Masquerading Bundle Branch Block in a Patient with Heart Failure in Nigeria.

BACKGROUND: Masquerading bundle branch block (MBBB) is a rare and important electrocardiographic pattern. It consists of right bundle branch block (RBBB) in precordial leads and left bundle branch block (LBBB) in limb leads. It indicates advanced conduction system abnormality usually associated with severe underlying heart disease. MBBB is associated with poor prognosis. MBBB patients are at increased risk of complete atrioventricular (AV) block. To our knowledge, there is no previous published report of MBBB in heart failure in Nigeria. AIM: To present a case of an African patient with heart failure and masquerading bundle branch block, a rare and important finding on 12-lead electrocardiogram. OBJECTIVE: To highlight the electrocardiographic feature of masquerading bundle branch block in a heart failure patient in our environment and the need for early recognition and close monitoring. PATIENT AND METHODS: A 65-year-old man, known hypertensive and asthmatic, who presented with cough productive of whitish frothy sputum, bilateral leg swelling, and difficulty in breathing of 3 weeks duration. There was associated paroxysmal nocturnal dyspnea, orthopnea, and early satiety. No central chest pain on exertion or at rest. RESULTS: The 12-lead electrocardiography (ECG) showed precordial type MBBB with right bundle branch block in V1 and LBBB without deep and wide S waves in leads V5 and V6. Echocardiography confirmed heart failure with reduced ejection fraction of 19%, grade 3 diastolic dysfunction with E/A velocity ratio of 2.31, E/e' of 29.7. Chest X-ray revealed unfolded aorta and cardiomegaly with cardio-thoracic ratio (CTR) of 65%. Patient was stabilized on anti-failure drugs and is being followed up. CONCLUSION: We have reported electrocardiographic feature of MBBB in an African patient with heart failure. Early recognition of this rare electrocardiographic pattern, close monitoring and follow-up of these patients is important because of its association with poor prognosis.

Mixed connective tissue disease complicated by heart failure in Ile-Ife, Nigeria: management challenges in a resource-limited economy.

BACKGROUND: Mixed connective tissue disease (MCTD; also known as Sharp's syndrome) is a rare autoimmune inflammatory disorder characterized by high titer of U1 ribonucleoprotein (U1RNP) antibody and clinical and serological overlap of systemic lupus erythematosus, systemic sclerosis, and polymyositis. The diagnosis is based on clinical and serological factors in criteria such as Alarcon-Segovia, Khan, Kusakawa, and Sharps. Cardiac disease can be a complication of connective tissue disease (CTD). There are few reports in Africa. AIMS: To present MCTD as underlying cause of heart failure with reduced ejection fraction and highlight challenges of investigations and treatment. OBJECTIVES: To highlight the first case in our center and discuss the cardiac, respiratory, and rheumatologic management. PATIENT AND METHODS: We present a 52-year-old woman with 3 weeks history of productive cough with whitish sputum, severe dyspnea, orthopnea, paroxysmal nocturnal dyspnea, right sided abdominal pain, leg swellings, a one year history of recurrent fever, Raynaud's phenomenon, small joint swellings and deformities with pain in both hands. RESULTS: On examination there was microstomia, tethered forehead and lower eyelid skin, tender swelling of the interphalangeal joints and arthritis mutilans. Laboratory findings showed estimated glomerular filtration rate <60 mL/kg/min/1.73 m2, U1RNP antibody levels were eight times upper limit of normal, elevated rheumatoid factor, speckled antinuclear antibody pattern, negative anticentromere antibody, anti Scl-70 and anticyclic citrullinated peptide. Chest X-ray/CT revealed pulmonary fibrosis. Echocardiography findings showed reduced ejection fraction of 40%, elevated pulmonary arterial pressure at rest of 60.16 mmHg. The patient showed improvement on antifailure drugs, but prednisolone was stopped for sudden reversal of previously controlled stage 2 hypertension (HTN), and the patient was discharged in a stable condition. Difficulties ensued in obtaining prompt definite results due to the unavailability of serologic tests in the hospital, and the tests were done outside the state and country. CONCLUSION: Identifying MCTD is critical, especially in patients requiring steroids that may worsen systemic HTN and heart failure. There is a need to have definitive investigative facilities for such patients in hospitals.

Pulmonary hypertension in Nigerian adults with sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) is the commonest hemoglobinopathy and is associated with high morbidity and mortality. Pulmonary hypertension (PH) is reported to play a significant role in this regard. There is very limited literature on PH in SCA in Nigeria. OBJECTIVES: The objectives of this study were to determine the prevalence of Doppler-derived PH in SCA, assess its influence on exercise capacity, and determine the correlates and predictors of measures of estimated pulmonary pressure. METHODS: A total of 92 SCA subjects had echocardiography and 6-minute self-paced walking exercise. PH was diagnosed by Doppler echocardiography on finding a tricuspid regurgitant velocity (TRV) of ≥2.5 m/s. The pulmonary flow profile was also assessed to estimate mean pulmonary arterial pressure (MPAP). RESULTS: Doppler-derived PH was detected in 23.9% of adults with SCA. The 6-minute walking distance (6MWD) was significantly lower in SCA adults with PH than in those without PH (380.33 ± 63.17 m vs 474.28 ± 76.74 m; p = 0.014). TRV and estimated MPAP had a significant inverse correlation with the 6MWD (r = -0.442; p < 0.001 and r = -0.571; p < 0.001, respectively). CONCLUSION: PH as derived by Doppler is common in Nigerian adults with SCA and has a significantly negative influence on exercise capacity. Screening for PH should be encouraged to optimize management and thus improve their quality of life and life expectancy.

Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test.

BACKGROUND: Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors. OBJECTIVE: The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients. METHODS: A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as "mortality vs alive" and as "events vs no-events" based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group. RESULTS: HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the "alive" group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59). CONCLUSION: High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.

Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria.

BACKGROUND: Pulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH. METHODS: A total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile. RESULTS: PH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity (E'), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E' ratio. CONCLUSION: PH is very common in heart failure and has significant relationship with left ventricular function.

Comparison between treadmill and bicycle ergometer exercise tests in mild-to-moderate hypertensive Nigerians.

BACKGROUND: Comparative cardiovascular responses to treadmill and bicycle ergometer (bike) exercise tests in hypertensive Nigerians are not known. This study compared cardiovascular responses to the two modes of exercise testing in hypertensives using maximal exercise protocols. METHODS: One hundred and ten male subjects with mild-to-moderate hypertension underwent maximal treadmill and bike test one after the other at a single visit in a simple random manner. Paired-sampled t-test was used to compare responses to both exercise tests while chi-squared test was used to compare categorical variables. RESULTS: The maximal heart rate (P<0.001), peak systolic blood pressure (P=0.02), rate pressure product (P<0.001), peak oxygen uptake (P<0.001), and exercise capacity (P<0.001) in metabolic equivalents were signifcantly higher on the treadmill than on the bike. CONCLUSION: Higher cardiovascular responses on treadmill in Nigerian male hypertensives in this study, similar to findings in non-hypertensives and non-Nigerians in earlier studies, suggest that treadmill may be of better diagnostic utility in our population.

Pattern of arrhythmias among Nigerians with congestive heart failure.

BACKGROUND: In patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure. MATERIALS AND METHODS: Thirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan's analysis, Fisher's exact test, and linear regression analysis using SPSS version 16. RESULTS: CHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001). CONCLUSION: Cardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.

Sonographic assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian population.

BACKGROUND: Hypertension is a common health problem and a major risk factor of cardiovascular disease. The most important mechanism by which hypertension acts as a cardiovascular risk factor is the induction of arteriosclerosis. The early phase of atherosclerosis before its clinical manifestation can be studied using B-mode ultrasonography. AIMS AND OBJECTIVES: This study evaluated the intima-media thickness of the common carotid artery (CCA), carotid intima-media thickness (CIMT) of subjects with essential hypertension as a way of detecting these early changes of atherosclerosis. SUBJECTS AND METHODS: The study was performed on 200 subjects with newly diagnosed hypertension and 100 apparently normal controls that were consecutively recruited by a cardiologist. An ultrasound examination of both CCA were done to obtain the CIMT. Data were analyzed using the SPSS data analysis software. RESULTS: The CIMT of males were greater in the hypertensive group compared to the controls (0.10 ± 0.02 cm vs. 0.077 ± 0.02 cm [P < 0.0001] and 0.10 ± 0.02 cm vs. 0.078 ± 0.02 cm [P < 0.0001] for the right and left sides, respectively). The female group showed a similar pattern of results (0.09 ± 0.02 cm vs. 0.072 ± 0.02 cm [P < 0.0001] and 0.1 ± 0.02 cm vs. 0.076 ± 0.02 cm [P < 0.0001] for the right and left sides respectively). CONCLUSION: A statistically significant increase in CIMT was noted in both male and female hypertensives in comparison to a normal population.

Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria.

BACKGROUND: There are very limited published studies in Nigeria on the use of 24 hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients. OBJECTIVE: To evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit. METHODS: Seventy-nine patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101) Holter ECG machine. RESULTS: Out of the 79 patients, 17 (21.5%) had HHD without heart failure, 33 (41.8%) had HHD with hypertensive heart failure (HHF), while 29 (36.7%) were T2DM patients. The mean (standard deviation) ages of HHD without heart failure, HHF and T2DM patients were 59.65 (±14.38), 65.15 (±14.30), and 54.66 (±8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV using standard deviation of all normal-normal intervals was significantly reduced in T2DM patients (81.03±26.33, confidence interval [CI] =71.02-91.05) compared to the HHD without heart failure (119.65±29.86, CI =104.30-135.00) and HHF (107.03±62.50, CI =84.00-129.19). There was a negative correlation between the duration of T2DM and HRV (r=-0.613). CONCLUSION: Palpitation was the commonest Holter ECG indication and premature ventricular contractions were the commonest arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients.

Marked First Degree Atrioventricular Block: an extremely prolonged PR interval associated with Atrioventricular Dissociation in a young Nigerian man with Pseudo-Pacemaker Syndrome: a case report.

BACKGROUND: The diagnosis of Marked First Degree Atrioventricular Block is made with electrocardiogram when PR interval ≥0.30 s. A PR interval of up to 0.48 s had been reported in literature. Data is sparse on an extremely prolonged PR interval associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome. Electrocardiogram with this type of uncommon features poses diagnostic and management challenges in clinical practice. CASE PRESENTATION: We report a case of a 22 year old Nigerian male from Igbo ethnic group who presented himself for medical screening with a history of exercise intolerance, occasional palpitation and fainting spells. He has no history of cough, orthopnoea, paroxysmal nocturnal dyspnoea nor body swelling. A physical examination revealed that the patient has a pulse rate of 64 beats per minute, blood pressure of 110/70 mmHg and soft heart sounds. Standard 12-lead electrocardiogram showed an uncommon Marked First Degree Atrioventricular Block with an extremely prolonged PR interval of 0.56 s. Long rhythm strips of the electrocardiogram showed extremely prolonged PR interval associated with Atrioventricular Dissociation and variable degrees of Atrioventricular Block (Mobitz type I and II). CONCLUSIONS: An extremely prolonged PR interval may occur in First Degree Atrioventricular Block and it may be associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome which may pose diagnostic and management challenges. This suggests that not all cases of First Degree Atrioventricular Block are benign and so should be sub-classified based on degree of PR interval prolongation and associated electrical abnormalities.

Blood pressure control and exaggerated blood pressure response in nigerians with essential hypertension.

BACKGROUND: Blood pressure (BP) control in hypertensives is important in preventing cardiovascular (CV) morbidity and mortality. This work was done to assess control of BP among Nigerian hypertensives at rest and during exercise. MATERIALS AND METHODS: A total of 85 male hypertensives were recruited consecutively and had clinical evaluation and treadmill (TM) exercise testing using the Bruce protocol. Independent t-test, chi-square, and Fisher's exact tests were used to compare patients with controlled and uncontrolled BP using SPSS version 16 software. Adjustment for confounders was by logistic regression and general linear model. RESULTS: Resting systolic BP (rSBP) (mmHg) and resting diastolic BP (rDBP) (mmHg) were significantly lower in the controlled group (115.0 ± 12.29, 133.1 ± 12.27, P = <0.001 and 76.00 ± 6.55, 91.4 ± 8.00, P = <0.001). The proportion of subjects with controlled BP was 37.7%. Adjusted peak SBP (PSBP) during exercise (mmHg) was significantly higher in the uncontrolled than in the controlled group (210.5 ± 27.31, 191.8 ± 20.77, P = 0.001). Adjusted exaggerated blood pressure response (EBPR) was found in 37 subjects (44%) in the uncontrolled group while seven subjects (0.1%) had EBPR in the controlled group (P = 0.003). CONCLUSION: This study shows that EBPR is significantly higher in subjects with uncontrolled BP compared with those with controlled BP. Therefore, good BP control may be the key factor in preventing EBPR in hypertensives.

Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria.

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

Relationship between socioeconomic status and metabolic syndrome among Nigerian adults.

The study determined the diastolic and systolic pressure, anthropometric parameters, serological parameters comprising fasting blood glucose (FBG), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) as well as the socio-economic status (SES) of inhabitants of Ilora with a view to providing information on impact of SES on metabolic syndrome (MetS). One hundred participants (54 males and 46 females) whose ages ranged from 30 and 70 years, participated in the study. Participants were recruited from the three wards of the town using multi-stage random sampling procedure. Subjects' weights, height, blood pressure, waist circumference (WC) were measured using standard instruments. Fasting blood glucose (FBG) was measured using a glucometer on participants' blood samples taken after at least 8h of fasting. Serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were analyzed using enzyme colometric assay kits in the laboratory. SES of the participants was determined by using a questionnaire, which sought information on annual income, occupation and education. Participants who had MetS were determined using the new International Diabetes Foundation definition of MetS. Both descriptive and inferential statistics were used to analyze the data. The mean scores for the males and females systolic blood pressure (SBP) were 123.20 ± 20.72 mmHg and 117.78 ± 14.64 mmHg, and the diastolic blood pressure (DBP), 78.63 ± 11.72 mmHg and 75.98 ± 13.06 mmHg, respectively. The mean of serological variables scores for the males and females, respectively, were FBG (4.95 ± 0.81 mmol/L and 4.84 ± 1.36 mmol/L), TG (1.28 ± 0.75 mmol/L and 1.35 ± 1.05 mmol/L), HDL-C (1.26 ± 0.21 mmol/L and 2.32 ± 7.34 mmol/L). The mean SES scores for the males and females were 14.35 ± 4.75 and 13.13 ± 4.66, respectively. The prevalence of MetS was 43.5% in females and 9.3% in males. Significant differences were found in SBP and FBG across the three SES groups (F=3.148 and 3.862, respectively, p<0.05). The high SES group was found to have significantly higher SBP and FBG than the low and middle SES groups. There were significant correlations between SES scores and SBP (r=0.255; p<0.05), FBG (r=0.270; p<0.01), and BMI (r=0.210; p<0.05). Also, significant relationships were found between weight and TG (r=0.282; p<0.05), waist circumference (WC) and FBG (r=0.264; p<0.05), and WC and TG (r=0.414; p<0.01). The study concluded that SES has significant relationship with metabolic syndrome components such as SBP and fasting blood glucose among adult population in Nigeria.

The "obesity paradox" in Nigerians with heart failure.

BACKGROUND: Previous studies have suggested that a high body mass index (BMI) was associated with improved outcome in congestive heart failure (CHF). The aim of this study was to examine the relationship between BMI and echocardiographic variables of cardiac function in stable outpatients with heart failure. METHODS AND MATERIALS: This is a cross-sectional study in which the cardiology clinic out-patients of Obafemi Awolowo University Teaching Hospital with heart failure were recruited. Patients were categorized using baseline BMI as normal weight BMI = 18.5-24.9 kg/m(2) and overweight/obese (BMI > 25.0 kg/m(2)). Risks associated with BMI groups were evaluated and the data were analyzed with the aid of SPSS 15.0 software. RESULTS: Patients with higher BMI have higher left ventricular ejection fraction and fractional shortening and lesser tendency to have an abnormal left ventricular geometry and better functional (New York Heart Association) class of heart failure at presentation. CONCLUSION: Overweight and obese patients had less severe degree of heart failure than normal weight patients and efforts should be made to prevent excessive weight loss in patients with heart failure.

Gender differences in the variables of exercise treadmill test in type 2 diabetes mellitus.

BACKGROUND: Exercise capacity, like some other variables of exercise stress test, is a strong predictor of cardiovascular and overall mortality. Many confounding factors, including gender, have been found to affect exercise capacity. This study evaluated whether exercise capacity differs in age-matched type 2 diabetic Nigerian men and their women counterparts and the hemodynamic variables of exercise treadmill test that correlate with exercise capacity in them. MATERIALS AND METHODS: A total of 61 type 2 diabetics (male = 34; female = 27) aged 30 to 60 years who were recruited through the Medical Out-patient Department of OAUTHC, Ile Ife, Nigeria, underwent symptom-limited maximal treadmill exercise using Bruce protocol. RESULT: Patients had comparable clinical and demographic patterns. There was no gender difference in the chronotropic response to exercise. Males had faster heart rate recovery (HRR) than females. Though both sexes had similar resting systolic blood pressure (SBP), males had significantly higher peak SBP than females (216.2 ± 23.7 mmHg vs 203.3 ± 21.7 mmHg; P = 0.03). Exercise capacity was significantly higher in males (7.5 ± 2.0 METs) than females (6.4 ± 1.5 METs); P = 0.01. Significant correlates of exercise capacity in both sexes were fasting plasma glucose, resting diastolic blood pressure, Duke Treadmill Score, and HRR. Majority of the patients were in moderate DUKE risk subgroup and there was no statistically significant difference between males and females in this regard. CONCLUSION: Gender difference occurs in the exercise capacity of diabetic patients and the factors associated with this disparity may be related to gender differences in resting heart rate and HRR, both reflecting a withdrawal of vagal tone.

Standard 12-lead electrocardiogram in healthy young adults in South-Western Nigeria.

OBJECTIVE: This study aimed to determine the mean values of electrocardiographic parameters, and to describe the pattern of electrocardiograms in young adults. METHODS AND RESULTS: 353 healthy young adults were evaluated by medical history, physical examination, and standard 12-lead electrocardiogram. The mean heart rate, QRS duration, PR interval, QT interval, corrected QT interval (QTc),T wave axis, P wave duration and amplitude were: 74 +/- 9 beats per min, 0.09 +/- 0.01s, 0.15 +/- 0.02 s, 0.36 +/- 0.02 s, 0.40 +/- 0.02 s, 54 +/- 20 degrees, 49 +/- 14 degrees, 0.09 +/- 0.01 s, 1.28 +/- 0.41 mm, respectively. The dominant electrocardiographic peculiarity among the participants was early repolarization which was characterized by male preponderance. CONCLUSION: This study defined baseline values for electrocardiographic variables in healthy young adults. Early repolarization is a common ECG feature in young adults.

Gender differences in the variables of exercise treadmill test in type 2 diabetes mellitus

Background: Exercise capacity, like some other variables of exercise stress test, is a strong predictor of cardiovascular and overall mortality. Many confounding factors, including gender, have been found to affect exercise capacity. This study evaluated whether exercise capacity differs in age-matched type 2 diabetic Nigerian men and their women counterparts and the hemodynamic variables of exercise treadmill test that correlate with exercise capacity in them. Materials and Methods: A total of 61 type 2 diabetics (male = 34; female = 27) aged 30 to 60 years who were recruited through the Medical Out-patient Department of OAUTHC, Ile Ife, Nigeria, underwent symptom- limited maximal treadmill exercise using Bruce protocol. Result: Patients had comparable clinical and demographic patterns. There was no gender difference in the chronotropic response to exercise. Males had faster heart rate recovery (HRR) than females. Though both sexes had similar resting systolic blood pressure (SBP), males had significantly higher peak SBP than females (216.2 ± 23.7 mmHg vs 203.3 ± 21.7 mmHg; P = 0.03). Exercise capacity was significantly higher in males (7.5 ± 2.0 METs) than females (6.4 ± 1.5 METs); P = 0.01. Significant correlates of exercise capacity in both sexes were fasting plasma glucose, resting diastolic blood pressure, Duke Treadmill Score, and HRR. Majority of the patients were in moderate DUKE risk subgroup and there was no statistically significant difference between males and females in this regard. Conclusion: Gender difference occurs in the exercise capacity of diabetic patients and the factors associated with this disparity may be related to gender differences in resting heart rate and HRR, both reflecting a withdrawal of vagal tone

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test.

BACKGROUND: The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF). METHOD: Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations. RESULTS: Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO(2) max) (r = 0.65, P < 0.01). The average distance walked was 327 m +/- 12.03 m. The VO(2) max estimated during bicycle ergometry was higher (13.7 +/- 1.9 L) than during the six minutes walk (8.9 +/- 1.2 L). CONCLUSION: Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Evaluation of renal volume by ultrasonography in patients with essential hypertension in Ile-Ife, south western Nigeria.

BACKGROUND AND AIMS: To determine renal volume in adult patients with essential hypertension and correlate it with age, sex, body mass index (BMI), body surface area (BSA) and duration of hypertension. PATIENTS AND METHODS: A total of 150 patients (75 males, 75 females) with essential hypertension and normal renal status were evaluated sonographically in this prospective study. Fifty healthy individuals (25 males, 25 females) without hypertension were also evaluated as control. Renal volume was then calculated from the kidney's length, width and anterio-posterior diameter using the formula L×W×AP×0.523. RESULTS: The range of renal volume obtained was 51.65-205.02 cm(3), with a mean of 114.06 ± 29.78 cm(3) for the left kidney and 47.37-177.50 cm(3) with a mean of 106.14 ± 25.42 cm(3) for the right kidney. The mean volumes of the right and left kidneys in males (112.98 ± 25.56 cm(3) and 123.11 ± 32.49 cm(3), respectively), were significantly higher than in females (99.31 ± 23.07 cm(3) and 105.01 ± 23.77 cm(3), respectively). Renal volume correlated significantly with BSA and BMI, but decreased with age. The renal volume showed no correlation with duration of hypertension. CONCLUSION: Renal volume is higher in the left than the right kidney in hypertensive patients of both sexes and female hypertensive patients have smaller kidney size compared to males. The study also shows that volume of both kidneys decreases with age and positive correlation between renal volume, BSA and BMI. However, there is no correlation between renal size and duration of hypertension.

Relationship of ultrasonographically determined kidney volume with measured GFR, calculated creatinine clearance and other parameters in chronic kidney disease (CKD).

INTRODUCTION: Kidney length has traditionally been used as a predictor of chronic kidney disease (CKD); however, kidney volume (KV) rather than length has been emphasized by researchers as a true predictor of kidney size in states of good health and disease. Since KV can be assumed to be a predictor of kidney mass or remaining surviving nephrons in CKD patients, we theorized that the KV should reflect the functional capacity of the kidneys, i.e. the glomerular filtration rate (GFR). METHODOLOGY: Forty CKD patients were recruited and investigated. Measured GFR was determined by calculating the average of endogenous creatinine clearance (mCrCl) and urea clearance (mUrCl) while predicted GFR was determined using Cockcroft and Gault, Hull and Modification of Diet in Renal Disease (MDRD) equations. KV was assessed ultrasonographically using the formulae of Dinkel et al. and Solvig et al. for ellipsoid organ. The relationship between the KV and GFR was assessed using Spearman's correlation coefficient while Bland and Altman tests were used to assess intraobserver variation and agreement between measured and predicted GFR. RESULTS: The results showed a weak but positive correlation between KV and various indices of GFR, best with measured CrCl (correlation coefficient ranged between 0.408 and 0.503; P < 0.05), and which was not improved after normalization for body surface area (BSA). We also found a significant correlation between the measured CrCl and various values of estimated CrCl. CONCLUSION: Ultrasonographically determined KV was found to correlate with GFR and hence can be used to predict it in established CKD, particularly in resource-poor settings.