Arrow-related injuries are rare in most developed countries and may occasionally occur as sports-related injuries; however, this is still a problem in most crisis-prone areas in Nigeria. Though arrow-related injuries are classified as low velocity injuries, they may cause enormous damage to vital structures as in the case of a penetrating arrow-related cardiac injury in a Fulani boy; though he presented late and it took almost 48-hours before surgical intervention, he was successfully managed and discharged home without any complication.

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Background: The clinical profile and the mortality rate among patients with acute coronary syndromes (ACS) is not well-studied in Kumaun region of Uttarakhand. Objective: The aim of the present study is to determine the clinical characteristics, mortality rate and possible risk factors for high mortality among patients with ACS in Kumaun region of Uttarakhand. Methods: Retrospective analytic study conducted at Dr. Susheela Tiwari hospital associated with Government Medical College, Haldwani. All the cases admitted to the coronary care unit of Dr. Susheela Tiwari hospital, between May 2012 and April 2013 were included. Cases were grouped into ST-segment elevation myocardial infarction (STEMI) and non-STEMI/unstable angina (NSTEMI/UA) for the purpose of analysis. Chi-square test and unpaired t-test. Results: Mean age of presentation was 55.86 ± 13.4 years. Mortality rate was higher among patients with inferior wall infarctions when compared with anterior wall infarctions (12.94% vs. 7.14%; P < 0.05). ACS cases with co-existent cardiovascular risk factors such as diabetes mellitus (DM), dyslipidemia, obesity and previous coronary artery disease (CAD) reveal statistically significant higher risk for death when compared to those without these risk factors. Mortality rate was higher among patients with inferior wall infarctions when compared to anterior wall infarctions (12.94% vs. 7.14%; P < 0.05). Conclusions: Mortality rates among patients was 10.95%. ACS Subjects with DM, dyslipidemia, obesity, previous CAD history and elderly individuals had greater mortality rates and are high risk groups. Among the patients with NSTEMI/UA females had higher mortality rate. Hence, these findings can be taken into account during management of ACS patients.

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Atrial myxoma has been reported as source of coronary emboli, a rare complication, causing acute myocardial infarction (MI). We report case of a 28-year-old male, who presented with acute chest pain, radiating to left arm, with sweating and palpitation. Transthoracic echocardiography (TTE) showed an irregular homogenous pedunculated mass of size 3.7 × 2.1 cm attached to the interatrial septum towards the base of the anterior mitral leaflet, prolapsing into left ventricle (LV) during diastole, but not obstructing the flow. Emergency coronary angiography revealed a tubular lesion (thrombus containing) in left anterior descending (LAD) coronary artery. The patient was diagnosed as acute anteroseptal MI due to LAD coronary artery embolization originating from left atrial myxoma. Coronary artery bypass graft (CABG) along with surgical resection of friable myxomatous mass was done. Histopathological examination was consistent with atrial myxoma. Present case justifies that atrial myxomas should be considered as a differential diagnosis while dealing with MI in young patients.

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Background: In Nigeria, there is increasing urbanization and westernization of the population with resultant increase in non-communicable diseases. Though records of hospital admissions may not indicate the actual prevalence of such diseases in the community, it may provide clues about pattern and assist in disease-specific health promotion and education. Objective: We, therefore, undertook this study to describe the pattern and outcome of cardiovascular diseases (CVD) admissions in a new referral hospital in Nigeria. Methods: A five-year retrospective analysis of CVD admissions into the Medical Wards of Ekiti State University Teaching Hospital from May 2008 to April 2013 was done. SPSS IBM 20 software was used to analyze data. Results: A total of 3,076 medical admissions were recorded with 1,009 (32.80%) being CVD. Mean age of CVD patients was 61.16±15.95 years. Patients aged >65 years accounted for 478 (47.8%) of the admissions. The 3 major CVD admissions were cerebrovascular diseases (47.7%), heart failure (27.6%), and hypertensive diseases (22.0%). Deaths due to CVD were 192 (19.0%) comprising mostly 136 (13.51%), 43 (4.26%), and 12 (1.19%) of deaths due to cerebrovascular disease, heart failure, and hypertensive diseases, respectively. Most deaths occurred within 3 days of admission with a decline in mortality with increasing length of hospital stay thereafter. Mean duration of hospitalization was 8.76±7.23 days. Conclusion: Admissions from CVD to the medical wards in this hospital are high, so is mortality from them. We advocate for preventive strategies to reduce the burden of CVD and improved health care facilities to improve outcomes of their treatment.

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Background: Increased left ventricular mass (LVM) and diastolic dysfunction are associated with higher morbidity and mortality among adult patients with human immunodeficiency virus (HIV) infection. Objective: The objective of the following study is to determine the prevalence of increased LVM and diastolic dysfunction in Nigerian children infected with HIV. Methods: Cross-sectional comparative study of LVM and left ventricular (LV) diastolic function of 150 HIV-positive children and controls asymptomatic for cardiac disease. Results: Mean LVM was larger in subjects than controls - 66.5 (95% confidence interval, 63.7-69.3) versus 56.9 (54.1-59.7) g/m ² respectively - P < 0.001. An increased LVM was present in 21 (14.0%) subjects and 4 (2.7%) controls - P < 0.001. Mean mitral valve peak flow velocities and pressure gradients for the early and late diastolic waves were higher among HIV positive children than controls (P < 0.001). LV diastolic dysfunction was present in 46 (30.7%) subjects and 19 (12.7%) controls (P < 0.001). Subjects with increased LVM were younger and had more severe disease than those with normal LVM. Subjects and controls were similar with respect to their clinical and immunological stages of disease and use of nucleoside reverse transcriptase inhibitors. Conclusion: Increased LVM and diastolic dysfunction are significantly more common in HIV-infected children compared with controls and occur in asymptomatic subjects.

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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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Cor triatriatum dextrum is an exceptionally rare congenital heart disease, in which the right atrium is partitioned into two chambers by a membrane to form a triatrial heart. It is caused by persistence of the right valve of sinus venosus. The aim of presenting this case is to highlight that cor triatriatum dextrum though rare can result in right heart failure, mimicking other common causes of heart failure such as mitral valve disease. 2D-echocardiography is an important tool in making early and accurate diagnosis. We report a case of an adult Nigerian with cor triatriatum dextrum presenting with pulmonary hypertension in heart failure that was initially misdiagnosed as pulmonary tuberculosis with right heart failure at the referring center, and then mixed mitral valve disease clinically by us prior to echocardiographic assessment.

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Coronary artery anomalies (CAAs) are assorted group of congenital disorder whose nomenclature, manifestations, and pathophysiological mechanisms are highly inconsistent. The prevalence of congenital anomalies of the coronary arteries is reported to be approximately 0.6%-1.3% of the general population. Of them, double right coronary artery (RCA) is one of the rarest coronary anomalies . In this case, double split right coronary arteries are diseased with these other two left-sided arteries are also having atherosclerosis disease with significant stenosis, labeling this patient as having "Four vessel disease." If this anomaly had gone undiagnosed or missed, the patient's symptoms would have been recurred despite revascularization.

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Background: Asymptomatic myocardial ischemia is more common in diabetic than in the normal individual. Therefore, it becomes necessary to screen cardiovascular disease as early as possible. Objective: The present study was aimed to assess non-invasive procedures for the detection of asymptomatic myocardial ischemia and other coexistent risk factors in type 2 diabetics. Methods: A total of 76 patients with type 2 diabetes mellitus (T2DM) with no clinical history of coronary heart disease were included in the study and evaluated for silent myocardial ischemia by stress cardiac exercise tolerance test (ETT), echocardiography and electrocardiogram (ECG). Baseline clinical characteristic such as age, gender, Smoking, duration of diabetes, hemoglobin A1C (HbA1c) %, urinary microalbuminuria, hypertension, dyslipidemia and retinopathy were evaluated and reported. The clinical characteristic of ischemic ETT and normal ETT patients were compared. Results: The ETT showed an ischemic pattern in 22 patients (28.94%), the ECG was suggestive of ischemia in six patients (7.89%), echocardiography showed diastolic dysfunction in 18 (23.68%). Patients with microalbuminuria, hypertension, dyslipidemia and smoking and/or diastolic dysfunction were more prone than others to have ischemic ETT and patients with diastolic dysfunction had a higher prevalence of ischemic ETT. The prevalence of microalbuminuria, hypertension, dyslipidemia and smoking were found significantly higher in ischemic ETT when compared to normal ETT patients. The body mass index, HbA1c% and duration of diabetes were not shown significant deference in patients with positive ischemic ETT when compared to normal ischemic ETT patients. Conclusion: The cardiac ETT was found to be most helpful for detecting asymptomatic myocardial ischemia in T2DM patients on outpatient department basis. Study provides evidence for prevalence of asymptomatic myocardial infarction (MI) in diabetic patients. Moreover, this study will help to other diabetes care center for screening and prevention of asymptomatic MI in T2DM patients.

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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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Background: Myocardial bridges (MBs) are a congenital abnormality in which a part of the coronary artery is tunneled or immersed in the myocardium, most commonly found in the left anterior descending (LAD) artery. In the artery proximal to the bridge, there is formation of atherosclerosis causing stenosis. However, the tunneled and distal part of the artery is free from atherosclerosis. Objective: This study will investigate the relationship between MB type and proximal stenosis in hypertensive patients. Methods: A total of 140 MB patients were selected form Nanjing Hospital database, all aged between 31 and 91 years. A total of 33 were further excluded from the study. The data of the remaining 107 patients, including the type of bridge, length, depth, blood pressure, cholesterol level, and artery involved, were all taken. The Pearson's Chi-square test was done to compare the relationship between the bridge type and degree of stenosis in the artery proximal to the bridge in hypertensive patients. Results: Among those 107 patients, 69 (64.4%) had a superficial bridge and 38 (35.5%) had a deep bridge. The P value of the superficial bridge group was (0.993), while that of the deep bridge group was (0.580). Conclusion: In this study, superficial bridges were the most common form of MB and the most common artery involved was the (middle segment of) LAD. There were no signs of atherosclerosis in the MB (or tunneled) arteries or the distal parts. This study found no link between MB type and proximal stenosis in hypertensive patients.

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Background: Regular short term use of mobile phone at domestic level did not impact upon the health of humans. Objective: The objective of the following study is to look for the effect of radiofrequency emitted by mobile phone during turned on mode on the electrocardiogram (ECG) record in patients presented with acute coronary syndrome (ACS). Methods: A total number of 102 patients comprise of 61 males and 41 females presented with ACS were included in this study. The patients were grouped according to the ECG record into patients with non-ST elevation myocardial infarction (Group I) and ST elevation myocardial infarction (Group II). ECG records were obtained at baseline and during exposure to the radiofrequency (900 MHz) of mobile placed at the belt level and over the precordial region. Results: Radiofrequency of mobile phone (turn ON mode) placed at belt level significantly shortened P-R period In Group I. The other variables related to the cardiac conductive system; the QT period and the duration of QRS wave complex or to the voltage criteria did not significantly alter in both groups. Conclusion: Regular short term use of mobile during the recovery period of ACS is safe and does not impact upon ECG record.

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