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: Proper interpretation of electrocardiogram (ECG) in children relies on comparisons with standards derived from normal population. Comprehensive data on ECG in Nigerian children are lacking. Objective: To determine the ECG reference values for Nigerian Children. Subjects and Methods: A cross-sectional study was conducted on 1500 apparently healthy Nigerian children between 0-12 years at Ilorin. The ECG was recorded at a sampling rate of 1000Hz with V ₃ R replacing V ₃ and the ECG parameters were measured by hand. Results: The means and standard deviations of the lead independent ECG indices are as follows: Heart rate, 117 ± 23; QRS duration 0.05 ± 0.01 PR Interval 0.13 ± 0.02, QRS axis 63.80 ± 37.6, P wave axis 46.6 ± 18.4, T wave axis 44.5 ± 18.5, P wave duration 0.07 ± 0.01, P wave amplitude 1.4 ± 0.48. These values are similar to those of the Caucasian children. The mean amplitude values of Q, R, S and T waves are also similar to the Caucasian Children. The 98 ^th percentile values in some of these leads are substantially higher than that of the Caucasian children. This calls for caution when interpreting ECG in Nigerian children. Conclusion: ECG normal limits have been established in Nigerian children at Ilorin. Similar studies should be conducted in other geo-political zones in Nigeria so that ECG reference values for Nigerian children could be established.

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Background: Heart diseases of childhood are of public health importance, especially in developing countries. Community-based studies are important in ascertaining the burden of disease. We set out to clinically evaluate the prevalence of heart disease among primary school children in Hwolshe electoral Ward, Jos, Plateau State. Subjects and Methods: A total of 418 primary school pupils were selected by multistage sampling from three schools in Hwolshe ward of Jos South Local Government Area, Plateau State. They were studied for the prevalence of heart disease using clinical examination, followed by chest radiography, electrocardiography and echocardiography (echo) in those with clinical signs of heart disease. Results: The 418 subjects were aged 6-12 (mean 9.0 ± 1.95) years. 252 (55.5%) were girls. Significant tachycardia and pulse irregularity were present in 1 (0.24%) and 3 (0.72%) children respectively. None had hypertension - according to the seventh Joint National Committee criteria. 4 (0.96%) had audible murmurs of which 3 (0.72%) were pathologic. These three subjects were subsequently confirmed by echo to have congenital heart disease (CHD) - two ventricular septal defects and one atrial septal defect. The heart disease prevalence was therefore, 0.72%. All three identified cases of CHD had associated cardiac dysrhythmias: Wandering atrial pacemaker, first degree heart block, and incomplete right bundle branch block, respectively. No case of rheumatic heart disease was identified. Conclusions: Prevalence of heart disease by clinical screening in Jos South school children is approximately 0.72%. Careful cardiac auscultation as part of compulsory health screening at primary school entry and exit will help detect asymptomatic children with heart disease and facilitate treatment before the onset of complications.

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Background: Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries. According to the World Health Organization (WHO), rheumatic fever (RF)/RHD affects about 15.6 million people worldwide, with 282,000 new cases and 233,000 deaths each year. There are about 2 million people with RHD requiring repeated hospitalization and 1 million likely to require surgery globally. Objective: The objective of the study is to explore the pattern of RHD in Abeokuta where such a study has not been reported in the past. Materials and Methods: This is an analysis of a prospectively collected data over a period of 5 years (Jan 2006-Dec 2010). We collected information on the bio-data, clinical features and echocardiographic diagnoses. Results: During this period, a total of 107 cases of RHD were seen, 66 females (61.7%) and 41 males (38.3%) aged 43.9 ± 19.3 years (range, 7 to 92 years). Mitral regurgitation was the most common lesion (63.6%). Other common lesions include pure mitral stenosis (14.0%), mixed mitral valve disease (6.5%), and mixed mitral and aortic regurgitation (5.6%). Complications of RHD observed included secondary pulmonary hypertension, valvular cardiomyopathy, atrial fibrillation, stroke and infective endocarditis. Conclusions: Our data show that RHD is an important cause of heart disease in this city although the prevalence is lower than studies done in southern Nigeria in the 60s and 70s. Most present with complications and many do not have access to surgical therapy. There is, therefore, a need for improved surveillance and control of the disease at the community level.

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Background: The population of elderly persons with diabetes mellitus is increasing worldwide. However, there is scarcity of data on this subgroup of diabetic subjects in our locale. Objective: To study the clinical and biochemical characteristics of elderly diabetic subjects who developed DM at the age of 65 years and above. Subjects and Methods: Hospital records of all persons with type 2 DM seen at a Diabetes Clinic in Benin City, Nigeria who were diagnosed at the age of 65 years and above were retrieved for the study. Data on patient's age, sex, duration of diabetes mellitus, body mass index, waist circumference, blood pressure, fasting plasma glucose, glycosylated hemoglobin A1c (HbA1c), and fasting lipid profile were extracted. Medical records of clinic patients with DM who were diagnosed before the age of 65 years served as controls. Results: Sixty-three patients who developed DM at the age of 65 years and above were included as study subjects while 398 who developed DM before the age of 65 years served as controls. The study subjects consisted of 33 (52.4%) females and 30 (47.6%) males. The mean ± SEM age of study subjects was 73.40 ± 0.72 years (min-max, 66-92 years). Thirty-three (52.4%) of the study subjects had concurrent DM and hypertension. Hypertension and generalized obesity were found in 30 (47.6%) and 8 (12.7%) subjects, respectively. Abdominal obesity was found in 28 (44.4%) of female and in 12 (19%) of male study subjects. The mean body mass index (BMI) was significantly larger in the controls than in the study subjects (28.76 ± 0.45 vs. 26.64 ± 0.72; P = 0.016). The mean systolic and diastolic blood pressures and lipid profile were comparable in study subjects and the controls. Conclusion: Hypertension and dyslipidemia were more common in our elderly study subjects but generalized obesity was less common.

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Restrictive cardiomyopathy is characterized by restrictive filling and reduced diastolic volume of either or both ventricles with normal or near-normal systolic function and wall thickness. Here, author reports a case of 18-year-old boy who presented with cardioembolic stroke. On further workup, restrictive physiology was identified and possibility of constrictive pericarditis (CP) could not be ruled out on two-dimensional echocardiographic examination, which was subsequently ruled out by 64 slice cardiac computed tomography scan. The identification of the condition is important for the point of diagnosis and management; rheumatic valvular diseases are prevalent most commonly and are a source of embolism for ischemic stroke in young patients. CP is also common due to high prevalence of tuberculosis in India, which poses diagnostic difficulties.

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Background: Thrombotic event in Acquired Immune Deficiency Syndrome (AIDS) patients was a rare clinical entity prior to Highly Active Anti Retro Viral Therapy (HAART) era, but it is increasing. Aortic thrombosis, a rare fatal event, leads to arterial embolic events often due to thrombi associated with extensive underlying atherosclerosis. Case Presentation: We report a case of young male suffering from AIDS, presented with chronic diarrhea and abdominal pain. Patient was diagnosed as a case of partial abdominal aortic thrombosis. No familial predisposition or any other risk factor for thrombosis was identified. Treatment following intravenous heparin was started and later on switched to oral warfarin. After 10 days, he was devoid of symptoms and discharged on oral warfarin and Anti-Retro Viral Therapy (ART). Discussion: The current case report reinforces that similar situations are bound to arise again in the future. Clinicians should also consider etiologies other than infectious as cause of abdominal pain to prevent any catastrophe. Clinicians should be aware and alert of unprovoked thrombosis to promote timely treatment and prophylaxis.

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Background: The reported prevalence of concomitant coronary and carotid atherosclerotic disease has varied among studies due to differences in study populations and methodologies used. Objectives: The purpose of the study was to know the prevalence of carotid atherosclerotic disease and to evaluate the relationship between coronary and carotid atherosclerotic disease. Materials and Methods: We performed a prospective study from December 2010 to November 2012 to determine the association of carotid artery stenosis (CAS) with documented coronary artery disease on Angiography in Kashmiri population. Continuous variables were expressed as mean ± SD. Two-sided unpaired "t"- test was performed for continuous variables and x ² test for discrete variables. Multivariate stepwise logistic regression analysis was performed to detect independent predictors of CAS using factors that had significant relation in univariate analysis. A value of P ≤ 0.05 was considered statistically significant. Results: The study included 100 patients among whom 19.0% had significant carotid atherosclerotic stenosis (stenosis > 50%). The severity of carotid atherosclerotic stenosis and the carotid artery disease were significantly correlated (P = 0.001). The percentage of patients with three vessel involvements (42.1%) and significant carotid stenosis were more as compared with two vessels (31.6%) and one vessel involvement (21.1%). Independent predictors of significant CAS were the presence of left main descending carotid artery disease (31.3%), triple vessel carotid artery disease (17.8%), increasing age, a history of stroke or myocardial infarction (21.05%), smoking status (78.9%), diabetes mellitus (78.94%), and hypertension (78.94%). We did not find any significant correlation between carotid atherosclerotic stenosis and gender or degree of dyslipidemia. Conclusions: The degree of carotid atherosclerotic disease is related to the extent of coronary artery disease and important risk factors.

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Background: Coronary artery disease (CAD) is mainly caused by atherosclerosis and its complications. Red blood cell distribution width (RDW) is a numerical measure of the variability in size of circulating erythrocytes. Several studies reported a strong, independent relation between higher levels of RDW, hematocrit (Hct), and the risk of death and cardiovascular events in people with prior CAD. We tested the hypothesis that RDW, Hct, and other red blood corpuscle (RBC) indices are associated with CAD. Hence, we measured RDW, Hct, and other RBC indices in AMI and stable CAD (SCAD) and compared them with age- and sex-matched controls. Objectives: To study the changes in RDW and RBC indices in acute myocardial infarction (AMI) and SCAD and compare them with age- and sex-matched controls. Materials and Methods: This was a comparative study of 128 subjects (39 patients with AMI, 24 patients with SCAD, and 65 controls). Venous sample were drawn from AMI subjects on admission (within 6 h of chest pain) and collected in standardized ethylenediaminetetraacetic acid (EDTA) sample tubes. RDW and RBC indices were assayed within 30 min of blood collection, using Sysmex KX21-N autoanalyzer. Venous samples were also drawn from stable CAD patients who were admitted for angiography and subject attending routine checkups. Results: There was no significant difference in RDW in patients with CAD (14.12 ± 1.31%) as compared to controls (15.62 ± 6.51%). There was no significant difference in RWD in patients with AMI (14.36 ± 1.4%) as compared to stable CAD (13.7 ± 1.09%) and controls (15.62 ± 6.51%). There was no significant difference in Hct in patients with CAD (43.16 ± 5%) as compared to controls (41.9 ± 6.9%). Conclusions: There was no association between RWD, Hct, and other RBC indices with CAD, AMI, and stable CAD.

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Infective endocarditis is a rare complication of salmonellosis. The most commonly observed species in endemic areas is Salmonella typhi as a cause of enteric fever associated with various complications. Endocarditis caused by Salmonella paratyphi is very rare and so far only seven cases have been reported in medical literature. We report a case of Salmonella paratyphi A endocarditis in a 20 year old young man who had an underlying chronic rheumatic heart disease with aortic and mitral valve involvement. These rare cardiac complications should always be considered especially in persons with underlying congenital or acquired cardiac diseases with unrelenting fever particularly if they reside in an endemic area of enteric fever or during outbreak of the disease. The case is highlighted not only for its rarity but also to keep in mind the importance of looking minutely for uncommon organisms like Salmonella paratyphi in cases of PUO and complicated chronic rheumatic heart disease.

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Marfan's syndrome is a rare congenital connective tissue disorder. It occurs worldwide with no sex predilection. Mutation in the fibrillin genes result in production of abnormal elastic tissue, which predisposes the aorta to cystic medial degeneration and may result in dissection, rupture, or aneurysm formation. Other vascular structures like the heart valves may also be involved causing aortic regurgitation and mitral valve prolapse and regurgitation. Aortic dissection is rare in children even in those with Marfan's syndrome. We report a case of an 11-years-old girl with Marfan's syndrome who had an intramural aortic hematoma.

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Background: Patients' perception about the status of their current health and its direct measurement has become vital among researchers measuring outcomes. Health-related quality of life (HRQOL) scoring systems have been used as the objective measurement of performance status in various cardiovascular diseases. Objective: Our aim of the study was to determine the HRQoL of the patients undergoing angioplasty procedure. Materials and Methods: In this prospective interventional study period, all consecutive patients treated with Percutaneous Coronary Intervention (PCI), due to myocardial infarction. EQ5D questionnaire was introduced to them and the responses were collected by self response/interview method. Same procedure was repeated at 1 month follow-up. At the baseline, mean utility and visual analog score was relatively low. Results: In the conditions of anterior wall, inferior wall myocardial infarction conditions, mean utility value and VAS was improved after the intervention. Conclusions: The present study shows the prominent changes occurring in mobility and pain domains and moderate changes in usual activity, self care and anxiety domains.

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Background: The role of interleukin-17 (IL-17) in patients with acute coronary syndrome (ACS) is controversial. Objective: The aim of this study was to assess the serum level of IL-17 in patients with acute myocardial infarction (AMI) and unstable angina (UA) in Babol, Northern Iran in 2012. Materials and Methods: A total of 60 patients with ACS (30 with AMI, 30 with UA) and 30 healthy blood donors of Babol city, Iran were recruited in this cross-sectional study. Simple sampling method was used for patient selection. The inclusion criteria were the recent (<48 h) diagnosis of AMI or UA. The exclusion criteria were: Diagnosis of AMI or UA >48 h, recent history of infection or use of antibiotics. The serum IL-17 level was measured using enzyme-linked immunosorbent assay kit (Bioscience, Texas, USA). The lowest concentration of IL-17 that the kit could detect was 0.8 pg/ml. Chi-square, and Kruskal-Wallis tests were used for the comparison of IL-17 level between participants. P < 0.05 was considered as significant. Results: A total of 10 participants were excluded due to contaminated blood samples. Fifty (62.5%) were males and 30 (37.5%) were females. Four (13.3%) patients of AMI group and 1 (3.3%) of UA group had detectable levels of IL-17 (P = 0.353), but no one in blood donors (P = 0.114). There was also no significant association between the presence of detectable level of IL-17 and history of diabetes mellitus, hypertension, hyperlipidemia, smoking (P > 0.05). Conclusion: Our study did not find any significant differences in the serum level of IL-17 in individuals with or without ACS and therefore did not support the theory in which IL-17 has deleterious role in atherosclerosis.

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Tricuspid atresia (TA) is a cyanotic congenital heart disease (CHD) with incidence of 0.06/1000 live birth with a prevalence rate of 1-3% of all CHDs. TA can be associated with either normally related (type I) or transposed great arteries (TGA) (type II and III) and can be associated with/without ventricular septal defect (VSD) ± pulmonary stenosis (PS). An atrial level shunt through atrial septal defect/ patent foramen ovale (ASD/PFO) is essential for life. Although advanced atrioventricular (AV) block including complete heart block is seen in few CHDs like with congenitally corrected TGA (CC-TGA), AV discordance (isolated ventricular inversion), endocardial cushion defect (ECD), and left isomerism (polysplenia), it is not described in TA. Here, we report a neonate having TA with transposition with VSD, no PS (type IIc) who also had advanced heart block since intrauterine life. His mother was worked for autoimmune disease, but did not reveal any evidence of such.

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Objective: The aim of the present study was to evaluate the effects of aspiration thrombectomy (AT) using an Aspiration Catheter (INVATEC SPA DIVER C.E. MAX, Italy) during primary stenting in patients with acute myocardial infarction (AMI). Methods and Results: Our study group consisted of 136 patients. The Aspiration Catheter group included 74 patients treated by direct stenting after AT and the control group included 62 patients treated by primary stenting after balloon predilation without thrombectomy. Measurement of left ventricular ejection fraction (LVEF) by echocardiography was obtained before (acute LVEF) percutaneous coronary intervention (PCI) and 1 week after (late LVEF) the procedure. The number of patients with thrombolysis in myocardial infarction (TIMI) grade 3, myocardial blush grade (MBG) 3 and with full restoration of ST segment elevation following PCI was higher in the aspiration Catheter group compared to the control group (90 vs 68%, P < 0.01), (86 vs 62%, P < 0.01) and (90 vs 64%, P < 0.01) respectively. Minimal change in LVEF was observed in patients between the Aspiration Catheter group and control group at 1 week post procedure. Conclusion: Combination of AT using Aspiration Catheter (INVATEC SPA DIVER C.E. MAX) with primary stenting can better restore epicardial coronary flow and myocardial perfusion, while left ventricle (LV) function had subtle change in AMI when compared to primary stenting after balloon predilation without thrombectomy.

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Williams syndrome is a multisystem disorder caused by the deletion of multiple genes on chromosome 7. Many patients are identified through presence of dysmorphic features and associated cardiac abnormalities. Cardiovascular abnormalities in Williams syndrome is characterized by presence of supravalvular aortic stenosis which is most common followed by pulmonary artery stenosis, mitral valve prolapse, aortic hypoplasia, coarctation of aorta, and septal defects. Usually, these obstructive lesions are mild and do not present in infancy and progress slowly. If severe in infantile age-group, they often require surgery. We are reporting a case of Williams syndrome who presented with heart failure demonstrating supravalvular aortic stenosis (a common feature of Williams syndrome) and rapidly progressive coarctation of aorta with refractory symptoms.

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Coronary artery aneurysm commonly occurs secondary to atherosclerosis,but aneurysm formation after stenting is a rare phenomenon specially after drug eluting stent implantation. Drug-eluting stents (DES) elute antiproliferative drugs, can inhibit neointimal growth and may delay healing after vascular injury, and DES implantation may be associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. Incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%). In our case,the patient is a nondiabetic ,nonhypertensive 68 year old male who underwent coronary angioplasty in the RCA with everolimus eluting stent following acute coronary syndrome.After few weeks the patient came with exertional angina and coronary angiography revealed stent aneurysm formation with new disease proximal to the stent.

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Background: Cardiac resynchronization therapy (CRT) is a relatively new therapy for patients with symptomatic heart failure resulting from systolic dysfunction. The procedure is carried out regularly in the Cardiac Catheterization laboratory of Madras Medical Mission, India. Objective: We sought to determine the benefit of cardiac resynchronization therapy in patients followed up at the centre. Methods: We retrospectively studied cases of cardiac resynchronization therapy carried out at the Madras Medical Mission over the past five years with respect to clinical as well as echocardiographic changes from the time of implantation to follow-up. Results: After a mean interval of 11.32 ± 9.25 months the improvements were observed as follows: Mean heart rate 77.94 ± 16.58/min to 69.13 ± 8.37/min (P = 0.066), mean systolic blood pressure 121.13 ± 16.33 mmHg to 131.73 ± 16.85 mmHg (P = 0.022), mean NYHA class, 3.27 ± 0.57 to 1.69 ± 0.67 (P = 0.000), QRS duration 169.39 ± 0.17 ms to 125.40 ± 24.40 ms (P = 0.000), mean ejection fraction 27.56 ± 5.47 to 38.62 ± 8.91 (P = 0.000), mean septal to posterior wall delay 164.30 ± 106.03 ms to 78.13 ± 38.04 ms (P = 0.001), mean interventricular delay 44.47 ± 23.47 ms to 26.72 ± 16.87 ms (P = 0.006), mean mitral regurgitation grade 2.50 ± 0.98 to 1.88 ± 0.90 (P = 0.026) and mean systolic dysfunction grade 3.96 ± 0.20 to 3.31 ± 0.97 (P = 0.001). Conclusion: The improvements in mean NYHA class, ejection fraction and synchrony, at follow-up, were highly significant.

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