Systolic left ventricular dysfunction detected by echocardiography: demographics and aetiology - abstract

The aim of this retrospective study was to determine the demographic features and causes of heart failure in patients presenting a tertiary care institution: 65 patients aged >16 years with an ejection fraction (EF) < 40 percent, undergoing echocardiography during a two-year period, 1992-94, were included in the study. The mean age was 60 ñ 12 years, 68 percent were male, 50 percent and 42 percent were African and East Indian, respectively. The prevalence of diabetes and hypertension was 40 percent and 45.3 percent respectively. The majority of patients were in NYHA class II or III. The mean left ventricular ejection fraction (LVEF) was 29.7 ñ 8.6 percent. There was no correlation between NYHA class and LVEF at initial presentation. The underlying causes of heart failure were coronary artery disease (CAD) (42 percent), idiopathic dilated cardiomyopathy (10.9 percent), hypertensive heart disease (9.4 percent), alcohol related dilated cardiomyopathy (7.8 percent), valvular heart disease (7.8 percent), myocarditis (1.6 percent) and hypertrophic cardiomyopathy (1.6 percent). The dominant primary cause could not be determined in 18.8 percent. LVEF was similarly depressed in the two major ethnic groups and in the ischaemic and non-ischemic cardiomyopathy groups. We concluded that CAD was the most common cause of LV systolic dsyfunction and that LVEF was not related to ethnicity, aetiology or severity of symptoms. (AU)

Is cardiac catheterization being appropriately utilized in Trinidad and Tobago?

Coronary angiography is an expensive technology which has recently become available in Trinidad and Tobago. Established methods have not so far been proposed to monitor the appropriateness of its utilization. We hypothesized that a frequency of normal results comprising greater than 25 percent of the population undergoing coronary angiography should prompt a review of policy with a view to improving resource utilization. This is consistent with the American Heart Association's benchmark figure of 25 percent set for mature laboratories operating in the United States. We therefore retrospectively reviewed all catheterization records of patients undergoing cardiac catheterization at the Eric Williams Medical Sciences Complex during its first three years of operation (1993-1995). Of a total of 785 patients undergoing procedures, 453 had coronary angiography. The number of studies per year increased from 96 in 1993, to 190 in 1994 and 167 in 1995. Thirty-one percent of patients were reported to have normal coronary arteries in the first year of operation. However, this fell to 22 per cent in 1994 and 21 percent in 1995. The first year's statistics are believed to represent a cautious initial referring practice and a learning curve. Second and third year statistics confirm an appropriate pattern of cost-efficient utilization of cardiac catheterization resources at this institution. We propose that the frequency of the finding of normal coronary angiograms is a valid indicator of the appropriateness of resource utilization, which should be voluntarily reported by catheterization laboratories throughout the region (AU)

Coronary artery bypass surgery at the Eric Williams Medical Sciences Complex: clinical profile and outcome - abstract

Coronary artery bypass grafting surgery (CABG) has been recently performed at the Eric Williams Medical Sciences Complex, for the management of patients with coronary artery disease (CAD). This is a review of the joint experience of the Eric WIlliams Medical Sciences Complex/Caribbean Heart Care Venture. Forty-one patients had CABG between November, 1993 and October, 1994. Their ages ranged from 39 to 73 years with mean age 56 years; 28 patients (83 per cent) were male and 7 (17 per cent) were female. Twenty patients (49 per cent) were hypertensive, 16 (39 per cent) were diabetic, 5 had mild pre-operative impairment of renal function, 1 had had previous bypass surgery in 1984 and pre-operatively most patients were using maximal oral therapy for angina control. The indications for surgery were: left main coronary disease (7 per cent), 3-vessel coronary disease with ejection fraction < 50 per cent (12 per cent), unstable or refractory stable angina due to 2-vessel, 3-vessel or proximal left anterior descending coronary disease with good LV function (80 per cent). Left internal mammary artery grafts were used in 68 per cent of patients and saphenous vein grafts in the rest. The mean stay in hospital post-operatively was 9.6 days. Two patients died, both in the early post-operative period. In two patients, in whom complete revascularization was not possible, mild angina occurred during the post-discharge mobilization period. All other patients have been free of angina since discharge. Complications included early re-operation (day 1) for excessive bleeding from the chest drains (1 patient), aortic dissection requiring repair (1 patient), lobar atelectasis requiring prolonged physiotherapy (4 patients), pneumonia (1 patient), severe transient post-pericardiotomy syndrome (1 patient) and peroneal nerve palsy (1 patient) (AU)

A clinico-pathological study of yellow fever with demonstration of the virus in the human liver

The clinical histopathological and serological findings in three patients who developed yellow fever after entering the Guayaguayare forest in south-east Trinidad in January and February 1979 are described in this report. The patients were all previously healthy young males and the clinical features of the disease varied from fulminant viral hepatitis with hepato-renal failure to a self-limiting anicteric viral illness. The first patient died, and histopathological examination of the liver was done post-mortem. Needle biopsy of the liver was done on case 2 which presented with the clinical picture of infective hepatitis, and on case 3 with the features of an anicteric viral illness. The histopathological hallmarks of midzonal necrosis, granular eosinophilic degeneration (Councilman bodies) and fatty change in the parenchymal cells of the liver were seen in three cases. The electron microscopic study demonstrated the presence of the yellow fever virus in the liver of the patient who died (AU)

A clinico-pathological study of yellow fever with demonstration of the virus in the human liver

The clinical histopathological and serological findings in three patients who developed yellow fever after entering the Guayaguayare forest in south-east Trinidad in January and February 1979 are described in this report. The patients were all previously healthy young males and the clinical features of the disease varied from fulminant viral hepatitis with hepato-renal failure to a self-limiting anicteric viral illness. The first patient died, and histopathological examination of the liver was done post-mortem. Needle biopsy of the liver was done on case 2 which presented with the clinical picture of infective hepatitis, and on case 3 with the features of an anicteric viral illness. The histopathological hallmarks of midzonal necrosis, granular eosinophilic degeneration (Councilman bodies) and fatty change in the parenchymal cells of the liver were seen in three cases. The electron microscopic study demonstrated the presence of the yellow fever virus in the liver of the patient who died.

Pregnancy complicated by maternal heart disease - abstract

Forty pregnancies, complicated by maternal heart disease, from 1984 to 1986 were reviewed. Sixty-two per cent of rheumatic and 38 percent of congenital heart disease. There were no maternal nor perinatal deaths although 17 percent of the patients had cardiac failure. Heart failure occurred only in patients with acquired valvular defects, particularly mitral stenosis. Infective endocarditis did not occur. Therapeutic abortion was not practical and a conservative approach was adopted to obstetrical intervention and in drug therapy. This study reflects the remarkably good maternal and foetal prognosis in pregnancies complicated by heart disease. Obstetrical complications were minimal, spontaneous abortion rate was not higher than in non-cardiac mothers, and general anaesthesia can be used for patients undergoing either elective or emergency Caesarean Sections (AU)

Paraquat poisoning in South Trinidad 1972-1982

Self-poisoning is a major health problem in Trinidad. The changing pattern of self-poisoning between 1972 and 1982 was studied. Paraquat poisoning which was rare in 1972 reached epidemic proportions in 1982. The population at risk were young East Indians living in rural areas. In spite of the high morbidity and mortality associated with paraquat poisoning, this toxic herbicide is still easily available over the counter. Enforced legislation to control the sale of paraquat is urgently needed. (AU)

Paraquat as a cause of self-poisoning in South Trinidad: 1972 - 1982 - abstract

In 1974 we reported four (4) deaths from Paraquat poisoning in South Trinidad. The present study is an analysis of self-poisoning during a 16 month period from June 1981 to September 1982. Four hundred and thirty-five (435) cases of self poisoning were admitted to the San Fernando General Hospital during the period. Thirty-two (32) patients ingested "Tablets", -9 percent Paraquat, less than 1 percent organophosphorus insecticide and 58 percent a miscellaneous group of compounds. Admissions for self-poisoning have increased by 51 percent during the last 10 years. Paraquat poisoning which accounted for 1.3 percent in 1972 now accounts for 8.6 percent. Organophosphorus poisoning has decreased from 3.5 percent in 1972 to less than 1 percent in 1982. "Tablets" were the commonest ingested substance, both in 1972 (42 percent) and 1982 (32 percent). The morbidity and mortality from Paraquat continue to be high. Absorbents (Charcoal and Fuller's Earth), gastric lavage, whole gut lavage, and peritoneal dialysis were used in the treatment. In spite of intensive treatment mortality remains high (75 percent). The survivors usually ingested a small quantity and were treated aggressively. Deaths from self-poisoning in South Trinidad increased from 26 in 1972 to 57 in 1982. Of the 57 deaths at least 37 patients ingested Paraquat as compared to only 4 in 1972. Deaths from Paraquat poisoning were commonest among East Indian females living in rural areas. Our study highlights the increasing importance of Paraquat poisoning as a method of self-poisoning in Trinidad (AU)

Congenital heart disease in the adult - abstract

This study is an analysis of eighty (80) cases of congenital heart disease seen in adults at the San Fernando General Hospital. This diagnosis was based on history, physical examination, chest X-Ray, electrocardiography, M-mode echocardiography, two-dimensional echocardiography and contrast two-dimensional echocardiography. Seventy per cent (70 percent) of the cases had septal defect, thirty-five per cent (35 percent) atrial and thirty-five per cent (35 percent) ventricular. Patent ductus arteriosus accounted for 12.5 per cent and cyanotic congenital heart disease 10 per cent. There were two cases of coarctation of the aorta, two of pulmonary stenosis and one each of aortic stenosis and anolamous pulmonary venous return. Females exceeded males by 2:1. Fifty-two per cent (52 percent) of the cases were in the age group 12 - 20 years and twenty-five per cent (25 percent) were older than age 30. Moderate to severe pulmonary hypertension was present in 23 cases - two patent ductus arteriosus, nine atrial septal defect and twelve ventricular septal defect. Shunt reversal was demonstrated with contrast two-dimensional echocardiography in five cases of ASD and six cases of ventricular septal defect. Two patients had corrective surgery - one closure of ASD at age 32 and the other repair of Fallot's tetralogy at age 17. After cardiac catherization two patients were considered inoperable because of severe pulmonary hypertension and poor ventricular function. Six patients died from congential heart disease. Three had trial septal defect with severe pulmonary hypertension, one each had ventricular septal defect, coarctation of the aorta and cyanotic congenital heart disease. The majority of our patients have defects which are surgically correctable with low mortality. The introduction of open-heart surgery in Trinidad in the near future should improve the prognosis of these patients (AU)