The term early repolarization (ER) is defined electrocardiographically by either a sharp well-defined positive deflection or notch immediately following a positive QRS complex at the onset of the ST-segment, or slurring at the terminal part of the QRS complex. This pattern is frequently observed in the general population. For decades, ER was regarded as a benign electrocardiographic variant. However, in 2008, Haïssaguerre et al described a strong relationship between J-waves and many different forms of ventricular arrhythmias in the absence of known heart disease. It seems likely that ER results from a net increase in outward current caused by a loss of inward-channel function or a gain in outward-channel function. It remains unclear whether these mutations are more functionally important in the epicardium, or whether they simply exaggerate the magnitude of preexisting epicardial-endocardial differences by increasing overall net outward current flow. This review will discuss the underlying mechanisms, genetic basis, risk stratification and management.

The incidence of cardiovascular (CV) diseases is increasing worldwide raising the urgency for early detection of the underlying pathological processes. Early identification of risk factors is important to avoid hospitalization and to reduce CV morbidity and mortality rates. Cardiovascular risk can be assessed by history taking (age, gender, smoking habits), clinical examination (body mass index, heart rate, respiratory rate, blood pressure (BP), temperature and pulse oximetry), laboratory analysis (cholesterol, glucose, triglycerides, potassium, sodium) and with novel techniques like pulse wave velocity (PWV) and augmentation index. Pulse wave velocity is an emerging technique used for CV risk stratification, assessment of arterial stiffness and follow the efficiency of the therapeutic intervention. Pulse wave velocity proved to have independent predictive value when evaluated in conjunction with standard risk factors for CV diseases. However, the field of arterial stiffness research, which evolutes over the past 20 years, lacks guidance for research investigators. This review summarizes the mechanisms of arterial stiffness, various methodologies to assess arterial stiffness and the latest scientific statements regarding its clinical applications.

Background: Developing countries though faced with increasing burden of cardiovascular disease have the least contribution in articles published on cardiovascular research. There is a paucity of report on the trend of cardiovascular diseases particularly no report is available on the trend in Nigerian female patients. The aim of this study is to determine the trend of cardiovascular diseases and the gender effect. Materials and Methods: A retrospective analysis of medical admission in a public, secondary health center over a 5-year period (1997–2001) was carried out. Results: Of the 2474 patients, 37.0% with a mean age of 54.9 (14.6) years had cardiovascular diseases, 51.3% were females. Mean duration of hospital stay was 11.8 (9.1) days, range 1–90 days. This was a significant steady rise in the trend of cardiovascular disease which was higher among females (P = 0.003). Hypertension and hypertension-related complications constituted the bulk of cardiovascular diseases. Overall mortality was 155 (17%) for cardiovascular diseases although not significantly different gender wise was higher in males (86, 55.5%), P = 0.063. Conclusion: Targeted research and control of cardiovascular diseases among women may enhance the control of the menace of cardiovascular diseases.

Introduction: Undetected hypertension and diabetes could result in cardiovascular and cerebrovascular complications and may result in fatal road accidents if they occur while driving. Commercial drivers are prone to risk factors for these diseases. This study determined the prevalence of hypertension and diabetes among commercial drivers in Ibadan metropolis, South-western Nigeria. Methodology: A cross-sectional study was conducted among 305 commercial drivers selected using multistage sampling technique from motor parks across Ibadan metropolis. The WHO stepwise interviewer-administered questionnaire was used for data collection on respondents' sociodemographic characteristics, work-related characteristics, knowledge about hypertension and diabetes, physical activity, alcohol consumption, and tobacco use. Blood pressure, anthropometry, and blood sugar level measurements were carried out. Hypertension was defined as systolic blood pressure of ≥140 mmHg and diastolic blood pressure of ≥90 mmHg and diabetes was defined as ≥126 mg/dl fasting blood sugar. Data were analyzed using descriptive statistics, Chi-square test. and logistic regression at α = 5%. Results: Mean age of respondents was 45.3 ± 10.5 years. About 47.5% and 37.8% demonstrated good knowledge about hypertension and diabetes, respectively. About 49% reported to have ever smoked, 78.0% had consumed alcohol, 45.5% ever had traffic accident, and 44.6% reported physical inactivity. The prevalence of hypertension was 27.7% and diabetes was 3.4% while 42.9% had comorbidity. Hypertension was found among 26.2% of those who had ever smoked and 47.2% of those obese (body mass index ≥30 kg/m²). Age ≥41 years (adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 0.99–5.88) and abdominal obesity (aOR = 2.41, 95% CI = 0.99–5.83) were predictors of hypertension, and frequent fruit consumption was predictor of diabetes (aOR = 2.71, 95% CI = 0.23–32) although not significant. Conclusions: High prevalence of hypertension and relatively low prevalence of diabetes among commercial drivers in Ibadan metropolis call for health awareness campaign and free health screening in motor parks for early detection and prevention of the diseases.

Background: Coronary artery disease (CAD) is most common cause of mortality. Its incidence in young Indians is about 12%–16%. Myocardial infarction (MI) in young can be divided into two groups, those with angiographically normal coronaries and those with CAD. 15%–20% of those with CAD have no identifiable risk factors and therefore miss the opportunity for primary prevention. Recent reports have suggested that increased lipoprotein a (Lp[a]) and hyperhomocysteinemia play an important role in MI. The true prevalence of CAD in young is grossly underestimated. Aims: (1) Study of risk factors for MI in patients <35 years. (2) Clinical presentation. (3) Disease pattern in coronary angiography. (4) To assess the relationship of emerging risk factors such as homocysteine and Lp(a) with MI. Materials and Methods: Fifty patients aged 35 years or younger diagnosed with acute MI were included. Results: The majority of patients were males (80%). The mean age was 33.3 in males and 31.8 years in females. Chest pain was the most common presenting complaint (94%). Smoking was the most prevalent risk factor (72%). Hyperhomocysteinemia (42%) and raised Lp(a) (24%) were emerging risk factors. Anterior wall MI was most prevalent (64%) and most patients had single vessel disease with left descending coronary being the most commonly involved artery. Conclusions: Homocysteine and Lp(a) should be measured in young MI patients. Smoking cessation and prevention of diabetes and hypertension should be encouraged. As young patients have more discrete lesion, timely revascularization will reduce myocardial damage.

Background: Low-dose antiplatelet therapy is the standard of care for the prevention of primary and secondary cardiovascular events. Dyspeptic symptoms may result in discontinuation of treatment. Aim: The aim of the study was to determine the prevalence of dyspeptic symptoms among patients on low-dose antiplatelet therapy for primary and secondary prevention of cardiovascular events. Subjects, Materials, and Methods: This was a cross-sectional descriptive study of 253 adults on low-dose antiplatelet attending the Cardiology Clinic of the University of Calabar Teaching Hospital. Prevalence and clinical impact of dyspepsia were assessed using a structured questionnaire incorporating the gastrointestinal symptom rating scale. Data were analyzed using the Statistical Package for Social Sciences version 20. Results: A total of 253 patients were recruited for this study. The mean age was 54 ± 12.2 years. The prevalence of dyspeptic symptoms was 47.8%. Epigastric pain was the most common self-reported dyspeptic symptom (33.2%) followed by heartburn (23.7%). Melena and hematemesis were reported by 5.5% and 1.2% of the patients. Treatment duration was longer for those with dyspeptic symptoms (45.8 ± 139.6 vs. 28.3 ± 31 months), but the difference was not statistically significant (P = 0.17). A prior history of peptic ulcer disease was predictive of dyspeptic symptoms (odds radio; 8.62, confidence interval; 2.49–29.83). Majority (71.7%) of the patients reported their symptoms as occasional episodes which mildly impair their daily quality of life. Compliance was impacted in 6.7% of the patients. Conclusion: Dyspeptic symptoms, mostly epigastric pain, are prevalent among Nigerian patients on low-dose antiplatelets which negatively impact their daily life activities and compliance to treatment.

Background: Group A beta-hemolytic Streptococcus (GABHS) is the only causative organism of pharyngitis that is linked to the etiopathogenesis of acute rheumatic fever and rheumatic heart disease. Aim and Objectives: The objectives of the study were to determine the proportion of GABHS-related pharyngitis, the relationship of clinical symptoms and signs with positive culture outcome, and the antibiotic sensitivity pattern of GABHS among children aged 3–15 years, presenting with symptoms of sore throat in three public hospital settings across Abeokuta. Methods: Consecutive children aged 3–15 years who present with sore throat or drooling of saliva and any one of these following signs and symptoms were considered eligible: fever >37.5C, cervical lymphadenopathy, inflamed tonsils, and exudative tonsils. All bacitracin susceptible Gram-positive, catalase-negative cocci were classified as Streptococcus pyogenes. Results: Of 3386 children that were seen, (30) children met the eligibility criteria. Sixteen (53.3%) were males while 14 (46.7%) were females. The mean age of the children was 7.37 years ± 3.146. Cough was the most sensitive symptom (65%) while the presence of exudate was the most specific sign (70%) for GABHS acute sore throat. GABHS was isolated in 66.7% of the children. Streptococcus viridans was found in 4 (13.3%) while the remaining 6 (20%) were sterile. The highest sensitivity was shown to gentamicin and chloramphenicol while amoxicillin-clavulanic acid had the highest resistance (94%). Conclusion: The proportion of GABHS throat infection is high in this environment. The current findings underscore the need to increase awareness about appropriate throat examination and treatment of sore throat among primary care physicians.

A 28-year-old apparently healthy young male working in Border Security Force referred to our institute for annual master health checkup. The routine biochemical tests, 12-lead electrocardiogram (EKG), chest X-ray, and echo were normal. His exercise ECG was remarkable for significant horizontal ST depression in lead I, AVL, V4–V6 during treadmill test at 15 METs. He had usual breathlessness during exercise. Coronary angiogram revealed conus branch of right coronary artery to right atrial coronary cameral fistula draining into right atrium which may be an unusual reason for inducible ischemia at high-intensity exercise as the other coronary arteries were normal. He is now under regular follow-up for need–based, catheter-based intervention in the future because of asymptomatic presentation and small size fistula. A period of 12-month follow-up was uneventful.

Rhabdomyomas are rare tumors in children often associated with tuberous sclerosis. They are usually diagnosed during antenatal period or as an incidental finding. The first case is a 2.5-month-old child who was diagnosed to have rhabdomyomas at gestational age of 24 weeks. Electrocardiogram revealed left axis deviation and multiple premature atrial contractions. Echocardiography showed massive tumor occupying the right ventricular cavity. Tuberous sclerosis was seen on magnetic resonance imaging. He was commenced on everolimus with obvious regression of tumor. The second case is an 8-month-old male who was referred to us for cardiac evaluation. Echocardiography showed two masses of rhabdomyoma. He was also placed on everolimus but was lost to follow-up. Rhabdomyomas are rare tumors of the heart which respond well to chemotherapy.

Uhl's anomaly of the right ventricle is a rare anomaly. At present, only about 84 cases have been reported in over a century. We report a case of a 1-year-old male child who presented to our outpatient pediatric cardiology clinic with a history of recurrent cough and difficulty in breathing and failure to gain weight in the preceding 2 months. Chest X-ray showed cardiomegaly, whereas electrocardiogram showed a normal sinus rhythm with poor right ventricular (RV) forces. Echocardiography showed severely dilated right ventricle with thinned out right ventricle wall and poor RV function with severe tricuspid regurgitation. He has been placed on aspirin, lasilactone, and clexane. However, there was no satisfactory surgical option available, and heart transplant was recommended. Uhl's anomaly of the right ventricle is a very rare anomaly which defies all surgical option except transplant. Early recognition institution of drugs that improves cardiac function may improve the quality of life of the child.

Kawasaki disease (KD) is associated with coronary artery lesion, especially in the form of aneurysm and ectasia. The first case is 1-year, 9-month-old female; the second is a 13-month-old male, the third is a 14-month-old female, and the fourth is a 5-year, 6-month-old male who all satisfied the criteria of KD. Echocardiography done for all the series showed dilatation of the left anterior descending coronary artery measuring 2.15 mm with Z score of 2.53 and focal dilatation of left main coronary artery with maximum diameter of 2.9 mm with Z score of 2.44 for the first case, prominent left coronary artery measuring 2.19 mm with Z score of 1.28 with borderline dilatation of the circumflex coronary artery measuring 2 mm with a Z score of 2.13 for the second case, and left coronary dilatation measuring 3.5 mm with Z score of 3.61 and borderline left coronary artery dilatation measuring 3.5 mm with a Z score of 2.24, respectively, for the last two cases. We documented four cases of KD as much as we know, and all the four cases presented with coronary artery aneurism with a good response to chemotherapy.

In the era of percutaneous coronary interventions, stent thrombosis is a rare, but potentially catastrophic complication with the majority of patients presenting with acute coronary syndromes or life-threatening arrhythmias. However, development of pseudoaneurysm following stent thrombosis is extremely rare. We report a case of left ventricular pseudoaneurysm following stent thrombosis that was successfully managed with coronary artery bypass grafting with resection of the pseudoaneurysm.

Although chest pain is the most common presentation of ischemic heart disease, there are other rare presenting symptoms such as indigestion, diaphoresis, and rarely only with headache. High degree of clinical suspicion is needed in any patient presenting with headache to have ischemic heart disease as an etiology. Hereby, we report an unusual case of acute coronary syndrome in a young patient under the age of 50 presenting with only headache.