Background: Risk stratification is an important step in proper management of acute coronary syndromes (ACS). This should be carried in every hospital as it might improve the outcome even in hospitals with no coronary angiogram facility but are following the guideline of management. Objective: We present the characterization based on thrombolysis in myocardial infarction (TIMI) risk profile of unstable angina (UA)/non-ST-segment elevation (NSTEMI) myocardial infarction - ACS in diabetic patients in King Abdulaziz Medical City National Guard Hospital (KAMC) in Jeddah, a noninvasive facility and compared with 4 other hospitals in the Kingdom of Saudi Arabia with cardiac catheterization facilities. These hospitals were involved in multicenter international diabetes-ACS study. In addition, we compared the characterization of two therapeutic modalities used in management of such cases: Glycoprotein (GP) IIb/IIIa inhibitors and coronary angiogram. Materials and Methods: The characterization of the risk profile of 35 diabetic patients from KAMC, noninvasive hospital were compared with 142 patients from four hospitals in KSA, and 3,624 patients from the international hospitals who had cardiac catheterization facility admitted with UA/NSTEMI, ACS. Results: The distributions of TIMI scores were similar among the three groups. The odds ratios were also comparable across the three groups. When GP IIb/IIIa inhibitors usages were compared, the usage for a particular group was not different. The high risk factors were similar in patients who underwent coronary angiogram in the centers of KSA who had cardiac catheterization in comparison to those international centers. Conclusions: The nonavailability of catheterization facilities does not cause referral bias, with risk factors being similar and treatment approach was matching. Immediate triage and risk stratification, e.g. TIMI score will affect the outcome of cardiovascular mortality and might explain some similarity in the outcome between invasive and noninvasive hospitals.

Background: There is evidence that ischemia modified albumin increases (IMA) in acute coronary syndrome, but enough work has not been done in assessing the correlation between IMA and inflammatory markers in myocardial infarction (MI). Objective: The objective of the present study was to observe whether IMA would significantly be altered in MI patients and also whether the same would be correlated with selected acute phase reactants. Methods: The present hospital based, noninterventional, cross-sectional study was undertaken in Medical College and Hospital, Kolkata. Fifty cases of acute MI (AMI) and 50 suitable controls were enrolled for the study. Serum IMA, serum albumin, serum total cholesterol, serum high-sensitivity C-reactive protein (hsCRP), serum ceruloplasmin and serum transferrin were measured in blood from the study population. Results: Serum IMA and hsCRP (P < 0.0005) were significantly higher in cases whereas serum transferrin (P < 0.0005) and albumin (P < 0.005) were significantly lower in cases as compared to controls. In cases, IMA was found to be positively correlated (r = 0.470, P = 0.001) with hsCRP, one of the common markers of inflammation in AMI. Serum IMA, hsCRP and transferrin play a significant role (P < 0.05) in assessing the severity of inflammation. Conclusion: Serum IMA was altered in AMI patients and positive correlation was obtained between IMA and positive acute phase reactant hsCRP. This study encourages future studies probing the role of inflammation in the causation of MI.

Background: Hypertension is the most common, most potent universal contributor to CVD mortality. Primary prevention of hypertension and ischemic heart disease in adults necessitates a scientific evaluation of the predictors in childhood. BP studies in children provide important epidemiological information, which may help in controlling or modifying coronary risk factors. Objective: 1) To determine the prevalence of hypertension and pre-hypertension among urban school adolescents in Shimla city. 2) To determine the association between hypertension and BMI for age in both the genders in the adolescents. Materials and Methods: A total sample of 3385 students with 1665 females and 1720 male students was drawn for the purpose of the study. Socio-demographic profile, anthropometric and blood pressure readings were obtained. The prevalence of pre-hypertension, hypertension, obesity among the adolescents was determined. Results: Overall mean SBP and DBP increased significantly with age in both the genders. Mean SBP (111.60 mmHg ± 11.43) and DBP (72.88mmHg ± 7.41) were higher in males in comparison to females in whom mean SBP and DBP were 109.91 ± 12.04mmHg and 71.84 ± 7.37mmHg, respectively. The prevalence of hypertension in females was more i. e., 13.1% in comparison to males 9.5%. However, the prevalence of pre-hypertension was nearly equal (11.0% in females and 11.3% in males). There was significant association of hypertension and BMI for age in both the genders. Conclusion: There is an urgent need for public health measures to prevent high BP in children and adolescents from becoming another public health burden. There is trend toward higher prevalence of hypertension in school going children which reflects the changing scenario of cardiovascular diseases in current era due to changing lifestyle, dietary pattern, decreased physical activity and increase in obesity. Early detection and intervention in childhood can prevent adult hypertension.

Background: 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 internal jugular vein at bedside cannot be overemphasized. A handy instrument for this purpose was compared with the age-long procedure of combining two rulers. Objective: To compare the conventional means of jugular venous pressure (JVP) estimation with the use of a new instrument (Jugulometre). Materials and Methods: Forty-one (41) patients with elevated JVP in heart failure were recruited consecutively from two centers in a prospective study. JVP was estimated by conventional method. This was repeated using the jugulometre with and without light source separately. The time taken and height of JVP were noted. Data analysis was done 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 ΁ 13.79 years were examined. 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 (P < 0.000 each). Also the difference seen in the values of JVP height were not statistically significant (P > 0.174, 0.179 and 1.000). Time difference (in seconds) for measuring the JVP were found to be statistically significant (P < 0.004, 0.000 and 0.011) and shorter with the jugulometre. Conclusion: The Zaria-made jugulometre is faster, less cumbersome and has comparable accuracy to the conventional way of JVP estimation by the bedside. It is therefore recommended for routine patient examination.

Background: Hypertension is highly prevalent in sub-Saharan Africa, underlying many of the fatal and non-fatal cardiovascular events. Objectives: To examine the level of knowledge of primary care physicians in urban Nigeria, as regards to hypertension. Participants: A cross-sectional survey of general medical practitioners in Lagos, Nigeria was undertaken in the months of July and August 2011 using self-administered semi-structured questionnaires. Results: There were 74 respondents, 59.5% of whom were men and the bulk of the subjects, 41.9% were in the 30-39 years age range. Duration since graduation of 0-5 years, 56.8% and ≥21 years, 17.6% had the highest respondents. The bulk of the respondents, 90.5% were aware of the existence of guidelines on hypertension but 35.1% were not familiar with the details of any guideline. Majority, 97.3% agreed to the usefulness of guidelines and 93.2% correctly identified cut-off values for hypertension. All but one agreed to the need of referral of complicated cases to hypertension experts and would recommend lifestyle modification for all. About 44.6% of respondents generally attended 5 or more continuing professional development (CPD) per year. Conclusion: Awareness of the existence of guidelines on hypertension and attendance at CPD programs is quite high among general medical practitioners in urban Nigeria. Knowledge of the details of these guidelines however is not as high. Focus on hypertension guidelines in most of the CPDs is recommended considering the public health importance of hypertension.

Context: Diagnoses of supraventricular arrhythmias often depend on combination of varied features of baseline electrophysiology, tachycardia and responses to pacing manoeuvres. These investigations are carried out regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aims: The purpose of this study was to describe the initial outcome following cardiac electrophysiologic studies and radiofrequency ablation of typical atrio-ventricular nodal re-entrant tachycardia (AVNRT). Settings and Design: This retrospective study was carried out in the Cardiac Electrophysiology Department, of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. Subjects and Methods: Records of consecutive cases of typical AVNRT following cardiac electrophysiologic studies and radiofrequency ablation carried out between May 2013 to April 2014 were reviewed. Eighty-two cases were chosen for analysis. Statistical analysis used: The data obtained were analysed using SPSS statistical software version 15. Results: The 82 patients comprised 24 males and 58 females. Dual nodal physiology was documented in 79 (96.3%), A simultaneous V and A (VA interval <20 ms) was documented in 66 (80.5%). The presence of ventricular-atrial dissociation (VAD) during ventricular overdrive pacing (VOP), post-VOP V-A-V response, termination of tachycardia by VOP without advancing A, absence of VA linking and failure of His-refractory premature ventricular complex (PVC) to advance A were other characteristics used in differential diagnosis. The slow pathway was successfully ablated in 52 (63.4%), successfully modified in 29 (35.4%). The overall success rate was 98.8% while radiofrequency ablation was unsuccessful in 1 (1.2%). There was a very low incidence of complications. Conclusions: Treatment of typical AVNRT by radiofrequency cardiac catheter ablation at the Madras Medical Mission is highly effective and safe.

Background: Among the many adverse sequelae of congenital heart disease (CHD), malnutrition stands out as one of the major concerns. Objective: This study was undertaken to compare the nutritional status, parental age, and mid-parental heights of children with CHD and their apparently healthy control group. Material and Methods: Electrocardiography and echocardiography were used to confirm the presence or otherwise of CHD in consecutive 100 children with CHDs and 100 age, sex, and social class matched apparently healthy control group. Nutritional parameters, parental ages, and mid-parental heights were also obtained. Associations were tested using student t test and Chi square test. Level of significance was P < 0.05. Results: There were 54 males with CHD and the age-range of the children was 1-96 months. The commonest acyanotic CHD was ventricular septal defect (49.0%) while the commonest cyanotic CHD was Fallot's tetralogy (10%). Children with CHD compared with the control group had significantly lower mean z scores for weight for height, height for age, and weight for age. The mid upper arm circumference, triceps, and subscapular skinfold thickness were also lower than that found in the control group. Older parental age and lower mid-parental heights were found among parents of children with CHD compared with those of controls. 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 sequelae of malnutrition in these children. Parental malnutrition and older parental age are likely predisposing factors to CHD.

Background and objectives: Despite reduction in door-to-balloon time in the management of acute myocardial infarction (AMI), prehospital delay by the patients has remained a major concern as benefits derivable from reperfusion treatments are time dependent. This study aimed at evaluating knowledge and perception of warning signs of heart attack among civil servants in Ilorin, Nigeria. Materials and Methods: A pretested structured questionnaire was designed to obtain relevant information on knowledge and perception of heart attack symptoms; and action to be taken if one experiences the condition. Results: Questionnaires from 601 subjects consisting of 312 (51.9%) males and 289 (48.1%) females were analyzed. Although, 78% of the respondents have heard about heart attack, only 44.4% could discriminate a heart attack symptom from other conditions. Higher proportion of women (50.2%) than men (39.1%) could identify a core symptom of heart attack (P < 0.05). Similarly, higher percentage of participants 40 years and older (48.3%) were more knowledgeable than those younger than 40 years (42.9%), but the difference was not statistically significant (P > 0.05). Higher percentage of women reported prior cardiovascular disease/risk factors than men. Conclusion: We concluded that participants have low knowledge of heart attack symptoms with women being more knowledgeable than their male counterparts. There is the need for community education on heart attack warning signs and the need for early hospital presentation by affected individuals.

Background: Electrocardiogram (ECG) is a simple bedside investigation that can identify cardiovascular abnormalities among apparently normal individuals. Objectives: To assess the prevalence and determinants of ECG abnormalities among staff of a tertiary institution (Ladoke Akintola University of Technology [LAUTECH]) in Southwest, Nigeria. Materials and Methods: A total of 202 participants (47% men, 53% female) randomly selected staff of LAUTECH university was subjected to comprehensive medical examination, including body mass index, fasting lipid profile, ECG among others. ECG abnormalities were identified and related to potential determinants. Results: The main ECG aberrations (prevalence %) are: left ventricular hypertrophy (LVH) (39.6%), QTc prolongation (20.3%), sinus tachycardia (7.9%), right ventricular hypertrophy (4.7%), conduction defects (6.4%), ectopic beats (3.9%). T-wave abnormalities (2.1%), arrhythmia (1.0%), ischemic heart disease (1.5%), Wolf-Parkinson-White pattern (1.0%) and 82.3% had normal axis while the remaining had some form of abnormal axis. Blood pressure variables were consistently associated with all ECG abnormalities. Conclusion: ECG aberrations in this apparently normal population were dominated by conduction defects and LVH. This study emphasizes the necessity of regular cardiovascular assessment in apparently normal population in order to identify cardiovascular disease in its early stage and implement appropriate therapeutic and preventive strategies.

Background: Pleural effusion is very common in congestive heart failure, and should resolve with treatment of congestive heart failure, including diuretic. However, refractory, recurrent, massive, or significant pleural effusions contributing to symptoms in the patients with congestive heart failure warrant treatment by pleural drainage. We sought to discover the clinic-pathologic characteristic of such pleural effusion in our congestive heart failure patients. Materials and Methods: Retrospective analysis of medical records of congestive heart failure patients admitted for inpatient treatment between January 2007 and June 2011. Results: Out of the 342 patients that presented with congestive heart failure during the study period, ten (2.9%) patients had significant pleural effusions in 12 pleural spaces that contributed to symptoms and refused to resolve on treatment of the congestive heart failure including diuretic. Male:Female was 1.2:1, modal age range 40-50 years, 50% in the left, 30% in the right, and 20% bilateral. The estimate of the pleural effusion was <1000 ml->2000 ml with 90% being transudate and 10% exudates. One patient had associated pericardial effusion. Upon drainage, 70% of the patients improved immediately. Conclusion: We recommend drainage of refractory, recurrent, massive, significant pleural effusion in congestive heart failure contributing to symptoms and responding to diuretic therapy.

Introduction: Prolonged professional exercises such as it occurs among professional footballers are associated with functional and structural cardiac changes. It may also worsen already existing cardiovascular abnormalities. Reports are scarce on the pattern of echocardiographic changes among professional footballers in Nigeria. This study aimed to describe the structural and functional changes among Professional Footballers undergoing routine pre-season screening in Nigeria. Materials and Methods: Forty-nine active top-division club members of a Division 1 Football Club in Nigeria who had echocardiography were compared to 24 age- and sex-matched controls. They had 2-D, M-mode and Doppler echocardiography. Statistical analysis was done using SPSS 17.0. Results: The mean age of the footballers was 22.2 ± 6.3 years and they were well matched with the controls in age. All of them were males. Echocardiographic parameters were significantly different between professional footballers and controls. The left ventricular internal dimension in diastole, left ventricular posterior and septal wall thicknesses, right ventricular dimension, left atrial dimension and aortic root dimension were significantly higher among footballers than age-matched controls. Prevalence of left ventricular hypertrophy (67.3% vs. 16.7%, P < 0.05), RVD > 28 mm (49% vs. 4.2%, P < 0.05), LAD > 40 mm (59.2% vs. 0%, P < 0.05), AOD > 3 5 mm (12.2% vs. 0%, P < 0.05) and sclerosed mitral valve leaflets (18.4 vs. 12.5%, P > 0.05) were higher among footballers than controls. Conclusion: Professional footballing is associated with distinctive structural and functional echocardiographic adaptations among Nigerian professional footballers. A good understanding of this is important to differentiate disease states among them and also to identify high-risk individuals which may benefit from definitive intervention.

Background: Postoperative junctional ectopic tachycardia (JET) is a common and transient phenomenon occurring after repair of Tetalogy of Fallot (TOF). Although propranolol is used in these patients to prevent and control hypercyanotic spells, its effects are not widely studied in postoperative scenario. Aims: The aim of this study was to examine the effect of preoperative use of propranolol on the incidence of postoperative JET after complete surgical correction of TOF. Materials and Methods: This is a prospective observational study of 51 patients undergoing complete repair of TOF between July 2010 and February 2012. Of these, 25 patients did not receive propranolol (control group) and 26 patients did receive it (propranolol group). Results: Lowest hematocrit on Cardiopulmonary Bypass (CPB) was significantly low in control group compared to propranolol group (P = 0.008). Though inotropic score was high (P = 0.015), incidence of postoperative JET was significantly low in propranolol group compared to control group (P = 0.040). Conclusions: Our findings suggest that the preoperative use of propranolol is associated with a lower incidence of JET after complete surgical repair of TOF. A randomized control trial should be considered to explore causality.

Background: Heart disease in pregnancy is a potentially serious medical complication in pregnancy. Limited studies have been conducted in India to assess heart disease in pregnancy. Objective: To determine the type of cardiac lesions and to assess the maternal and fetal outcomes in patients with heart disease in pregnancy. Materials and Methods: In this retrospective study, 42 pregnant women with known or newly diagnosed heart disease were followed from January 2012 to December 2013. The data analysis was done using statistical software Systat 12. Results: Out of total 42 subjects selected for the study, maximum 13 (30.9%) were in the age group of 26-30 years. Majority of the women 30 (71.4%) were primigravida. Mostly 26 (61.9%) patients belonged to New York Heart Association (NYHA) class I andII. In total, 30 (71.4%) women presented with rheumatic heart disease and 6 (14.3%), with congenital heart disease. Majority 22 (52.4%) had spontaneous vaginal deliveryand only 8 (19.0%) required induction of labor. Most common maternal complication was heart failure (16.7%) and maternal deaths were 4.8%. The live birth was recorded in 38 cases (90.5%) of them 16 (42.1%) were preterm babies. Intrauterine death occurred in four cases while five babies died in neonatal period. Conclusion: The study results conclude that the rheumatic heart disease is still a predominant lesion and heart disease in pregnancy is associated with increased maternal and fetal risk.

Introduction: Kano has been described to have the highest burden of hypertension and dyslipidemia in Nigeria. It is not known whether the epidemiologic transition in Kano cuts across all socio-demographic strata. The present study aimed to assess the prevalence and determinants of hypertension and other cardiovascular disease (CVD) risk factors among a semi-nomadic Fulani population in Kano, Nigeria. Materials and Methods: The study was cross-sectional and carried out in Tofa village, Rano Local Government of Kano State, Nigeria. All semi-nomadic Fulani adults in Tofa and the surrounding hamlets were invited to participate in the study. Results: A total of 214 consecutive subjects were studied; 57.0% were males and 43.0% were females. The main occupations of the subjects were cattle rearing, subsistence farming and petty trading. The most prevalent CVD risk factor was hypertension found in 28.5% of the subjects. Only 39.3% of the hypertensives were aware of it, and only 25% of the known-hypertensives were taking anti-hypertensive treatment. Age was the only independent predictor of hypertension after controlling for confounding factors, and for every increase in age by 1 year, the risk of developing hypertension was increased by 6.6% (confidence interval, CI = 3.3-9.0; P < 0.001). Body mass index, plasma glucose, and hematocrit were higher among hypertensives than non-hypertensives (P < 0.05). Other CVD risk factors were uncommon. Conclusion: In the study, hypertension was common; its levels of awareness and treatment were low and mainly determined by increased age. "Western" lifestyle seems to be related to its development as age increased.

Background: Hypertension is associated with left ventricular hypertrophy (LVH). Serum uric acid is often elevated in hypertension. Objective: To assess the relationship between serum uric acid and left ventricular mass and geometry in untreated patients with essential hypertension. Materials and Methods: A cross-sectional study was carried out in 130 newly diagnosed untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular mass and geometry were evaluated by transthoracic echocardiography. 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 (384.79 ± 96.4 μmol/l) compared to controls (296.92 ± 89.8 μmol/l; P < 0.001). LVH was present in 55.4% of the cases and 10.8% of the controls (P < 0.001) and the commonest geometric pattern among the cases was concentric hypertrophy while the majority of the controls had normal left ventricular geometry. Among the hypertensive patients, LVH was commoner in the hypertensive patients with hyperuricemia compared to those with normal serum uric acid levels (70.5% versus 42.0%, P = 0.001) and the commonest geometry was concentric LVH. There was a significant linear relationship between mean uric acid levels and the left ventricular mass index (r = 0.346, P < 0.001). In regression analysis, uric acid was a significant independent predictor of LVH in women (β =0.406, P = 0.015) but not in men (β =0.161, P = 0.432). Conclusion: These results indicate that serum uric acid is associated with LVH in patients with hypertension especially women even at the time of diagnosis, thus may be a reliable marker of greater cardiovascular risk.

Background: Studies differ on the influence of gender and geometry on the functions of left ventricle (LV). We report the relation of abnormal geometry and gender to LV structure and functions in an African population. Materials and Methods: A total of 156 consecutive newly presenting hypertensives comprising 53% females were enrolled into the study. All participants underwent full clinical evaluation, and echocardiographic examination was performed according to the American Society of echocardiography recommendation. Using LV mass index (LVMI) and relative wall thickness, 145 subjects with complete echocardiographic parameters were divided into four LV geometric patterns; normal, concentric remodelling (CR), eccentric hypertrophy, and concentric hypertrophy. Results: The mean age of the hypertensive subjects was 59.5 (12.3) years. The mean age and blood pressure (BP) indices were comparable across the gender. While males were taller, females were heavier and had wider waist and hip circumferences. Men had larger left atrium, aortic root diameter, aortic valvular opening, LV dimensions, and LVM compared with females. LV systolic and diastolic functions were similar. More than half of the subjects had abnormal geometry with CR prevalent. The subjects with concentric hypertrophy were the youngest (P = 0.036) and had the highest mean diastolic BP (P = 0.037). There was no significant gender influence on the distribution of geometry pattern. Left Atrial diameter and LV dimensions except posterior wall thickness at diastole were significantly larger in eccentric hypertrophy when compared with other groups (P = 0.0001). LV ejection fraction was lowest among subjects with eccentric hypertrophy. Diastolic function parameters were comparable among the groups. Conclusion: The study showed that more than half of the study subjects had abnormal geometry even at the presentation. Abnormal geometry probably affects LV systolic function more than the diastolic filling patterns. Prompt management may alter the prognostic effect of abnormal geometry among the study group.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) also called as arrhythmogenic right ventricular dysplasia (ARVD) is an inherited heart muscle disease that predominantly affects the right ventricle (RV). The main pathologic feature is the progressive loss of RV myocardium and its replacement by fibrofatty tissue. Clinical manifestations develop most often between the second and third decades of life and are related to ventricular tachycardia (VT) or ventricular fibrillation (VF), which may lead to sudden death in young people.

Liver disease may lead to both reduced and increased risk of venous thromboembolism (VTE) caused by the changes in the coagulation cascade. We present a case of pulmonary embolism after the use of pegylated interferon (peg-IFN) plus ribavirin for treatment of chronic hepatitis C (CHC). Echocardiography revealed thrombus imaging in the pulmonary bifurcation zone and the patient treated successfully with thrombolytic therapy. Hemostatic work up showed no significant abnormalities. In the absence of underlying diseases and predisposing factors, drug interactions and incidental co-existence of pulmonary embolism should be kept in mind.

Truncus arteriosus is a rare congenital heart disease with average survival up to 5 weeks, and unrepaired truncus cases surviving into adulthood are very few. For these reasons, the natural history of the unrepaired defect is not very well-known, and is backed by only a handful of such cases that are reported. We report this very rare case of adult survival of an uncorrected truncus arteriosus, with certain aspects of presentation unique and insightful with regards to its natural history.

Wolf-Parkinson-White syndrome (WPW) is an uncommon condition associated with rhythm disorder. Supraventricular tachycardia (SVT) is often the rhythm abnormality sufferers present with. The cardiovascular status with the SVT could be stable or unstable, dictating how aggressive the management of the arrhythmia should be. In this case, the presentation and management of a neonate with SVT, whose arrhythmia was first detected in utero and later confirmed postpartum is presented.

Background: End-stage heart failure is often characterized by refractory symptoms, usually dyspnoea and fatigue at most times, despite optimal medical therapy. Specialized interventions are often required. Objective: To highlight the availability of some specialized interventions for Nigerian patients with end-stage heart failure. Materials and Methods: A 60-year-old man with chronic heart failure secondary to idiopathic dilated cardiomyopathy who was in steady state until 6 months prior to presentation when he developed recurrent episodes of exacerbation of symptoms despite optimal medical therapy. Echocardiography showed grossly dilated cardiac chambers, hypokinetic left ventricle, and ejection fraction (EF) of 20%. He was managed as a case of end-stage heart failure. Owing to poor response to medical therapy, specialized interventions were recommended. Result: He subsequently had successful orthotopic cardiac transplantation and was commenced on triple immunosuppressant drug therapy. Conclusion: All patients with end-stage heart failure should be availed the opportunity of having specialized interventions where resources are available.