Background: The electrocardiogram (ECG) is recorded in the supine position and values of various parameters are based on calculations made from supine ECG recordings. In certain situations, such as exercise stress testing and evaluation of syncope by the head-up tilt test, the ECG is recorded in the upright position. Thus, it becomes equally important to study and quantify the nature and magnitude of changes seen in the ECG with a change of posture from supine to upright in healthy individuals. Aim: To study and investigate the effect of a change in body position on the frontal plane on ECG. Materials and Methods: Thirty healthy adult subjects (15 male and 15 female) in the age group of 18-25 years were included. The ECG was recorded in four body positions, supine, reclining with the trunk flexed at 70°, sitting upright, and standing. Results: The mean frontal plane QRS axis recorded in the supine and standing positions was comparable. The reclining and sitting ECG show a significant variation of the mean QRS axis as compared to the supine position. The T-wave axis was found to be comparable in the supine and standing positions. The corrected QT (QTc) interval showed a significant change with a change in the body position from supine to standing. Conclusion: All the subjects showed similar ECG changes, but differences in the magnitude of the changes with change in body position. The change in the QTc interval with standing needs to be explored.

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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.

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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.

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Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.

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America's Joint National Committee (JNC) on the prevention, detection, evaluation, and treatment of high blood pressure is one of the foremost regional regulatory bodies on the management of hypertension. Its latest report (JNC-8) of 2014 has attracted a lot of strong criticisms. The aim of this review is to offer a summarized insight into the different opinions that have trailed its process and content since its publication.

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Cardiovascular diseases (CVDs) are a leading cause of death worldwide with an accelerated increase in CVD-related death in Nigeria and other low-income and middle-income countries. A review of the trend of presentation and management of CVDs in Nigeria over the past 20 years revealed a transition from high incidence of CVDs associated or resulting from poverty and malnutrition (such as rheumatic heart disease) initially to a fall in the prevalence of these poverty-related CVDs occurring subsequently at same time with a rising prevalence of other noncommunicable CVDs (such as hypertension and heart failure). Although some CVDs such as coronary heart disease and cardiomyopathies maintained a steady prevalence within the period in review, this trend was associated with changing availability of healthcare services in Nigeria, with better services and newer treatments becoming more available over time and increasing prevalence of CVD risk factors among Nigerians. Despite these, Nigeria is at a plateau now as a result of poor funding and support of the health sector. This has resulted in most health funding coming from donor agencies, religious bodies, philanthropists, and nongovernment organizations. For progress, there is a need for an increase focus in the health sector with increased funding and support from the government and all players. Increased awareness and education of the general population on the prevention and control of risk factors and training of health professionals on appropriate diagnosis and management of CVDs is advocated.

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Background: The response to chronic heart failure (CHF) involves activation of neurohormonal mechanisms that may alter the water and electrolytes homeostasis. Diuretic therapy also influences the electrolytes and water balance. Objective: This study aims to evaluate the electrolytes, urea and creatinine levels in children with CHF on diuretic therapy in comparison with controls who do not have heart failure and are not on diuretics. Methods: This cross-sectional study involved children with congenital heart disease on high ceiling diuretic, spironolatone and captopril with their age and sex matched controls. The electrolytes, urea and creatinine values were determined in standard fashion and compared between subjects and controls. Results: There were 25 each of subjects and controls recruited for the study. The differences in the mean electrolytes, urea and creatinine values between subjects and controls were not significantly different, P > 0.05. There was no case of hypokalemia in either subject or control. There were more subjects than controls who had hyponatremia, P = 0.25. The mean electrolytes, urea and creatinine in subjects on therapy for <6 months were not significantly different from those on therapy for ≥6 months, P > 0.05. Conclusion: The combination of high ceiling diuretic, spironolactone and captopril was able to maintain most electrolytes, urea and creatinine levels in children with CHF. However, subjects were more likely to have hyponatremia than controls. Regular electrolyte determination to exclude hypotremia is therefore recommended in children with CHF on diuretic therapy.

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Heart failure (HF) is a major cause of morbidity and mortality worldwide. HF severity and mortality can be predicted by measurement of quality of life (QOL). Generic and disease-specific instruments for measurement of QOL have been shown to be effective in clinical settings and in research. QOL compares favorably with traditional calibrators of HF severity such as New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), 6-min walk test (6MWT), and B-type natriuretic peptide levels. QOL measurement using domains such as social interaction, emotion, environmental interaction, sexual activity, and demographic characteristics, among others, can be used effectively in resource-limited environments, as well as adjunct to echocardiography and BNP. Lower QOL predicts early and more frequent HF hospitalization, depression, higher NYHA class, poor 6MWT, lower estimated glomerular filtration rate, and lower LVEF. Older age, lower socioeconomic status, longer duration of HF, and comorbidities correspond to lower QOL scores. Clinical trials incorporating QOL as primary and/or secondary end-point show improved QOL with the use of angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, beta blockers, device therapies, such as implantable cardiac defibrillator, and exercise-based rehabilitation. The aim of this paper is to review information on QOL in HF.

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Peripartum cardiomyopathy is cardiovascular disorder that is seen only in females in third trimester to 6 months post delivery. It is a diagnosis of exclusion. The syndrome is still seen in Nigeria more especially Northern Nigeria where the largest cohort of patients were described in the early 70s. The longest follow up (30-35) years of the syndrome was also done in Zaria, Northern Nigeria. The etiology of the syndrome is unknown but from different parts of the world clinicians have associated the syndrome to different risk factors. The authors did a Medline, AJOL and other search to review write ups on this syndrome. Of the 27 publications on the syndrome from Nigeria, 90% came from the Northern Nigeria. In Nigeria the syndrome was associated with the famous Wakan Jeko which composes of a triad of hot baths, ingestion of pap (kunun kanwa) which is made with lake salt that has high levels of sodium (Na ⁺ ). Other authors have associated it with hypertension, myocarditis, use of tocolytics and deficiency of trace elements like selenium. Recently the South Africans have also proposed the possibility by products of stress on Prolactin leading to cardiac damage/Peripartum cardiomyopathy has maternal and child health implications in Nigeria, sometimes it does lead to maternal mortality so also infant mortality. Patients have been reported to have developed recurrent Peripartum cardiac failure if they did not take heed to the advice regarding avoiding the wakan jeko. Some of these patients have gone on to develop hypertension and presented with hypertensive cardiac failure or cerebrovascular accident. Peripartum cardiomyopathy etiology is still an enigma. A coordinated national and international effort is required to do a comprehensive research on this syndrome to put to rest or uphold some of the theories regarding etiology.

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Syphilis is less commonly seen in clinical practice. Hence, presenting features of primary, secondary, and tertiary forms of syphilis are not recalled during discussion. A case of syphilitic aneurysm observed in a 54-year-old male is presented to create awareness of this condition among healthcare professionals and stress importance of this entity in the differential diagnosis and treatment of mass in the chest wall.

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Background: The goal of the health education is to influence their perception of tobacco use, thereby discouraging smokers and would be-smokers from smoking. Objective: This study is aimed at ascertaining the level of awareness of the warning against smoking, perception of tobacco use and tobacco control measures among residents of Abia State, South-East Nigeria. Materials and Methods: A cross-sectional, population-based survey of respondents (aged 18 years and above) were selected by multi-staged sampling technique. Responses were elicited from them using an interviewer-administered questionnaire on sociodemographic characteristics; awareness of warning against tobacco use, sources of information, perception of harmful effect of tobacco and tobacco control measures. Results: About 88% of the respondents were aware of warning against tobacco use, the most common source of information was media adverts (50.7%). Awareness of warning against tobacco use was found to be associated with sociodemographic characteristics, history of smoking, exposure to smoke at home and public places, and perception of tobacco use. Conclusion: The findings from this study present an opportunity for initiating more robust policies, programs and interventions for tobacco control in the state.

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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.

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Objective: The objective of this study was to assess the prevalence and pattern of congenital heart disease (CHD) using echocardiography. Materials and Methods: Patients of 0–12-year-old attending outpatient and inpatient of pediatric department clinically diagnosed with heart disease were further evaluated with chest radiography, twelve-lead electrocardiograms, and the confirmation of the diagnosis was done using two-dimensional echocardiography. Results: Among a total of 42,423 patients availing outpatient and inpatient facilities at the pediatric department of a tertiary referral center, 655 were clinically suspected as having heart disease among which 430 patients were identified as CHD, giving a prevalence of 10.13/1000 live births. About 56.28% patients were below 1 year and male:female ratio was 1.3:1. Consanguinity was observed in 42.09% and most of them were of third degree. Breathlessness was the most common symptom and tachycardia was the most common sign. About 66.74% of patients were diagnosed with acyanotic and 33.26% with cyanotic type. The most common CHD was ventricular septal defect (VSD) (30.01%) followed by atrial septal defect (20.70%), tetralogy of fallot (TOF) (16.05%), and patent ductus arteriosus (10.23%). The most common cyanotic CHD was TOF followed by transposition of great vessels, total anomalous pulmonary venous connection, and single ventricle. Case fatality rate was 19.23% and most of the deaths in neonatal age group due to complex CHD, refractory congestive cardiac failure, sepsis, and pneumonia. Conclusion: The prevalence of CHD in this study was 10.13/1000 live births. VSD and TOF were the most common acyanotic and cyanotic CHD, respectively. Case fatality rate was 19.23% and most of the deaths occurred in neonatal age.

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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.

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Background: Endomyocardial fibrosis (EMF), an obliterative cardiomyopathy of uncertain etiology, is the most common restrictive cardiomyopathy worldwide with no specific treatment and usually associated with poor prognosis due to late presentation. First described in the literature in 1946 among Africans, the prevalence seem to be decreasing, but without much change in its management in the region due to late presentation and inadequate surgical responsiveness. Earlier literature described EMF as a disease of the rain forest, only restricted to dwellers in the coastal regions. Despite the growing body of knowledge on this condition, there is not enough corresponding advancement in therapeutic interventions for the sufferers in Nigeria. Materials and Methods: Between May 2010 and July 2011, we reviewed cases of endomyocardial fibrosis presenting to the cardiology unit of Jos University Teaching Hospital, Plateau State Nigeria. The institutional board of the hospital approved the review, and consent was obtained from the patients/guardians. Effort was made to withhold identity of the patients in accordance with established protocol. Result: The first case was an 18-year-old female student with features of chronic heart failure who has earlier been misdiagnosed as having rheumatic valvular heart disease, but had biventricular EMF. Case 2 was a 33-year-old man who presented with breathlessness and hemoptysis and was erroneously on treatment for tuberculosis. Echocardiography revealed right ventricular EMF. The final case was a 27-year-old farmer with cough, progressive shortness of breath and abdominal swelling. Holter monitoring revealed ventricular and atrial arrhythmias, and echocardiography showed pericardial effusion with features of right ventricular EMF. He had bouts of arrhythmia with collapse, and finally died suddenly. Conclusion: There have been little advances in management of EMF seven decades after it was discovered, and despite being one of the major causes of heart failure in the tropics, awareness and response to management in these areas have lagged behind.

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Dextrocardia occurs when the heart is located on the right side of the thoracic cavity. It may be classified as dextroposition, isolated dextrocardia, dextrocardia with situs inversus, and dextrocardia with situs ambiguous. Dextrocardia may also be associated with other co-morbidities. We report cases of dextrocardia seen over a seven-year period with varied presentations.

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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.

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Background: The cardioprotective effect of estrogen has been well documented, and the effect of testosterone on blood pressure (BP) is controversial and remains inconclusive. Aim: The present study is aimed at investigating the effect of testosterone on BP in normotensive rats. Materials and Methods: In a blind study, 30 male albino rats (200-250 g) were divided into 5 oral treatment groups (n = 6 rats each) as follows: Groups I and II were intact rats that received 1 ml/kg normal saline (vehicle) and 25 mg/kg testosterone subcutaneously for 24 days. Group III was sham-operated and received normal saline for 24 days. Groups IV and V were bilaterally orchidectomized and received normal saline and 25 mg/kg testosterone subcutaneously for 24 days. Results: The systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) of the sham-operated rats that received normal saline were not significantly different from the intact (control) rats that received normal saline (P > 0.05). Testosterone treatment in control rats caused a sustainably higher SBP (P < 0.001), DBP (P < 0.001), PP (P < 0.001), and MAP (P < 0.001) when compared to control that received normal saline. The SBP (P < 0.01), DBP (P < 0.001), MAP (P < 0.001), but not PP (P > 0.05) was significantly reduced in orchidectomized rats that received normal saline when compared to control. However, administration of testosterone in orchidectomized rats abolished orchidectomy-induced reduction in SBP, DBP, MAP, but not PP and further increased them above the control level (P < 0.05). Conclusion: This study shows that testosterone is prohypertensive in normotensive rats.

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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.

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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.

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Background: Cardiovascular disease (CVD) is responsible for a large proportion of death and disability worldwide. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the world's population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD. Objective: This study was aimed at determining the frequency and pattern of cardiovascular disorders in the medical wards as well as the emergency and intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Southeast Nigeria. Methods: A retrospective study of consecutive adult patients with diagnosis of cardiovascular disorders admitted into the medical wards and/or the emergency/intensive care units of UNTH Enugu between January 2000 and January 2007 was carried out using the ward admission and discharge registers. Results: A total of 6,162 patients (males 3,385 (54.93%); female 2,777 (45.07%)) were admitted over the period covered by the study. Out of these; 1,261 (20.46%) patients were found to have cardiovascular disorder. Prevalence of cardiovascular disorders was found to be higher among the female patients than among the males: 693 (24.95%) and 568 (16.78%) years, respectively. The ages ranged between 18 and 92 years with a mean ± standard deviation (SD) of 55.13 ± 15.37. The pattern of CVD observed in this study were hypertension and its complications (86.36%), rheumatic heart disease (4.52%), dilated cardiomyopathy (3.09%), and alcoholic heart muscle disease (0.95%). Conclusion: CVDs were major causes of morbidity in the environment of study. Early detection, improved outpatient care, as well as inclusion of appropriate secondary prevention programs in patient's management especially at the community level is recommended in order to reduce complications and the need for hospital admissions.

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