[Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.] / Évolution de l'épidémiologie et de la prise en charge des syndromes coronariens aigus à Abidjan : étude transversale de 1011 patients.

BACKGROUND: To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS). METHODS: Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS. RESULTS: One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07). CONCLUSION: The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.

[Practice of home blood pressure monitoring in a population of hypertensive patients in subsaharan Africa]. / Pratique de l'automesure tensionnelle dans une population d'hypertendus en Afrique subsharienne.

AIM: To investigate home blood pressure monitoring (HBPM) practice among treated hypertensive patients in a subsaharan Africa setting. PATIENTS AND METHODS: Cross-sectional observational study over a five-month period from April 30 to September 30, 2019. The survey was carried out among treated hypertensive patients aged at least 18-years-old, received in outpatient consultations department at the Abidjan Heart Institute during the study period. We assessed the rate of patients performing HBPM, and compared characteristics and rate of blood pressure control between patients according to the realization of HBPM. RESULTS: Three hundred hypertensive patients (mean age 59.2±12.0 years, sex ratio 1.4) were included. Of these, 68.3% reported to have information about HBPM. In 42.3% of cases, patients had an electronic blood pressure device at home, the majority of which were devices with arm cuffs (65.3%). The study showed that 40.3% of the patients had received education on hBPSM, most commonly provided by practitioners (71.9%). Among our population study, 36.3% performed HBPM, of whom only 13.8% according to the 3-day standardised protocol. In multivariate analysis, HBPM appeared to be an independent factor associated with better blood pressure control. CONCLUSION: HBPM is rarely used by patients with hypertension in our practice. Most of the patients do not receive education about HBPM and adequate training in order to perform it routinely.

[Assessment of peripheral artery disease in proven coronary patients in Abidjan Heart Institute of Côte d'Ivoire]. / Évaluation des lésions artérielles périphériques chez le coronarien avéré à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

BACKGROUND: Coronary artery disease is mainly due to atherosclerosis. The aim of this study was to evaluate the frequency of peripheral arterial disease in proven coronary artery disease and to determine the associated factors in our context. MATERIAL AND METHODS: We included in a cross-sectional descriptive and analytical study 224 patients with proven coronary artery disease confirmed on coronary angiography from March 1 to October 30, 2019. It took place in the external exploration department of the Abidjan Heart Institute. An ultrasonographic exploration of the supra-aortic trunks and arteries of the lower extremity with measurement of the ankle brachial index (ABI) was carried out. RESULTS: The mean age was 57.4±10.9 years (27-81years). There was a clear male predominance with a sex-ratio of 5. The prevalence of carotid artery disease was 56.4% of patients. The main factors associated with elevated Intima Media Thickness (IMT) and the presence of carotid plaques were male sex (OR=8.8; P=0.038), smoking (OR=2.5; P=0.049) and multi-truncular involvement (OR=3.2; P=0.014). In the lower extremities, there was a prevalence of peripheral arterial disease of 48.5%. The main factors associated with the decrease of ABI were age ≥50 years (OR=2.6; P=0.043), diabetes (OR=2.8; P=0.02), dyslipidemia (OR=3.8; P=0.001) and pluri-truncular involvement (OR=4.5; P<0.0001). CONCLUSION: The presence of significant coronary artery disease in our context is associated with a high prevalence of peripheral carotid artery and lower extremity artery disease. This is all the more so as we are male, over 50 years old, pluri-truncular with many cardiovascular risk factors.

[Pulmonary embolism and complete atrioventricular block]. / Embolie pulmonaire et bloc auriculoventriculaire complet.

Complete atrioventricular block is a rare complication of pulmonary embolism. We describe the case of a black African patient, aged 42 years, who presented to the emergency department of Abidjan Heart Institute for sudden onset dyspnea and hemoptysis. ECG revealed a third degree atrioventricular block. Computed tomographic angiography showed proximal pulmonary embolism of the right main pulmonary artery. To our knowledge, this is the first case of complete atrioventricular block in pulmonary embolism in Sub-Saharan Africa. In case of pulmonary embolism, clinical and electrocardiographic monitoring is necessary in order to identify this uncommon and potentially serious outcome.

[Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]. / Cardiopathies congénitales de l'adolescent et de l'adulte : prise en charge dans un service de cardiologie générale au Sénégal.

BACKGROUND: Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes. METHODS: We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography. RESULTS: We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%). CONCLUSION: Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]. / Les manifestations cardio-vasculaires au cours du lupus érythémateux systémique à Dakar : étude descriptive à propos de 50 cas.

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

[Implementation of palliative care in Ivory Coast]. / Mise en place de la politique nationale des soins palliatifs en Côte d'Ivoire.

Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place.