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Electrocardiographic and Echocardiographic Changes in Cameroonian Hypertensive Patients
Olivier Pancha Mbouemboue,
Herman Cabrel Ngangao,
Wavoulansa Zourmba,
Ahmadou Hayatou
Issue:
Volume 5, Issue 2, June 2021
Pages:
57-60
Received:
6 April 2021
Accepted:
22 April 2021
Published:
8 May 2021
Abstract: High blood pressure is a major cardiovascular risk factor. It has repercussions on the heart, which can be easily assessed by non-invasive examinations. The objective of this study was to describe electrocardiographic and echocardiographic abnormalities in hypertensive patients under follow up at the Ngaoundere Regional Hospital, (Cameroon). The study was analytical and cross-sectional in nature. It was carried out at the Ngaoundere Regional Hospital (Cameroon). All known adult hypertensive patients who had a resting electrocardiogram (ECG) and echocardiography done during their follow up were included in the study. The study population consisted of 200 hypertensive patients. The mean age of the patients was 59±1.6 years with extremes of 25 and 85 years. Of all the ECGs performed, a total of 94% had abnormal findings. The most frequent electrocardiographic abnormalities were cardiac arrhythmias (53.5%), and left ventricular hypertrophy (LVH) (22%). Overall, 91% of the cardiac echography performed had abnormal findings most of which were ventricular hypertrophy, diastolic dysfunction and left atrial enlargement. In conclusion: a wide variety of electrocardiographic and echocardiographic abnormalities are diagnosed in the hypertensive patient in our environnement. None of them should be neglected. They all present, although to varying degrees, an interest in the orientation and organization of the therapeutic strategy of patients with hypertension. The use of ECG and echocardiography for this purpose should be encouraged in resource-limited areas.
Abstract: High blood pressure is a major cardiovascular risk factor. It has repercussions on the heart, which can be easily assessed by non-invasive examinations. The objective of this study was to describe electrocardiographic and echocardiographic abnormalities in hypertensive patients under follow up at the Ngaoundere Regional Hospital, (Cameroon). The st...
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Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention
Abdalla Mostafa Kamal,
Mona Fikry Fathy,
Ghada Mahmoud Soltan
Issue:
Volume 5, Issue 2, June 2021
Pages:
61-66
Received:
15 April 2021
Accepted:
3 May 2021
Published:
14 May 2021
Abstract: Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Our work aims at finding the relation between PLR and the prognosis of IRA in STEMI patients. Methodology: Two hundred cases presented with STEMI were included for the study. Patency of IRA was estimated by Thrombolysis in Myocardial Infarction (TIMI) grade. Patent IRA was defined as TIMI grade III flow and occluded IRA was defined as TIMI grade 0-II flow. Blood samples were withdrawn on admission at emergency department to calculate PLR. Results: Forty-one (20.5%) cases revealed TIMI 3 flow in IRA before pPCI. Occluded group showed significantly higher PLR than patent group with mean PLR 231.3±94.2 vs 100.95±37.7 respectively with P value <0.0001. Multivariate regression analysis demonstrated, both HTN [95% CI (- 0.135)-(-0.747)] & PLR ratio [95% CI (-0.001)-(-0.002)] together are the most independent predictors for TIMI flow in IRA (F-ratio=12.2, p<0.001). Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI.
Abstract: Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and co...
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Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study
Atul Kapoor,
Goldaa Mahajan,
Aprajita Kapur
Issue:
Volume 5, Issue 2, June 2021
Pages:
67-73
Received:
18 April 2021
Accepted:
7 May 2021
Published:
14 May 2021
Abstract: Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.
Abstract: Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intra...
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Hospital Prevalence of Arterial Hypertension in the Cardiology Department of National Reference Teaching Hospital
Abdel-madjid Zakaria Zakaria,
Adam Ahamat Ali,
Foksouna Sakadi,
Allawaye Lucien,
Toure Ali Ibrahim
Issue:
Volume 5, Issue 2, June 2021
Pages:
74-77
Received:
8 March 2021
Accepted:
25 March 2021
Published:
21 May 2021
Abstract: Introduction: Arterial hypertension is a frequent pathology in cardiology consultations in Chad. We report these observations with the aim of determining the prevalence of arterial hypertension in cardiological consultation at the National Reference University Hospital in N’Djamena. Methodology: We conducted an 8-month retrospective study from September 12, 2019 to April 16th, 2020, in the Cardiology Department of the National Reference Teaching Hospital. The variables studied were socio-demographic and clinical. Results: out of 352 patients seen, 121 met the selection criteria, ie a hospital prevalence of 34.34% with a female predominance. The average age was 64.5 years old with extremes ranging from 17 to 94 years old. Household were the most represented with 47.93% of cases. The most common antecedents were multiparity, arterial hypertension during pregnancy, hyperuricemia with respectively 21, 48% then 4.95% for each of the last two. The most common associated cardiovascular risk factors (FDRCV) were obesity and diabetes with 13.22% and 6.61%. Grade III systolic hypertension was the most represented with 33.05% as well as grade III diastolic hypertension with 32.23% of cases. Conclusion: Hypertension is a public health problem in Chad. Hospital prevalence has almost tripled in 26 years in the same department.
Abstract: Introduction: Arterial hypertension is a frequent pathology in cardiology consultations in Chad. We report these observations with the aim of determining the prevalence of arterial hypertension in cardiological consultation at the National Reference University Hospital in N’Djamena. Methodology: We conducted an 8-month retrospective study from Sept...
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Cardio-Cerebral Infarction Syndrome (CCIS): Definition, Diagnosis, Pathophysiology and Treatment
Issue:
Volume 5, Issue 2, June 2021
Pages:
78-87
Received:
15 May 2021
Accepted:
29 May 2021
Published:
7 June 2021
Abstract: Acute ischemic stroke (AIS) and coronary artery disease are the major causes of death in Palestine and in the world. Ischemic stroke and acute coronary syndrome have similar vascular risk factors and may evolve as a complication of the respective other disease. The prevalence of coronary artery disease has been reported in one fifth of stroke patients. high incidence rate of acute myocardial infarction (AMI) after recent ischemic stroke and the high risk of acute ischemic stroke after recent myocardial infarction has been reported in several clinical or observational studies. Patients are at increased risk of ischemic stroke following recent myocardial infarction, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, but may be harmful in many conditions. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality. So that acute or recent problem in the heart or brain that could result in an acute infarction of the other. In this review we describe the definition and new classification of the cardio-cerebral infarction syndrome with 3 subtypes that reflect the definition, pathophysiology and treatment options.
Abstract: Acute ischemic stroke (AIS) and coronary artery disease are the major causes of death in Palestine and in the world. Ischemic stroke and acute coronary syndrome have similar vascular risk factors and may evolve as a complication of the respective other disease. The prevalence of coronary artery disease has been reported in one fifth of stroke patie...
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Impact of Sleep Duration and Quality on the Burden of Diabetes Among Urban and Rural Community Dwellers in Cameroon
Daniel Lemogoum,
William Ngatchou,
Philippe Van de Borne,
Basile Essola,
Thierry Messomo,
Marc Dandji,
Jean Paul Degaute,
Marc Leeman,
Michel P. Hermans
Issue:
Volume 5, Issue 2, June 2021
Pages:
88-93
Received:
2 May 2021
Accepted:
3 June 2021
Published:
15 June 2021
Abstract: Background: Sleep disorders are known to be linked with numerous cardiovascular comorbidities including type 2 diabetes mellitus. The prevalence and impact of sleep quality and duration on diabetes in the Cameroonian population is not well established. This study evaluates the isolated and combined contribution of two aspects of sleep (duration and quality) on glucose homeostasis in an urban and rural Cameroonian population. Methods: This was a cross-sectional prospective survey conducted among 249 rural and 250 urban community dwellers in Cameroon aged ≥18 years. Self-reported sleep duration (SD) and quality were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was considered for PSQI score>5 and short SD was considered≤ 6h. Diabetes was considered for fasting blood glucose>126mg/d Land/or use of glucose-lowering medications. Results: Mean age was 36±12 years, and men accounted for 39.1%. Frequency of poor sleep quality was 50.3% and was similar in urban and rural groups (48.2% vs 52.4% respectively, p=0.395). Short SD was present in 30.5% of subjects and was more frequent among urban dwellers (36.1% vs 24.8% in rural, p=0.006, respectively). Short SD was significantly associated with diabetes (OR 2.62, 95%CI 1.38-5.00). Although the frequency of diabetes was higher in participants with poor sleep quality compared to those with PSQI ≤5 (10% vs 6.5%, respectively), the observed difference was not significant (p>0.05). The combination of poor sleep quality and short SD was strongly associated with diabetes (OR 2.67, 95%CI 1.23-5.79). Conclusion: This survey demonstrates a significant association between short sleep duration as well as the combination of short sleep duration and poor sleep quality with type 2 diabetes prevalence. It is appropriate to consider sleep quality and duration as potentially modifiable variables associated with the presence or management of diabetes in these Cameroonian populations.
Abstract: Background: Sleep disorders are known to be linked with numerous cardiovascular comorbidities including type 2 diabetes mellitus. The prevalence and impact of sleep quality and duration on diabetes in the Cameroonian population is not well established. This study evaluates the isolated and combined contribution of two aspects of sleep (duration and...
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First Case Report of Transvenous Pacemaker Placement in a Patient with Congenital Absence of the Clavicles Due to Cleidocranial Dysplasia
Krista Diane Niezwaag,
Benjamin James Kotur,
Andrew David Michaels
Issue:
Volume 5, Issue 2, June 2021
Pages:
94-96
Received:
12 May 2021
Accepted:
2 June 2021
Published:
15 June 2021
Abstract: Cleidocranial dysplasia is a rare, autosomal dominant disease that is associated with clavicular absence or hypoplasia. Permanent pacemakers are most commonly implanted using percutaneous subclavian venous access. The clavicle is typically used as a bony landmark to guide venous access. Transvenous pacemaker implantation in the setting of clavicular hypoplasia, resection or other anomalies has not been described in literature. This is the first case report of a patient with clavicular absence undergoing transvenous permanent pacemaker implantation. This patient has a rare condition called cleidocranial dysplasia resulting in the congenital absence of his clavicles, along with other skeletal abnormalities. Cardiac anomalies are not associated with this disorder. This patient presented for permanent pacemaker placement in the setting of trifascicular block, symptomatic intermittent second-degree Mobitz type II atrioventricular block, and syncope. Using intra-procedural subclavian venography and intraprocedural Sonosite ultrasound imaging to identify vascular anatomy and surrounding anatomic landmarks, this patient underwent successful placement of a dual chamber transvenous pacemaker. Images from the intraprocedural venogram and the post-procedure chest x-ray illustrate the anatomy in this patient with congenital absence of the clavicles. This case has important implications in subclavian access and pacemaker placement in patients with clavicular abnormalities that may include absent, deformed, or resected clavicles.
Abstract: Cleidocranial dysplasia is a rare, autosomal dominant disease that is associated with clavicular absence or hypoplasia. Permanent pacemakers are most commonly implanted using percutaneous subclavian venous access. The clavicle is typically used as a bony landmark to guide venous access. Transvenous pacemaker implantation in the setting of clavicula...
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Curative and Preventive Treatment for Cardiovascular Disease (CVD) Targeting Multiple Etiology
Josefino Ballesteros Tunac
Issue:
Volume 5, Issue 2, June 2021
Pages:
97-119
Received:
19 May 2021
Accepted:
31 May 2021
Published:
15 June 2021
Abstract: Gene deficient or knockout (KO) mice and rabbits are models of atherosclerosis focusing on cholesterol plaques, which do not reflect the complex etiology of cardiovascular disease (CVD). Inhibiting the 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase or the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce cholesterol levels but not the rate of CVD. Moreover, the one-drug-one-gene paradigm particularly targeting any one of the G protein-coupled receptors (GPCRs), which represent the largest protein family encoded by the human genome, has at best produced palliative treatment. Vascular diseases including CVD are caused by extraneous (xeno) factors, which are of multifactorial etiology consisting of upstream and downstream phases. The upstream phase is the physical breach of the cells protective glycocalyx (GCX) shield by chemical and biological pollutants, resulting in a sequela of cell damages (plexic) that is manifested downstream in the form of diseases, herein called xenoplexic diseases. Xenoplexic disease is an etiologic description while chronic disease is symptom-centric. This study treated a natural mouse with extraneous agents, which produced plaques and plaque reduction was the end point to evaluate the curative and/or preventive treatment effect of the 3-component compound therapy. Histopathology monitored the presence of plaque, and a 4-panel biomarker, based on GCX disruption, was subsequently developed as a surrogate to monitor plaque formation. Of the several 3-NCE combos tested 4 combos were found to be preventive and curative of plaques indicating the effectiveness of a combo platform therapy. One combo is chosen as the lead candidate and hereby designated as Embotricin TM.
Abstract: Gene deficient or knockout (KO) mice and rabbits are models of atherosclerosis focusing on cholesterol plaques, which do not reflect the complex etiology of cardiovascular disease (CVD). Inhibiting the 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase or the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce cholesterol levels bu...
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Prevalence of Stroke, Coronary Artery Disease, Arrhythmias and Heart Failure: A Community-Based Study in Northern Cameroon
Olivier Pancha Mbouemboue,
Jacques Olivier Ngoufack Tsougmo,
Astride Houmkoua,
Daouda Alim
Issue:
Volume 5, Issue 2, June 2021
Pages:
120-124
Received:
4 May 2021
Accepted:
3 June 2021
Published:
16 June 2021
Abstract: Data on the cardiovascular disease epidemiology in Northern Cameroon remain insufficient. This study aimed at assessing the prevalence of stroke, coronary artery disease (CAD), arrhythmias and heart failure among the Ngaoundere population. This was a community-based study conducted in Ngaoundere from March to June 2018. The study population consisted of adults over 20 years’ old who had been living in the city of Ngaoundere for at least one year and who had consented to participate in the study. Data was collected using a structured questionnaire. The questionnaire included socio-demographic (gender, age, occupation, education, marital status, cardiovascular risk factors, personal and family history of CVD), and physical examination. Stroke, CAD, arrhythmias and heart failure were established by a combination of self reporting and the judgment of a cardiologist coauthor according to a physical examination. In total, 948 subjects aged 20 to 89 were included in the study. Their mean age was 39.92±14.75 years. The prevalence of stroke, CAD, arrhythmias and heart failure were 0.74%, 3.06%, 3.6%, and 12.45% respectively in the study population. In conclusion, in this area, prevalence of stroke, arrhythmias and heart failure was high among adult population. However, further studies including instrumental methods of cardiovascular diagnosis are needed to determine trends of CVD’s prevalence in Ngaoundere locality.
Abstract: Data on the cardiovascular disease epidemiology in Northern Cameroon remain insufficient. This study aimed at assessing the prevalence of stroke, coronary artery disease (CAD), arrhythmias and heart failure among the Ngaoundere population. This was a community-based study conducted in Ngaoundere from March to June 2018. The study population consist...
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Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report
Christoph Bauer,
Natascha Pramhofer,
Mouhamad El Haj-Moustafa,
Gerald Tulzer
Issue:
Volume 5, Issue 2, June 2021
Pages:
125-128
Received:
6 May 2021
Accepted:
26 May 2021
Published:
26 June 2021
Abstract: Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.
Abstract: Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-...
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