms of Doppler modalities where appropriate. Descriptive statistics was used in assessing the proportion of the different cardiac masses observed. Results: One thousand three hundred and two transthoracic echocardiograms were performed over the 3-year period, out of which 1224 comprising 591 (48.3%) males and 633 (51.7%) females were retrieved and reviewed. Their mean age was 39.62 (20.6) years. Cardiac masses were documented in 106 (8.7%) of the subjects. The most common cardiac mass was intracardiac thrombus, observed in 89 (84.0%) followed by vegetation in 10 (9.4%). A presumptive diagnosis of right atrial myxoma was made in 4 (3.8%), whereas 1 (0.9%) had a right atrial mass of uncertain cause. Inferior vena cava mass and metastatic lesion to pericardium were each diagnosed in 1 (0.9%) patient. Most of the cardiac thrombi involved the left ventricle (94.4%), whereas vegetations were mainly on the mitral valve (80%). Conclusion: The dominant causes of cardiac mass observed are cardiac thrombus, commonly involving the left ventricle, and vegetations on mitral valve.

Introduction: Approximately half of most common chronic disorders are undetected that half of those detected are not treated, and that half of those treated are not controlled. This is true of hypertension as well: The “rule of halves.” However, the relevance of this is being questioned now. Objective: The aim of the present study was to assess the applicability of the rule of halves in an urban adult population in North India to evaluate its relevance in establishing levels of awareness, thus control of hypertension in general population. Materials and Methods: A cross-sectional community survey was done to include 187 men and 213 women aged >20 years of age in Shimla city, Himachal Pradesh. Hypertension was assessed using standardized recording, structured schedule on diagnosis and antihypertensive drug treatment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Results: The data were expressed in percentages, and Chi-square test was used to list the significance of sociodemographic factors. Of the total 400 participates, 208 individuals (52%) had hypertension. The prevalence of self-reported hypertension was 35% (139/400). However, the prevalence of self-reported hypertension (aware) among diagnosed patients of hypertension on examination by investigator was 139/208. Conclusion: The relevance of “rule of halves” in establishing the levels of awareness and control of hypertension is undervalued and cannot be undermined especially in context of developing countries.

Background: The high prevalence of hypertension in developing countries has stimulated a lot of research, one of which is tracking of childhood blood pressure (BP). To the authors' knowledge, the point prevalence of elevated BP among primary school children in Kano Metropolis, Kano State, Nigeria has not been documented. Objective: To determine the BP levels and the point prevalence of elevated BP among primary school children in Kano Metropolis, Nigeria. Materials and Methods: A multistage sampling technique was used to select 2000 pupils from 66 primary schools in Kano aged 6–14 years. Data were collected using a standardized pretested questionnaires completed by the parents/guardians. BP was measured with a mercury sphygmomanometer. Average of three readings was recorded for each pupil as his/her BP. Weight and height were also recorded using standard techniques. Elevated BP was defined using the criteria by the 4^th task force, according to age, gender, and height. Results: A total of 2000 pupils were studied with 1058 females and 942 boys with a ratio of 1.1:1. The mean systolic blood pressures (SBP) among males and females were 93.17 ± 8.70 and 94.28 ± 9.06 mm Hg while the mean diastolic blood pressures (DBP) were 59.1 ± 6.9 and 60.3 ± 6.9 mm Hg, respectively. Overall, there was a significant positive correlation between SBP (r = 0.44) and DBP (r = 0.38) with body mass index (BMI). Using criteria by the 4^th report, 3% of pupils had elevated BP in this study. Conclusion: There is a positive correlation between SBP/DBP and BMI, the overall prevalence rate of elevated BP among the study population was 3%.

Introduction: Heart failure is a common pediatric emergency. This study was conducted to determine the prevalence and underlying causes of heart failure among children admitted to the Children's Emergency Ward of the Niger Delta University Teaching Hospital Okolobiri, Bayelsa State. Materials and Methods: Over a 1-year period from January 1, 2014 to December 31, 2014; consecutive children presenting to the emergency ward with clinical features of heart failure were recruited. After stabilization and management, a proforma was opened for each patient containing details of the history, physical examination, underlying causes of the heart failure, method of treatment, and outcome. Results: Of the 473 children seen over the study period, 79 of them presented with clinical features of heart failure, accounting for 16.7% of the total pediatric admissions with a male: female ratio of 1.4:1. Their ages ranged from 1½ months to 14 years (mean age 35.3 ± 34.9 months). The major underlying causes of heart failure were anemia (59.5%) and lower respiratory tract infections (21.5%). Severe malaria was the most common cause of anemia. Of the 79 cases, there were 17 deaths (case fatality rate of 21.5%), which accounted for over 50% of the total mortalities in the Children's Emergency room over the study period. Mortality from heart failure was significantly associated with increased severity of heart failure at presentation (P = 0.004; Fishers exact test). Conclusion: Scaling up malaria prevention programs, strengthening immunization practices, prompt recognition and treatment of the underlying causes of heart failure would reduce morbidity and mortality from this easily preventable and treatable condition.

Background: Hypertension is a major public health challenge worldwide. It is the most important risk factor for cardiovascular disease. Objectives: This study aimed to investigate the prevalence of hypertension and associated factors among the residents of Yemetu community in Ibadan-North Local Government Area of Oyo State, Nigeria. Methods: A descriptive cross-sectional design was used. The study involved 806 respondents aged from 18-90 years from 171 households, selected by cluster sampling technique. It was a house-to-house survey. Behavioural risk factors were measured using World Health Organisation (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS 1 & 2). Hypertension was defined as Systolic blood pressure (SBP) ≥ 140 and/or Diastolic blood pressure (DBP) ≥ 90mm Hg or currently on anti-hypertensive medication. Data were analysed using descriptive statistics, Chi-square and binary logistic regression tests at P<0.05. Results: The overall prevalence of hypertension was 33.1% (male 36.8% and female 31.1%). The proportion of self reported hypertension was 11.1%, while 5.1% were currently on anti-hypertensive medication. The mean age of the respondents was 38.8 ±15.6 years. The body mass index of the respondents was 5.2%, 52.0%, 29.5% and 13.3% for underweight, normal, overweight and obese, respectively. Alcohol and tobacco use were found in 11.5% and 3.2%, respectively. The result of binary logistic regression analysis revealed that hypertension was significantly associated with being in age groups 30-49 years (OR 2.258, 95% CI: 1.311 - 3.884), ≥50 years (OR 7.145, 95% CI: 3.644 - 14.011), being overweight or obese (OR 2.281, 95% CI: 1.022 – 5.088). Hypertension was inversely associated with being underweight (OR 0.537, 95% CI: 0.395 – 0.832). Conclusion: This study revealed a high prevalence of hypertension. These data underscores the need for urgent steps to create awareness and implement interventions for prevention and early detection of hypertension, especially among those aged ≥30 years and the overweight or obese.

Background: Cardiac electrophysiologic study and radiofrequency ablation have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India. Objective: The purpose of this study was to evaluate our experience with cardiac electrophysiologic studies (EPS) and radiofrequency catheter ablations (RFA) of ectopic atrial tachycardias (AT). Materials and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department, of the Institute of Cardiovascular diseases, Madras Medical Mission, India. All cases diagnosed to have ectopic AT following cardiac EPS between January 2010 and April 2014 were selected for study. The records, which were obtained from the cardiac electrophysiology clinical research office of Madras Medical Mission, were reviewed. 73 cases were chosen for analysis, using SPSS statistical software version 15. Results: There were 73 patients, comprised 31 males and 42 females. The mean age was 47.38 years. Commonly associated diseases were diabetes mellitus 16 (21.9%), hypertension 14 (19.1%), coronary heart disease 12 (16.5%) and congenital heart disease 8 (11%). The most common locations of AT were coronary sinus Ostial region 7 (14.0%), parahisian region 6 (12.0%) and crista terminaris region 4 (8.0%). Ablation was successful in 43 (84.3%). Complication rate was 4.11%. Conclusions: Treatment of ectopic AT by RFA is highly effective and safe.

The clinical course of Takayasu arteritis varies from nonspecific constitutional symptoms such as fever, malaise, rashes, loss of appetite, dizziness, and so on during the acute phase to those resulting from arterial stenosis and ischemia in chronic phase. We report a case of a young female presenting with resistant hypertension and lower limb claudication. The diagnosis was confirmed by multiple detector computed tomography-renal angiogram, which showed narrowing of abdominal aorta just above celiac trunk along with wall thickening. The lady was treated with balloon aortoplasty following which the claudication symptoms were subsided and blood pressure was normalized.

Transposition of the great arteries (TGA) is incompatible with life unless there exist shunts between the two parallel circulations. Even where shunts are present, it still remains a lethal cyanotic congenital heart disease if it is not surgically corrected soon after birth. We report the case of a 31-year-old woman with un-operated TGA who not only survived but was able to carry a pregnancy to term. This may not be unconnected with the fact that she has associated atrial and ventricular septal defects.