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  Citation statistics : Table of Contents
   2020| January-June  | Volume 17 | Issue 1  
    Online since June 30, 2020

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Cardiovascular diseases in Nigeria: What has happened in the past 20 years?
Samuel Obiajulu Ike, Chuka Timothy Onyema
January-June 2020, 17(1):21-26
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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Supraventricular tachycardia complicating pneumonia in a resource-poor setting
Ujuanbi Amenawon Susan, Uche-Ajunwa Prisca Ijeoma, Mankwe Abaram Chesa
January-June 2020, 17(1):71-75
Pneumonia is a common condition in children, especially among the under-fives and a leading cause of morbidity and mortality. Cardiac complications, including congestive heart failure, arrhythmias, myocarditis, and myocardial infarction, are a significant burden among patients hospitalized for pneumonia. Supraventricular tachycardia (SVT) is the most common cardiac arrhythmia in children requiring therapy. We present a 6-week-old Nigerian female child admitted into our children emergency with clinical features suggestive of pneumonia who subsequently developed SVT confirmed by electrocardiogram without an underlying cardiac defect. The child improved on antibiotics, propranolol, and digoxin and was discharged home for follow-up. SVT is a life-threatening clinical condition. High index of suspicion is required as recognition could be made difficult by its nonspecific symptoms.
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Anticoagulation in a pregnant patient with mechanical heart valves: Case reports and literature review
SA Isezuo, H Umar, MZ Usman, MA Ndakotsu
January-June 2020, 17(1):76-78
Patients with prosthetic mechanical heart valves require a life-long anticoagulation. This is more so during pregnancy which increases the risk of thrombosis. We present two pregnant patients with prosthetic mechanical valves managed up to delivery. All the patients were on warfarin before conception which was changed to unfractionated heparin after confirmation of pregnancy. At 14 weeks gestation, they were changed back to warfarin until 36 weeks gestation. Unfractionated heparin was reintroduced until delivery. All the patients had minimal postpartum hemorrhage. Mrs. XX, one of them, had four successful deliveries since the placement of mechanical valve. Pregnancy for a woman mechanical valve poses a greater risk to both the mother and the fetus. This group of women should have preconception care in a specialized program.
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Influenza myocarditis complicated with atrioventricular block in a pregnant woman
Chee Yik Chang, Joshua Bui Khiong Chung, David Perera
January-June 2020, 17(1):79-81
Acute myocarditis is a well-recognized complication of influenza infection. The incidence of myocardial involvement in influenza infection is variable, and the clinical severity can range from asymptomatic to fulminant forms. Influenza infection can rarely be complicated by acute myocarditis leading to high-degree atrioventricular block and cardiogenic shock. We report a previously healthy pregnant woman, who initially presented with symptoms of influenza-like illness, later confirmed as influenza A infection. She developed hypotension shortly after admission that did not respond to fluid bolus and required inotropic support. On day 5, the electrocardiogram showed Mobitz I second-degree heart block, which later progressed to the third-degree heart block. Echocardiogram showed good cardiac contractility and minimal pericardial effusion while cardiac biomarkers were normal. A diagnosis of influenza myocarditis was made. She completed a course of oral oseltamivir and had temporary cardiac pacing performed, and subsequently recovered well.
  - 1,123 109
Ventricular tachycardia revealing a peripartum cardiomyopathy in a 33-year-old new mother
Jospin Karel Bassakouahou Makani, Suzy Gisele Kimbally Kaky, Meo Stephane Ikama, Christian Michel Kouala Landa
January-June 2020, 17(1):82-83
We report a case of ventricular tachycardia due to peripartum cardiomyopathy in a 33-year-old woman. The clinical symptomatology was dominated by recurrent palpitations. Doppler echocardiography revealed dilated cardiac chambers and a left ventricular ejection fraction at 30%. Treatment with amiodarone led to cardioversion. Furosemide and captopril have been used to treat heart failure.
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Left atrial myxoma mimicking severe mitral stenosis and severe pulmonary hypertension
Balarabe Sulaiman Aminu, Kamilu Musa Karaye, Nasir Ishaq, Shehu Kana, Muzammil Muhammad Yakasai, Mahmud Umar Sani
January-June 2020, 17(1):84-86
Cardiac myxomas are the most commonly encountered benign intracardiac tumors. Although the left atrium is the most commonly involved in majority of cases, myxoma can arise in any cardiac chamber. We present the case of a 53-year-old female with background hypertension, who presented with the features of heart failure and found to have large left atrial myxoma mimicking severe mitral stenosis and severe pulmonary hypertension. She had the excision of the myxoma mass. The case illustrates that atrial myxoma is the diagnosis to keep in view as an occasional cause of cardiac murmur even in a society with a high prevalence of rheumatic valvular heart disease and cardiomyopathies.
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Electromechanical dyssynchrony and short-term outcomes of readmission and death, among heart failure patients in Aminu Kano teaching hospital, Kano State, Nigeria
Bashir Garba Ahmad, Muhammad Sani Mijinyawa, Mahmoud Umar Sani
January-June 2020, 17(1):37-41
Background: Cardiac dyssynchrony refers to a difference in the timing of contractions in different chambers and/or segments of the heart. Left ventricular (LV) dyssynchrony is frequently seen in patients with heart failure (HF) and is a poor prognostic marker if left untreated. The impact of cardiac dyssynchrony among HF patients in Nigeria is unknown. We set out to assess the role of electromechanical dyssynchrony in short-term outcomes in terms of readmission and 6-month mortality among HF patients in our hospital. Methods: We conducted a prospective observational study among adult HF patients in our hospital. Electrical and mechanical dyssynchrony were measured using electrocardiography and echocardiography, respectively. Data on the outcome of readmission and death within 6 months were collected. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 16 software. Results: A total of 100 participants were recruited for this study. Electrical dyssynchrony (Duration of QRS complex on ECG > 120ms) was found in 11%, 8 (73%) of them had QRS width between 120 and 150 ms, while in three, the QRS width was >150 ms. The prevalence of interventricular dyssynchrony (LV preejection interval – right ventricular preejection interval ≥40 ms) was found to be 79%, while that of intraventricular (septal to posterior wall motion delay >130 ms) was 75%. Nineteen percent of the study participants were readmitted with worsening HF symptoms, while up to 37% died within the 6 months follow-up period. Electrical dyssynchrony was a significant predictor of short-term readmission and death. There was also a statistically significant difference (P < 0.005) between all forms of dyssynchrony and death. Conclusion: The presence of electromechanical dyssynchrony is associated with a poor short-term outcome of readmission and death. More studies are needed in our country to fully define the burden of dyssynchrony among HF patients in our environment.
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Short-term outcomes and their predictors among patients admitted with acute heart failure in a Nigerian Teaching Hospital
Muhammad Nazir Shehu, Mahmoud Umar Sani, Basil N Okeahialam
January-June 2020, 17(1):42-47
Background: Despite many recent advances in the evaluation and management of heart failure (HF), the development of symptomatic HF still carries a poor prognosis. A study of clinical characteristics of patients with acute heart failure (AHF) will provide appropriate clinical decisions with regard to treatment and patients' monitoring. This study therefore aimed to determine the clinical characteristics of patients admitted with AHF. The outcome measures are death, rehospitalization, or combined death/rehospitalization. Methods: It was a longitudinal study carried out on eligible AHF patients aged 18 years and above who were consecutively recruited. On presentation, all patients had history obtained and physical examination performed. Baseline blood chemistry, full blood count, electrocardiography, and echocardiography were carried out as well. Data on vital status and rehospitalization/death were recorded at 1 month, 3 months, and 6 months of follow-up periods. Results: A total of 120 patients were studied. Fifty-five percent of them were female, and the mean age was 49.88 ± 18.87 years. Of the 120 patients studied, 35 (29.2%) died, 21 (17.5%) were rehospitalized only once, and 2 (1.7%) were rehospitalized twice. Renal impairment (RI) was an independent predictor of both mortality from AHF (odds ratio [OR] = 2.875, 95% confidence interval [CI]: 1.207–6.874 and P = 0.012) and composite endpoint of death or rehospitalization (OR = 3.131, 95% CI: 1.326–7.890, and P = 0.009). Rehospitalization was significantly higher among diabetics (OR = 5.000, 95% CI: 1.604–15.586 and P = 0.006). Conclusion: AHF was associated with high mortality rate and composite endpoint of death or rehospitalization. RI and diabetes were the independent predictors of poor outcomes.
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Assessment of right ventricular functions by echocardiography in patients with acute myocardial infarction in North India: An observational study
Hakim Irfan Showkat, Sadaf Anwar, LC Gupta, Rekha Mishra, S Padmawati, Arif Sarmast, Basharat Mujtaba, Vinod Sharma, Siddharth Saxena, Sudheer Saxena
January-June 2020, 17(1):48-54
Background: Right Ventricle (RV) dysfunction may be primarily attributed to abnormality of RV myocardium or secondary to left ventricle (LV) dysfunction, as a consequence of “Ventricular Interdependence” between the two ventricles, as they are encircled by common muscle fibres, share a common septal wall and are enclosed within a common pericardium6,7 Early recognition of RV dysfunction is warranted but till today it remains a challenging task because of complex structure and asymmetric. Aims: To study Right Ventricular functions in Acute coronary syndrome. Method: All patients with first presentation of Acute STEMI/NSTEMI with a total of 100 patients who match our inclusion criteria were studied from June 2015 to May 2017 on Phillips Epiq 7 echocardiography Machine with follow up echocardiography at discharge. Results: A total of 100 patients of acute myocardial infarction were studied with 73% STEMI & 27% NSTEMI & among these 68% were anterior wall MI (AWMI) & 32% inferior wal MI (IWMI). Prevalence of different risk factors observed in study population was as follows: Dyslipidaemia in 68% patients, diabetes mellitus 64%, hypertension was present in 54%, Family history of coronary artery disease (CAD) was present in 43 % of patients & Smoking was prevalent in 27 % of cases. The present study demonstrated presence of RV dysfunction assessed by echocardiography, in acute MI (STEMI/NSTEMI) irrespective of infarction location and was more commonly seen in AWMI than IWMI. Conclusions: The present study demonstrates presence of RV dysfunction assessed by echocardiography (RVEDD (RV end diastolic diameter), TAPSE (transannular plane systolic excursion), FAC (Fractional area change), E/E', RV MPI (Myocardial performance index) by TDI (tissue Doppler imaging)), in acute MI (STEMI/NSTEMI) irrespective of infarction location and was more commonly seen in AWMI than IWMI. This study demonstrated presence of RV dysfunction in acute MI more so in STEMI than NSTEMI with high morbidity and mortality in patients with RV dysfunction irrespective of site of infarction.
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Relationship between ECG QRS voltage and left ventricular functions in patients with heart failure attending federal Medical Centre Nguru, Northeastern Nigeria
Musa Mohammed Baba, Faruk Buba, Mohammed Abdullahi Talle, Hayatu Umar, Habu Abdul
January-June 2020, 17(1):55-60
Introduction: Heart failure (HF) is a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Electrocardiogram (ECG) is a widely available tool; it is relatively inexpensive and simple to perform; and it yields an instant result. A normal ECG makes systolic dysfunction unlikely and is rare in patients with suspected heart failure. Low ECG voltage has been reported as a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year. However, the relationship between ECG QRS voltage and left ventricular function in patients with heart failure has not been evaluated. Therefore, the objective of this study is to determine the relationship between electrocardiographic QRS voltage and left ventricular function. Methodology: This was a prospective cross-sectional study conducted among inpatients with HF in the medical ward of the hospital. Results: Three hundred and sixty patients were recruited for the study, of which 19 had incomplete data and were excluded in the analysis. The remaining 341 subjects were analyzed comprising 215 female and 126 male with a mean age of 47.54 ± 18.85 years. Majority of patients with normal or high QRS voltage had HF with preserved ejection fraction (HFpEF), while those with low QRS voltage had HF with reduced ejection fraction (HFrEF). On the other hand, patients with high QRS voltage had impaired relaxation pattern of diastolic dysfunction, while those with low QRS voltage had a restrictive pattern of diastolic dysfunction. There was a positive and significant correlation between the QRS voltage and ejection fraction, fractional shortening, isovolumic left ventricular relaxation time, and left ventricular deceleration time, while a negative but not significant correlation was observed between electrocardiographic QRS voltage and transmitral E/A ratio. Majority of patients with normal QRS voltage had normal left ventricular geometry, while those with high QRS voltage predominantly had concentric left ventricular hypertrophy and those with low QRS voltage had eccentric left ventricular hypertrophy. Patients with concentric left ventricular hypertrophy had predominantly HFpEF and impaired relaxation pattern of diastolic dysfunction, while those with eccentric left ventricular hypertrophy had HFrEF and restrictive pattern of diastolic dysfunction. Conclusion: HF patients with high QRS voltage had preserved left ventricular systolic function, impaired relaxation pattern of left ventricular diastolic dysfunction, and concentric left ventricular hypertrophy. While those with low QRS voltage predominantly had reduced left ventricular systolic function, restrictive pattern of left ventricular diastolic dysfunction, and eccentric left ventricular hypertrophy.
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Prevalence of arrhythmias on 24-h ambulatory Holter electrocardiogram monitoring in LASUTH: A report on 414 patients
Philip A Adebola, Folasade A Daniel, Adeola O Ajibare, Ajayi E Reima
January-June 2020, 17(1):61-66
Background: The 24-h ambulatory holter electrocardiogram (ECG) monitor is particularly able to document bradyarrhythmic or tachyarrhythmic episodes which might be missed on normal 12-lead resting ECG recordings. It is, therefore, particularly useful in evaluating patients with symptomatic or asymptomatic paroxysmal tachy/bradyarrhythmias and is also useful in monitoring patients on antiarrhythmic therapy. The present study was aimed at presenting our findings on the prevalence of arrhythmias on the 24-h Holter ECG of a relatively large cohort of patients referred to our cardiac facility, over the last few years. Methods: This was a retrospective audit of prevalence of cardiac arrhythmias among 414 patients consisting of 184 males and 230 females who were referred for 24-h Holter ambulatory ECG monitoring in LASUTH, Ikeja, Nigeria, between January 2014 and June 2019. Their age ranged from 13 to 95 years with a mean age of 50.42 ± 16.29. Results: The most common single indications for Holter monitoring in these patients were unexplained palpitation and presyncope/syncope. Ventricular extrasystole was the most common arrhythmias found on Holter ECG. Only 14 out of the 414 patients had Holter ECG evidence of nonsustained ventricular tachycardia (VT). There was no significant difference in the prevalence of cardiac arrhythmias in males compared to their female counterparts. However, elderly patients of 65 years and above had significantly higher prevalence of cardiac arrhythmias when compared to their younger counterparts (χ2 = 54.46, P < 0.01). Conclusion: The study suggests that palpitation is the most common reason for referral of patients for 24-h ambulatory Holter ECG test. It also showed that ventricular extrasystoles are the most common arrhythmias on the 24-h Holter ECG. In addition, it reinforces the fact that nonsustained VT is uncommon among the Nigerian patients and that elderly patients were more likely to have cardiac arrhythmias compared to their younger counterparts.
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Initial experience with interventional and definitive solutions for structural heart diseases in a resource-challenged setting
Oluwatoyin O Ogunkunle, Bosede E Adebayo, A Famosaya, Samuel Ilenre Omokhodion
January-June 2020, 17(1):67-70
Background: The first case of open-heart surgery (OHS) in the University College Hospital, Ibadan, took place on December 19, 1978. Since then, various attempts have been made to provide definitive solutions for patients with structural cardiac diseases, but till now, no permanent regular service exists. We present our initial experience with interventional cardiology (IC) and OHS in a resource-challenged setting. The challenges encountered are discussed, and the solutions we have proffered with each situation are presented as we forge ahead toward achieving a more regular service for IC and OHS in our center. Results: In January 2016, eight children underwent diagnostic cardiac catheterization with a view to performing a possible corrective intervention. Two subsequently had device closure of patent ductus arteriosus – the first in the history of the hospital. Four patients (one with a large atrial septal defect (ASD), one severe pulmonary stenosis, one with a large ventricular septal defect (VSD), and one with Fallot's tetralogy) were deemed to be more suitable for OHS and were, therefore, deferred. The muscular VSD in another patient was thought to be too small to need intervention. The last patient, initially thought to have a coarctation of the aorta, was found to have normal cardiac anatomy. The patient with large ASD and VSD subsequently underwent successful total repair of his lesions in our facility. Conclusion: The successful outcome in the three patients has encouraged us to be optimistic that despite various resource challenges, it will soon be possible to establish a regular service for both IC and OHS in our center.
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Rheumatic heart disease in Nigeria: A review
Okechukwu S Ogah, Fidelia Bode-Thomas, Christopher Yilgwan, Olukemi Ige, Fisayo Ogah, Oluwatoyin O Ogunkunle, Chimezie Okwuonu, Mahmoud Sani
January-June 2020, 17(1):27-36
Rheumatic heart disease (RHD) is a major public health problem in resource-poor countries, especially in sub-Saharan Africa where about 1 million affected children between 5 and 14 years of age live with the disease. The aim of this paper is to review current knowledge on the clinical epidemiology of RHD in Nigeria, identify gaps, and suggest possible future directions. A systematic literature search was conducted using African Journal online (AJOL), Cinahl, Google Scholar, PubMed, and Web of Science. In PubMed, the following medical subject headings and free text terms were used: “Rheumatic heart disease” OR “Rheumatic “Valvular heart disease” OR “Rheumatic fever” AND “Nigeria”. The same text word search was used in Google scholar, AJOL, CINAHL, and Web of Science. A search date was limited to articles published from January 1950 to December, 2018. A total of 44 original studies were reviewed. Nineteen (45.2%) of the studies used clinical criteria for diagnosis of RHD, 19 (40.5%) used echocardiographic diagnosis, and 6 (14.3%) used autopsy or post mortem examination of the patients for the diagnosis of RHD. Five (11.9%) of the studies were conducted in children only, 9 (16.7%) were in both children and adults, and the remaining 31 (73.8%) were done in adults only. Only 6 (14.3%) of the studies reported complications seen in patients with RHD. Of the 6 studies that reported on complications, only 1 reported on recurrent of acute rheumatic fever. Mitral valvular disease was the most common lesion reported in all the studies. RHD still remains a major cardiovascular health problem in Nigeria. There is therefore a need for more recent clinical studies on the contemporary pattern of RHD in Nigeria. In addition, community based screening for RHD is needed to determine the true burden of the disease in Nigeria. Finally, primary and secondary preventive measures are needed to help reduce the burden of RHD in Nigeria.
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Arrhythmia in people living with HIV/AIDS
Shailesh Singh, Katyayni Singh
January-June 2020, 17(1):1-10
With improvement in longevity and therapy of HIV; acquired heart diseases are expected to become more and more prevalent. The electric abnormalities in HIV/AIDS are not very rare. These electrical abnormalities in HIV/ AIDS patients may result from the structural heart diseases because of accelerated atherosclerosis, or cardiac dilation as a sequela of myocarditis, or infective endocarditis or pericardial afflictions in HIV. These electrical disorders can present with a history of palpitations, missed beats or even sudden cardiac death. Both tachy- and bradyarrhythmia may be seen in people living with HIV/AIDS.
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Therapeutic exercise for hypertension: An update for exercise prescribers
Mubarak Muhammad, Jibril M Nuhu, Tasneem M Hassan, Sani S Baba, Mustapha I Radda, Mubarak M Mutawakkil, Majida A Musa
January-June 2020, 17(1):11-20
Hypertension (HTN) remains the most common noncommunicable disease that constitutes the greatest public health problem worldwide, with the management involving pharmacological and nonpharmacological means. Therapeutic exercise is an important first-line intervention for a number of chronic diseases and has been recommended both as a measure for prevention and as an adjunctive nonpharmacological intervention for HTN, however; exercise prescription to hypertensive patients is still low, especially among primary healthcare professionals. This study examined from evidence-based literature the various aspects of therapeutic exercise and HTN to successfully stimulate the integration of exercise for HTN management in clinical settings, especially at the primary healthcare level. The paper reviewed published articles on exercise and HTN on Google Scholar, PubMed, and ScienceDirect using search terms “exercise” and “hypertension.” Studies identified in this review were summarized to further enrich literature with data and provide an update to exercise prescribers on exercise and HTN. This study revealed and identified three key aspects that need to be strengthened for successful integration of exercise for HTN management in all clinical settings: adequate and routine pre-exercise screening and monitoring; well-informed prescription of therapeutic exercise by qualified exercise professionals; and sufficient knowledge about potential interaction between exercise and antihypertensive medications.
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