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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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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Background: Globally, hypertension (HTN) control is poor. We studied the contribution of primary care physicians to this. Methods: Lagos-based primary care physicians were studied using anonymous self-administered questionnaire on HTN treatment goals and drug therapy. Results: Data from 403 respondents with a mean age and experience of 40 ± 11.34 years and 14.3 ± 11.1 years, respectively, were analyzed. Two hundred and twenty-eight physicians (61.1%) practiced in primary health-care facilities, while 125 (33.5%) and 20 (5.4%) practiced in facilities affiliated to the secondary and tertiary health-care centers, respectively. One hundred and twenty-three (35.7%) of the respondents correctly indicated the treatment blood pressure goal for uncomplicated HTN. Eighty (26.1%), 37 (12.2%), and 54 (18.5%) of respondents correctly indicated the treatment goals in hypertensive patients with diabetes mellitus (DM), old stroke, and coronary artery disease (CAD), respectively. The correct choice(s) of antihypertensive drugs vis-a-vis compelling/possible indications were made by 259 (76%) for uncomplicated HTN, 194 (63.4%) for hypertensives with chronic kidney disease, 128 (44.3%) for hypertensives with previous stroke, 250 (76.7%) for pregnant hypertensives, 166 (57%) for hypertensives with CAD, and 165 (61.6%) for hypertensives with DM. Choice(s) of antihypertensive medications were determined by the patient's age 302 (79.4%), gender 233 (58.4%), race 234 (59.8%), associated clinical condition 365 (90.6%), duration of action of antihypertensive drugs 340 (85.5%), and the cost of antihypertensive medications: 334 (85%). Conclusions: The physicians' knowledge of HTN management is suboptimal. This may be contributory to the poor HTN control in Nigeria. These deficiencies may be addressed through continuing medical education together with popularizing and simplifying of the guidelines.

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A 59-year-old female developed iatrogenic Type F spiral dissection of the right coronary artery (RCA) with retrograde extension as Type III aortic dissection (AD) during diagnostic coronary angiogram using 5 Fr Optitorque Tiger catheter. The spiral dissection of RCA was treated with angioplasty. AD was followed up with conservative management. The prompt identification of the starting point, the true lumen, and exit point of the dissection is the keys to the successful percutaneous revascularization. Visual eyeballing into multiple angiographic views is of immense help in the situation where optical coherence tomography and intravenous ultrasound are not available.

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Injury to coronary arteries can occur during diagnostic and therapeutic interventions. It is more common with angioplasty with certain guide catheters such as Amplatz catheter. The dissection is more common in ascending aorta with extension to the coronary arteries. We hereby report a case of right coronary artery (RCA) dissection without concurrent aortic dissection caused by injury with extra-backup left guide catheter during angioplasty of left anterior descending artery successfully managed by stenting of RCA from ostium with drug-eluting stent.

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Background: The concept of cirrhotic cardiomyopathy includes impaired cardiac contractility, decreased beta-adrenergic receptor function, abnormal beta-adrenergic postreceptor function, defective excitation-contraction coupling, and cardiac conduction abnormalities. This study was aimed to assess the cardiac structure and function in adult Nigerians with chronic liver disease (CLD). Methods: This was a cross-sectional descriptive study of consecutive patients with CLD without any known cardiac disease attending the Liver Clinic of the Medical Out-patient Department of the University College Hospital. Apparently, normal individuals with comparable age and sex distribution were recruited as controls. The subjects and controls underwent two-dimensional, M-mode and Doppler echocardiographic studies to determine the cardiac structure in relation to both systolic and diastolic cardiac functions. Results: A total of 46 subjects and 50 normal controls were recruited. There was no difference in the blood pressure parameters of the two groups. The septal wall thickness was statistically higher in control, but this difference was lost when adjusted for body mass index. On the other hand, the adjusted left atrial diameter and aortic root dimension were statistically larger in the subjects than the controls. There was no difference in the left ventricular (LV) fractional shortening or ejection fraction, relative wall thickness, and deceleration time of the E-wave. Conclusions: We demonstrated an increase in cardiac index at rest in the subjects, but there was no significant difference in the LV diastolic or systolic dysfunction using traditional methods. Studies using newer modalities of the assessment of cardiac structure and function are needed in our environment.

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Transcatheter closure (TCC) of ruptured sinus of Valsalva aneurysm (RSOVA) is as an alternative strategy to surgery. Its location, size, and relation to neighboring structures decide treatment plan. We present a 17-year-old young man who presented with the New York Heart Association II shortness of breath for last 2 months. Two-dimensional echocardiography revealed RSOVA of right coronary sinus into right ventricular outflow tract, Seller's II aortic valve regurgitation, and small subaortic ventricular septal defect. The echo estimated size of the defect was 9 mm on the aortic side. Echo was complemented by computed tomography. The defect was crossed retrogradely and was plugged antegradely using an Amplatzer duct occluder (ADO). At 1 year follow-up, ADO was across RSOVA without any residual shunt. TCC of RSOVA is feasible and effective with the support of multiple imaging methods.

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Guidewire fracture is more frequent during angioplasty of chronic total occlusion (CTO) of coronary artery though it is an infrequent complication in routine percutaneous coronary intervention. The percutaneous retrieval techniques such as balloon-assisted technique, wire intertwining method, triple wire technique, use of micro snare, stent to crush the wire, and conservative management are various methods which are used with various degrees of success. The surgical retrieval is almost a bail out option. In this case report, we illustrate a case of successful noncompliant coronary balloon-assisted retrieval of a broken piece of a coronary CTO guidewire.

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Adequate predilatation and balloon sizing of the lesion are must during coronary angioplasty. A well-prepared lesion not only responds well to stent expansion but also helps visualization of the lesion during stent implantation because of good antegrade flow despite the stent across the lesion. In this illustration, we just missed the distal part of lesion during angioplasty of critical stenotic lesion in the left anterior descending artery in a 54-year-old woman with crescendo angina despite predilatation. Because of inadequate predilatation, residual significance stenosis limited the forward flow of contrast when the stent was across the lesion for positioning before expansion. The narrow error in the judgment costed an additional stent to complete the procedure.

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Among the many causes of Post Percutaneous transluminal coronary angioplasty angina (Post PTCA angina), stent restenosis is the most important cause. Other causes include incomplete revascularization, microvascular angina, and appearance of new lesions. Coronary arterio-venous (A-V) fistula is a rare cause of angina following PTCA. We hereby report a case of post-PTCA angina caused by coronary A-V fistula.

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Left ventricular (LV) pseudoaneurysm (PA) is rarely seen and it is the result of free-wall myocardial rupture contained by overlying adherent pericardium, fibrous tissue without myocardial tissue. When it occurs, it is usually associated with myocardial infarction and is potentially prone to complications such as thromboembolic phenomenon and rupture with resultant cardiac tamponade. LV pseudoaneurysm is potentially fatal, and early detection with prompt treatment is important to prevent mortality. It is sometimes difficult to differentiate LV pseudoaneurysm from true aneurysm. It is, therefore, very important to use a combination of imaging modalities to evaluate the affected patients to confirm the diagnosis. We report the case of a fatal LV PA in a middle-aged man who had no history suggestive of prior myocardial infarction, diagnosed on two-dimensional Doppler echocardiography and contrast-enhanced computed tomography scan.

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