Intra-Cardiac Masses in Adults: A Review of Echocardiogram Records at Two Echocardiographic Laboratories in Enugu; South-East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses; even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses; especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90 sensitivity and greater than 85 specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE; especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra-cardiac masses in adults; as well as the gender distribution and commonest location of these masses.Results: There were 2;814 echo examinations in adults over this period; comprising 1;661 males (59.1) and 1;153 females (40.9). Intra-cardiac masses were found in 20 of these patients representing 0.7 of the study population. Thrombi were the commonest masses noted in our study; and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra-cardiac masses are rare; and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria

Aim: With increasing urbanization of lifestyle; cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have ypertension. Each participant's blood pressure was measured and any value =140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI =30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value =102 cm for males and =88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2). Females were more aware than the males. The prevalence of HBP was higher in males (49.3) compared with their female counterparts (42.3); whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2; global: 14.8) compared with the males (abdominal: 14.5; global: 10.1). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus; the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP

Cardiac Pacemaker Treatment of in Enugu a 5-Year. Review

Background: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation; sometimes after a period of misdiagnosis and inappropriate treatment. Methods: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre; Enugu; between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. Results: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100). Hypertensive heart disease was present in 65of the patients and a history of chronic chloroquine usage was positive in 73of the patients. Predominant pre-treatment pulse rate was in the range of 30-40 per minute (43) while 21of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16had hypotension. Third degree heart block was present in 65of the patients and 89of all patients needed pre-pacing haemodynamic stabilization with positive inotropic / chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65and epicardial pacing in 35of the patients with equally good response in symptoms; haemodynamic parameters and electrocardiographic features. Conclusion: Permanent artificial cardiac pacing is the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list