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   2020| July-December  | Volume 17 | Issue 2  
    Online since November 13, 2021

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Suicidal right ventricle in children and adults: Trends, triggers, and treatment: A systematic review of a rare but catastrophic event
Josephat M Chinawa, Awoere T Chinawa, Barthlomew F Chukwu, Chika O Duru, John C Eze, Anthony I Nwafor
July-December 2020, 17(2):87-91
Background: Suicidal right ventricle (SRV) is defined as a dynamic right ventricular outflow obstruction with a clinical hemodynamic significance. This is a rare and dangerous event in cardiology practice. Objectives: This systematic review is aimed at ascertaining different scenarios that can precipitate SRV in cardiology practice. Methods: Data for the systematic review was retrieved from Cochrane database, Google Scholar, PubMed review, Institute for Scientific Information “Web of Science,” and Medline. The search engine yielded 164 items on SRV. 148 articles were excluded thereafter because they did not meet the criteria for SRV with 16 articles left. The remaining 16 articles fulfilled the inclusion criteria and were further assessed for eligibility and 9 were excluded further, because they did not strictly fulfill the criteria for SRV. Finally, 7 research articles were included in the systematic review and quantitative synthesis. Results: Valvar pulmonary stenosis is the most common diagnosis warranting balloon pulmonary valvotomy (BPV). There is no gender predilection for SRV; 7 males and 6 females. The age range is 5–28 years with a mean of 19.8 ± 6.6 at 95 CI. The most common etiology of SRV was caused by a prior supra systemic right ventricle. In one study, 108 patients had balloon pulmonary valvuloplasty, but only 0.92% (1/108) of the patients who was >5 years developed SRV. Furthermore, out of six patients in another study who had BPV, only one (16.6%) had SRV. The commonest clinical presentation of SRV is cardiovascular collapse, the SRV was relieved in some cases by removing the offending agent (catheter) while some were treated with volume expanders and Beta-blockers. Conclusion: This review has shown that SRV is a rare abnormality in children and adults. It normally occurs during balloon valvotomy or surgical valvotomy.
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The cost of heart failure: Principles, processes, prospects, and pitfalls
Okechukwu Samuel Ogah, Olanike Alison Orimolade, Fisayo Ogah, Temilade Adeyanju
July-December 2020, 17(2):92-97
Heart failure (HF) is currently a global public health issue. It affects about 37 million people worldwide. The incidence and prevalence of HF increase with age, and it is the most common cause of hospitalizations in people aged 65 years and above based on data from high-income countries of Western Europe, North America, and Japan. HF burden is also projected to increase in countries undergoing demographic and epidemiologic transitions. It is associated with high health-care cost, and this has been supported by data from different parts of the world. The aim of this short review is to present a brief description of the principles, processes, prospects, and pitfalls involved in the estimation or quantification of the economic costs of HF.
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Nigerian cardiac society recommendations on the management of cardiovascular diseases in the coronavirus disease 2019 (COVID-19) era
Mahmoud U Sani, Funso A Adesanya, Abiodun Adeoye, Akinyemi Aje, Adaobi Ikemeh, Jameel I Ahmad, Shehu A Kana, Dike B Ojji, John A Okeniyi, Uvie U Onakpoya, Sandra Ofori, Elvis E Osobaye, Ejiroghene M Umuerri, Christopher S Yigwan, Okechukwu S Ogah
July-December 2020, 17(2):98-113
The global COVID-19 pandemic has created in its wake an urgent need for a clear guide for managing cardiovascular diseases and the complications it causes on the cardiovascular system. In this regard, the Executive Council of the Nigerian Cardiac Society constituted a committee to develop guidelines on management of Coronavirus Disease 2019 (COVID 19) and Cardiovascular Diseases. These guidelines have been written to provide a simple approach to managing cardiovascular diseases among COVID 19 patients in Nigeria. It will also provide information about potential cardiac implications of COVID 19 based on evidence and offer early clinical guidance on the management, given the current uncertainty of COVID 19. We have intended that this brief write up and set of recommendations be useful not only for primary care physicians, residents and medical students, but also for all professionals who work as hands-on practitioners.
  1,301 118 -
Type A aortic dissection surgery in a pregnant woman: The hypothermic circulatory arrest as a double life-saving method
Adama Sawadogo, Farid Belem, Nibepuo Hippolyte Some, Lionel Camilleri
July-December 2020, 17(2):151-153
The authors report a case of a 44-year-old pregnant woman with Marfan syndrome who was diagnosed with type A aortic dissection at 25 weeks of pregnancy. She underwent a mechanical Bentall procedure with cardiopulmonary bypass and circulatory arrest. Postoperatively, the fetus was not distressed; echocardiogram and magnetic resonance imaging were repeated, and a prophylactic cesarean section was performed at 36 weeks. Both the mother and the baby were followed up for 1 year and presented no clinical issue.
  1,329 42 -
Availability and perception of the importance of cardiac rehabilitation among health-care professionals in North-Western Nigeria
Jibril Mohammed Nuhu, Lubabatu Suleiman Gachi
July-December 2020, 17(2):114-119
Background: Cardiac rehabilitation (CR) is an important secondary prevention programme utilized for mitigating the burden of cardiovascular diseases. Information on the availability of CR in Nigeria has not been previously documented. Therefore, this study investigated the availability of CR and perception of its importance among health care personnel in North western Nigeria. Materials and Methods: A researcher designed questionnaire assessing the availability and perception of the importance of CR was used to collect the information from health care professionals that have roles to play in CR in seven tertiary health facilities in North western Nigeria. A total of 350 questionnaires were administered to the health professionals with a return rate of 70%. Results: CR was reported to be available by 4.08% of the respondents across only three of the selected hospitals. Physiotherapists, cardiologists, dieticians, and nurses were the most commonly involved health professionals with interventions not based on a comprehensive, coordinated multidisciplinary approach. The nonpharmacological components of CR mostly offered were smoking cessation, nutritional, and physical activity counseling with exercise training. Although CR was not available in most of the facilities, a large proportion (70%) of the respondents had good perception of its importance. Conclusion: We concluded that CR programmes were not available in North western Nigeria giving the small proportion of respondents who claimed it was available only used its components in a fragmented or uncoordinated fashion which does not constitute CR.
  1,177 106 -
Electrocardiographic changes among elite athletes in Port Harcourt, Nigeria
Kanayo Mercy Odia, Kenneth Chimbuoyim Anugweje, Victor Datonye Dapper, Osaretin James Odia
July-December 2020, 17(2):120-127
Background: Due to cardiac adaptations in athletes, the normal electrocardiogram (ECG) may be altered and abnormal patterns occur. Cardiovascular-related sudden death is a leading cause of mortality during sports. ECG interpretation in athletes therefore requires careful analysis to properly distinguish changes due to physiological adaptations from those suggestive of underlying pathology. The present study describes ECG changes and attempts to identify possible adaptive and maladaptive changes among a cohort of elite athletes of different sports in Port Harcourt, Nigeria. Subjects and Methods: Cross-sectional prospective study involving 339 subjects (16–35 years) comprising 170 athletes (63 males and 107 females) and 169 nonathletes (74 males and 95 females) serving as control were recruited. Anthropometric parameters and blood pressure indices were determined and physical examination conducted to exclude associated comorbidities. Electrocardiographic parameters were determined through standard procedure using a resting 12-lead ECG. Results: No significant differences were observed for anthropometric parameters and blood pressure indices between male athletes and male nonathletes; although, female athletes had significantly higher weight and body mass index than female nonathletes. Irrespective of gender, athletes had significantly lower heart rate, T-axis and significantly higher QT-intervals compared to nonathletes; with lower P-axis and higher PR-interval among male athletes compared to male nonathletes. The left ventricular hypertrophy was the most prevalent abnormality among athletes. Conclusion: Changes described are due majorly to physiologic adaptation. However, some mal adaptations suggestive of risk factors for possible sudden cardiac death were identified. We advise sports physicians to carefully interpret ECG features of athletes to distinguish physiological changes related to athletic conditioning from findings suggestive of pathology.
  1,124 118 -
Morphological and clinical indices determining mode of repair in children with tetralogy of Fallot in Enugu, Nigeria
Josephat M Chinawa, Chika O Duru, Bartholomew Chukwu, Awoere T Chinawa
July-December 2020, 17(2):128-135
Background: Children with tetralogy of Fallot (TOF) present with various clinical and morphological attributes which aid in screening for primary, stage, or elective repair. Objectives: This study is aimed at determining the morphological and clinical indices that predict mode of repair among children with TOF in our locale. Materials and Methods: This was a retrospective echocardiographic review of children with TOF carried out in three different institutions over a 5-year period. Results: The mean age of presentation was 5.0 ± 5.3 years. The nutritional status revealed that 18.2% (8/44) were wasted, 25.0% had severe wasting, while 2.3% were obese. Stunting was observed in 4.5% of the patients and severe stunting in 29.5%. The mean pulmonary valve (PV) annulus of 43 of the patients assessed was 11.0 ± 5.5 mm (mean z-score: −2.03 ± 1.95). Five of them (11.6%) had values one standard deviation (1SD) below the mean of the standard population, 32.6% had values 2SD below the mean, and 27.9% had values 3SD below the mean. Of the 33 children whose right pulmonary artery (RPA) z-scores were assessed, 24.2%, 12.1%, and 12.1%, respectively, had RPA z-scores of 1SD, 2SD, and 3SD below the mean of the standard population, while 17.5% and 7.5% of 40 children whose left pulmonary arteries were assessed had z-scores of 1SD and 2SD below the standard mean, respectively. Right aortic arch and major aortopulmonary collateral arteries (MAPCAs) were seen in 8.1% and 30.5% of the children, respectively. 30.5% of the children with TOF had MAPCAs. Features of Down syndrome were observed in 4.8% (3/62) of the patients. Conclusion: A large proportion of patients present with various degrees of malnutrition with a significant low z-score for PV annulus and branch pulmonary artery diameters. The presence of right aortic arch and MAPCAs was observed in the patients. The increased rate of protein–energy malnutrition, small PV annulus, MAPCAs and presence of right aortic arch, etc., are screening tools that may assist the surgeon in selecting the various surgical options and timing in the approach of children with TOF in this locale.
  767 64 -
Peripartum cardiomyopathy in Nigeria: A historical perspective
Okechukwu Samuel Ogah, Olanike Alison Orimolade, Omolola Boluwatife Awe, Fisayo Ogah, Ejiroghene Martha Umuerri
July-December 2020, 17(2):156-161
Nigeria has the highest burden of PPCM in the world. The condition occurs in one out of every hundred deliveries in the western axis of Northern Nigeria. It is relative uncommon in the southern part of the country. The aim of the paper is to summarise the historical aspect of PPCM report and care in Nigeria.
  716 61 -
Experience with cardiac pacing in the Nigerian Delta region
Emmanuel Auchi Edafe, James O Odia, Maclean R Akpa, Sotonye T Dodiyi-Manual, Herbert Oye, Zuoboemi Agadah
July-December 2020, 17(2):136-141
Introduction: Pacemaker implantation is an important intervention that has been shown to improve the quality of life and reduce mortality in patients with bradyarrhythmias. The objective of this study was to report the permanent cardiac pacing at the Bayelsa Specialist Hospital between June 1, 2017, and May 31, 2019, with the indications, pacemaker type, methods, and complications. Methods: This was a retrospective descriptive study of 44 adult patients with permanent cardiac pacing. Medical records of all patients who had permanent pacing between June 1, 2017, and May 31, 2019, were collected. Results: A total of 44 patients were treated. The age range was from 15 to 98 years with a median of 74.00 years. There were 25 (56.8%) males and 19 (43.2%) females. The major symptoms were syncope 20 (45.5%), dizziness and syncope 10 (22.7%), and palpitation and syncope 6 (13.6%). The most common electrocardiography finding was complete heart block (CHB) in 31 patients (70.46%). Four patients had single-chamber pacing (VVIR), 40 (90.9%) had dual-chamber pacing, and three had ventricular lead extraction and re-implantation of a new lead. Twenty-nine patients had apical pacing and 15 received septal pacing and all the leads were bipolar. Conclusion: CHB was the most common reason for pacemaker implantation and dual chamber was the preferred technique because it mimics the natural atrioventricular synchronization of the sinus rhythm in normal subjects.
  692 49 -
Clinical evaluation and current trends in the diagnosis and treatment of Brugada syndrome
Abaram Chesa Mankwe, Jyh-Ming Jimmy Juang
July-December 2020, 17(2):142-147
Brugada syndrome (BrS) is a cardiac channelopathy associated with an increased risk of unexplained syncope, life-threatening ventricular arrhythmia, or sudden cardiac death. The patients with BrS often have the arrhythmia at rest or while asleep. It could also be triggered by fever or medications. About 15% of those with BrS have a family history of this condition. BrS is diagnosed by identifying ST segment elevation in leads V1–V2 with a right bundle branch block-like appearance of standard 12-lead electrocardiogram (ECG) placed in the fourth intercostal space. The ST segment elevation could also be unmasked or become more obvious by placing lead V1–V2 in the second and third intercostal spaces. In some patients, the ECG shows a prolonged PR interval but normal QTc interval. The first-line therapy for patients with BrS presenting with prior cardiac arrest or documented ventricular tachycardia is an implantable cardioverter-defibrillator (ICD). In the cases with recurrent ventricular arrhythmia or electrical storm, pharmacological therapy with quinidine is recommended as an adjunct to an ICD. This article is an overview of the clinical evaluation and current trends in the diagnosis and treatment of BrS.
  602 46 -
It is high time to incorporate exercise therapy as an adjunct to drug therapy in the management of hypertension
Daha Garba Muhammad
July-December 2020, 17(2):154-155
  530 38 -
Recurrent palpitation and supraventricular tachycardia in a patient with a restrictive ventricular septal defect
Abubakar Yerima, Bello Abdullahi Ibrahim, Faruk Buba, Mohammed Abdullahi Talle
July-December 2020, 17(2):148-150
Ventricular septal defect (VSD) is the most commonly recognized congenital heart disease. The presentation in patients with VSD is variable depending on the size, location, hemodynamic consequences, and complications including bacterial endocarditis, pulmonary hypertension, and cardiac arrhythmias. The most common cardiac arrhythmias in unoperated VSD are premature ventricular contractions (isolated, couplets, and multiform). We present a case of supraventricular tachycardia, an uncommon occurrence, presenting with recurrent syncope in a 42-year-old female with restrictive VSD.
  408 48 -