Left Atrial Isomerism in Afro-Caribbean Adolescents and Adults with no Intervention: Echocardiographic Findings.

Left atrial isomerism (LAI) is a rare congenital anomaly usually associated with major or minor congenital cardiac lesions. Presentation beyond childhood is unusual as there is usually high morbidity of 63% associated with the co-morbid major congenital cardiac lesions in the first year of life. The four index cases highlight the myriad cardiac lesions facilitating survival into adolescence and adulthood of this rare cardiac condition. Presented are markedly different echocardiographic findings of four cases of LAI in Afro-Caribbeans who had no intervention. Their diagnostic transthoracic echocardiographic findings are the focussed features of this article and the first documentation of isolated patent ductus arteriosus with LAI. Fascinating diagnostic chest X-ray findings of the LAI index cases are presented. They are the first cases of LAI documented in Afro-Caribbeans.

Ischaemic Heart Disease at the University Hospital of the West Indies: Trends in Hospital Admissions and Inpatient Mortality Rates 2005-2010.

OBJECTIVES: This study aimed to estimate hospital admission rates and inpatient mortality rates for ischaemic heart disease (IHD) and its subtypes at the University Hospital of the West Indies (UHWI) for the years 2005─2010, and to identify factors associated with inpatient mortality. METHODS: Data from electronic discharge summaries for patients diagnosed with acute myocardial infarction (A-MI), unstable angina (UA) or other IHD were obtained from the Patient Information Management Systems database of the Medical Records Department of the UHWI. Data were entered into an electronic database and analysed using Stata 10.1. Random effects logistic regression was used to identify factors associated with inpatient mortality. RESULTS: Analysis included 3794 admissions (2821 persons: 1415 males, 1406 females; mean age 63.9 ± 13.5 years). Overall admission rates for IHD were 12.1% (95% CI 11.7, 12.5) for medical admissions and 4.02% (95% CI 3.89, 4.15) for non-paediatric admissions. Admission rates were higher among males compared to females. There was a statistically significant trend for an overall increase in the rates for IHD admissions over the study period. Inpatient mortality rate was 18.9% for A-MI, 1.6% for UA and 7.8% for other IHD. In multivariable models, adjusted for age and gender, A-MI was associated with higher mortality compared to other IHD (OR 3.38, p < 0.001). CONCLUSIONS: Ischaemic heart disease admission rate is increasing at the UHWI and accounts for approximately one of every eight medical admissions. Inpatient mortality for acute myocardial infarction is approximately 19%. Further studies are required to determine the factors associated with inpatient mortality and to inform strategies for improving outcomes.