Cardiac Dimensions in Normal Pregnancy: A Prospective Study.

BACKGROUND: Pregnancy, a unique physiologic state, is associated with several changes in the various body systems. The cardiovascular system is one of the systems affected, with chronic volume overload being one of the characteristic changes experienced during pregnancy. Cardiovascular disease in pregnancy is the leading cause of non-obstetric maternal death worldwide. AIM: This study aims to determine and describe the changes in left and right ventricular and atrial sizes in systole and diastole in the course of normal pregnancy. METHODS AND MATERIALS: A cohort study was conducted among healthy pregnant women between the age of 18 and 40 who attended the antenatal clinic of Federal Medical Centre (FMC), Yenagoa, Bayelsa State. Fifty women were recruited during the first trimester (T1) of pregnancy and followed up until six weeks postpartum. Ethical approval was obtained from the Research Ethics Committee of Federal Medical Centre, Yenagoa, with approval number FMCY/REC/ECC/2019/JAN/150. Clinical evaluation, hematologic, biochemical, and anthropometric assessments, and two-dimensional M-mode and Doppler echocardiography were done for the participants in each trimester of pregnancy and at six weeks postpartum. The clinical and echocardiographic parameters were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: The mean trend of left ventricular posterior wall thickness in diastole (LVPWd) and left ventricular posterior wall thickness in systole (LVPWs) increased progressively from the first to third trimester (T3) (not statistically significant) but dropped toward initial values in postpartum to the level that was statistically significant for LVWPd alone when compared to baseline first trimester values. The left atrial diameter in systole (LADs) was largest in the third trimester, and the left atrial volume index (LAVI) and right ventricular basal diameter (RVD1) also showed a similar trend. The left ventricular internal diameter (LVID) in both systole and diastole increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). The right atrial diameter (RAD) and right atrial volume (RAV) also increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). CONCLUSION: Changes were noticed in the cardiac chamber sizes during pregnancy. However, this reversed back to levels similar to the first trimester during the postpartum period. To aid in the early detection and treatment of cardiovascular disorders in pregnancy, screening of apparently healthy pregnant women who later developed complaints is advised as cardiovascular changes could be significant during pregnancy.

Prevalence of hyperuricaemia in a rural population of Nigerian Niger Delta region.

INTRODUCTION: Hyperuricemia is a cardiovascular disease risk factor that has been poorly researched into in Africa and its prevalence is largely unknown in the rural areas in Nigeria and in the Niger Delta region of Nigeria in particular. METHODS: A cross-sectional rural survey involving 500 subjects aged 15 years and above. Demographic and social data were obtained using a questionnaire. Anthropometric (height, weight, waist circumference) and blood pressure measurements were taken. Blood samples were taken for blood uric acid, glucose and lipid check. RESULTS: The mean age of the study subjects was 41.32 +/- 17.0 (males, 42.84 +/- 17.8; females, 40.62 +/- 16.6) with a range of 15 years to 95 years. The male to female ratio was 1:2.3. The mean serum uric acid was 337.58 +/- 94.59 mmol/l with a significant higher mean for females (males 333.20 +/- 88.70, females 339.56 +/- 97.21, p < 0.001). Hyperuricemia was found in 86 subject giving a prevalence of 17.2% with higher prevalence in males (males 25%, females 13.7%; x2 = 7.75, p = 0.006). Correlational analysis of serum uric acid with other parameters revealed that waist circumference, total cholesterol, low-density lipoprotein and gender had significant association with uric acid. Male gender was found to be a significant predictor for hyperuricaemia following a logistic regression. CONCLUSION: The prevalence of hyperuricemia is high in this rural community of study. There is need for more research considering the cardiovascular and other implications of hyperuricaemia.

Prevalence of metabolic syndrome in urban and suburban Rivers State, Nigeria: International Diabetes Federation and Adult Treatment Panel III definitions.

BACKGROUND: It was not clear for a while, which of the definitions of metabolic syndrome best predicted those at risk of cardiovascular disease and diabetes but recent studies have confirmed the predictive ability of various definitions of metabolic syndrome and have reported that the International Diabetes Federation definition, although more sensitive is associated with a higher false positive predictive rate. OBJECTIVES: To determine the prevalence of metabolic syndrome, using the International Diabetes Federation and Adult Treatment Panel III definitions among adult Nigerians attending Family Medicine Clinics at two hospitals in Rivers State Nigeria. METHODS: Adult subjects attending family medicine clinics at an urban and a sub-urban hospital in Rivers State, Nigeria were bled after an overnight fast, and venous blood obtained for lipid studies and fasting plasma glucose estimations. Measurements were made to determine height, weight, waist circumference and blood pressure. The data obtained was analysed using SPSS for Windows software version 12 and Epi info version 6.04D RESULTS: The prevalence of metabolic syndrome was 19.81% (ATP III) and 23.19% (IDF) at one centre and 34.17% (ATP III) and 35.42% (IDF) at the other centre. CONCLUSION: The prevalence of metabolic syndrome by the two definitions was significantly higher at the second centre. The difference in the prevalence rates by the two definitions was also much smaller in the second centre perhaps because the second centre had more women and the mean age of the subjects was significantly higher.

Relative Risk of Metabolic Syndrome Components in Nigerians: the Adult Treatment Panel III Definition

Background: The prevalence of metabolic syndrome is increasing in all populations worldwide and is associated with a substantially elevated risk of type 2 diabetes (5-fold) and of cardiovascular disease (2-3 fold). Metabolic syndrome is now established as a simple means of identifying individuals at increased risk of future cardio vascular disease and type 2 diabetes mellitus. Aim: To determine the prevalence of metabolic syndrome among adult Nigerians attending Family Medicine Clinics at two health facilities in Rivers State; Nigeria and to determine how much each diagnostic criterion contributed to the diagnosis of metabolic syndrome. Methods: Subjects were bled after an overnight fast; and venous blood obtained for lipid studies and fasting blood glucose estimation. Measurements were made to determine height; weight; waist circumference and blood pressure. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Project: Adult Treatment Panel III (ATP III) definition. Results: The unadjusted and age-adjusted prevalence rates of metabolic syndrome at one centre were 19.8and 20.9respectively while they were 34.2and 31.6respectively at the other centre. The prevalence of low HDL-cholesterol was very high at both centres (78.3at one centre and 92.1at the other). Metabolic syndrome is most prevalent in females and older subjects. Conclusion: The prevalence of metabolic syndrome (19.8and 20.9; unadjusted and age-adjusted; respectively) were lower at one centre than the other (34.2and 31.6; unadjusted and age-adjusted; respectively). Despite the very high prevalence of low HDL- cholesterol; the relative risk for metabolic syndrome was not statistical significant (RR=6.73; 95CI: 0.99-45.55)

Current epidemiology of hypertension in Port Harcourt metropolis, Rivers state, Nigeria

Background: Hypertension is the sustained elevation of the blood pressure to 140/90 mmHg or more. It is the commonest non-communicable disease in the world and all races are affected with variable prevalence. In Nigeria, prevalence was between 10 and 14% based on a national survey conducted over a decade ago. Since that survey, the definition of hypertension has changed and social and demographic changes have also taken place, and so changes in prevalence and epidemiology are expected, hence the need for the present survey. Methods: A cluster sample of adult Nigerians, aged 18 years and above, living in Port Harcourt, Rivers State, drawn from civil servants at the Federal secretariat, state secretariat, six selected secondary schools, two major markets, two major motor parks and one of the higher institutions as well as staff of the University of Port Harcourt Teaching Hospital formed the cohort for this study. Their blood pressures were measured in the various locations on the day of visit using standard protocol. The height and weight of all participants were measured, social and demographic information was obtained as well as history of previous hypertension, treatment if any and family history of diabetes mellitus or hypertension. The information obtained was entered into the questionnaire designed for the survey. All pregnant females were excluded. Results: A total of nine hundred and twenty one (921) adult Nigerians made up of 449 males (48.75%) and 472 females (51.25%) participated in the survey. The age range was 19 to 68 years, mean age was 39.94 ± 8.61 years, mean systolic blood pressure was 129.99 ± 22.85 mmHg and mean diastolic blood pressure was 84.84 ± 28.02 mmHg. A total of 376 of those surveyed were hypertensive giving a prevalence of 40.82%, out of which 49 (13.03%) were aware of being hypertensive and 33 (67.35%) of these were receiving treatment. Among those found to be hypertensive, 17.55% had family history of hypertension, and 12.23% had family history of diabetes mellitus. The mean body mass index (BMI) was 26.14 ± 8.08 kg/m2, 408 (44.30%) had a normal BMI of ≤ 24.9, 343 (37.24%) were overweight (BMI = 25-29.9) and 170 (18.46%) were obese with BMI of ≥ 30. Conclusion: The prevalence of hypertension in Port Harcourt is high and only a small fraction of hypertensives are aware of their condition. There is need for large scale screening and education of the public as a major public health measure to reduce the numerous catastrophic complications of hypertension

Pattern of ECG abnormalities in Nigerian hypertensive patients seen in University of Port Harcourt Teaching Hospital

Objective: The aim of the study was to document the pattern of EGG abnormalities in the hypertensive patients in Port Harcourt and to compare their prevalence with what obtains in the apparently normal population as documented in previous studies. Methods: The electrocardiographic profile of one hundred and thirty two consecutive hypertensive patients seen at the consultant medical clinic of the University of Port Harcourt Teaching Hospital were studied prospectively. All patients were above 15 years of age with blood pressures above 140/90 mmHg taken at more than two visits. As part of their investigations, twelve lead surface electrocardiograms were recorded. They were interpreted by either of the authors and data were analyzed by simple statistical methods. P value was taken as significant if up to or below 0.5. Results: The abnormalities identified were left ventricular hypertrophy(LVH)in37.1%, left axis deviation(LAD) in 30.3%, sinus tachycardia 25.0%,left atrial enlargement(LAE) in 21.2%, atrial fibrillation(AF) in 3.8%, right bundle branch block (RBBB) in 1.5% and left anterior hemi block (LAH) in 0.8%. There were no cases of myocardial infarction nor pathological Q waves. Conclusion: The study concluded that ECG abnormalities are prevalent in our hypertensive patients and given their prognostic significance, the surface ECG remains relevant as one of the first line investigations in these patients

Addison's disease presenting as acute chest syndrome: case report and review of literature.

BACKGROUND: Addison's disease is due to primary adrenal failure. It is an uncommon condition with equal prevalence in both males and females. The onset of symptoms is gradual and manifestation is non specific, hence diagnosis is easily missed without a high index of suspicion. METHODS: The medical records of a patient who presented with acute chest pain to the cardiac unit of the University of Port Harcourt Teaching Hospital were reviewed. A review of the literature using manual library and Medline search on Addison's disease was also done. RESULT: A 48 years old male presented in our medical outpatient department with a three day history of sudden onset of severe precordial chest pain that started while playing football which was associated with nausea, vomiting and difficulty in breathing. After initial clinical evaluation a diagnosis of acute myocardial infarction and cardiac failure with a suspicion of background Addison's disease was made. Serial electrocardiography done over a two week period did not show evidence of myocardial infarction, but the patient had elevated serum ACTH and very low serum cortisol levels. An abdominal CT scan done two weeks after admission showed absence of the Adrenal glands bilaterally, confirming Addison's disease. He received treatment for cardiac failure, analgesics, prednisolone and a mineralocorticoid to which he responded satisfactorily and has remained healthy. He also received a six months course of antituberculous treatment empirically. CONCLUSION: Addison's disease is an uncommon endocrine disorder which can present insidiously in a non specific manner. Diagnosis requires a high index of suspicion.

The bacteriology of diabetic foot ulcers in Port Harcourt, Nigeria.

BACKGROUND: Diabetic foot ulcer and/or gangrene is a common cause of morbidity and mortality in Nigeria. The lesions are usually infected and early treatment of the infection will reduce the associated problems. The study was carried out to determine the common bacteriological flora of diabetic foot ulcers in Port Harcourt. The antimicrobial sensitivity pattern of the isolates was determined to enhance possible empirical treatment. METHODS: Deep wound swabs were collected from 60 consecutive diabetic patients admitted with foot ulcers and/or gangrene into the medical wards of the University of Port Harcourt Teaching Hospital from January 2001 to April 2002. The bacteriological isolation and antimicrobial sensitivity tests of the isolates was carried out by standard microbiological methods. RESULTS: Aerobes and anaerobes constituted 95.4% and 4.6% of the total bacterial isolates respectively. Staphylococcus aureus was the commonest bacterial isolate; it was cultured from 32 (56.1%) of infected patients and constituted 24.4% of the total isolate. The mean bacterial isolate per patient infected was 2.3. The aerobic isolates showed significant sensitivity to ciprofloxacin (78.4%), pefloxacine (71.2%), ceftazidime (73.6%) and cefuroxime (69.6%). All the anaerobic isolates were sensitive to metronidazole and clindamycin. CONCLUSION: Infections of diabetic foot ulcers are usually polymicrobial. From the in vitro antimicrobial susceptibility pattern of the bacterial isolates, diabetic patients presenting with foot ulcers and/or gangrene could be commenced empirically on a combination of clindamycin or metronidazole and either a fluoroquinolone (ciprofloxacin or pefloxacine) or a second or third generation cephalosporin (e.g. cefuroxime or ceftazidime).

Drug compliance among hypertensive patients in Port Harcourt, Nigeria.

BACKGROUND: Hypertension contributes significantly to cardiovascular morbidity and mortality. Adequate blood pressure control would therefore reduce cardiovascular morbidity and mortality, however adequate blood pressure control requires good treatment compliance. METHODS: One hundred consecutive patients aged 30-79 years attending the cardiac clinic of the medical out-patients clinic of the University of Port Harcourt Teaching Hospital were directly questioned about compliance with their antihypertensive drugs and results entered into the questionnaire designed for the study. RESULTS: Compliance was good in sixty percent (60%) of respondents, fair in twenty nine percent (29%) and poor in eleven percent (11%). Compliance was also found to be good in sixty-seven percent (67%) of patients with tertiary education, good in forty one percent (41%) of those with primary education. Compliance was good in seventy four percent (74%) of those taking one drug, good in only thirty three percent (33%) of those taking four drugs. Patients taking single daily dose drugs had good compliance in seventy percent (70%), twice daily dosing had good compliance in fifty five percent (55%) and among those taking thrice daily dosage, compliance was good in only seventeen percent (17%). CONCLUSION: The study shows that good compliance with anti-hypertensive therapy is best achieved with monotherapy given as single dosage. It also shows the role of education in the level of compliance.

Effects of age, sex and body build on ECG QRS voltages in Nigerians.

The effects of age, sex and body build on ECG QRS voltages were studied in Nigerian Africans. Eighty-nine subjects consisted of 35 hypertensives, 20 patients with mitral incompetence and/or aortic incompetence and 34 healthy subjects. QRS voltage summations were made where necessary to reflect available ECG voltage criteria for left ventricular hypertrophy. Pearson's correlation coefficients were then determined between the ECG QRS voltage values and age, height, weight and body surface area in each group of subjects with the aid of an IBM 370/135 computer utilising SPSS programs. The study showed that ECG QRS voltages in our Nigerian African subjects significantly decreased with age and that men had higher voltages than women. Weight had variable effects on ECG QRS voltages. It is suggested that correction factors for age, sex and weight be determined by ECG laboratories for their population groups with the use of multiple regression analysis in order to improve on the widely used ECG QRS voltage criteria for left ventricular hypertrophy.

Correlation between left ventricular wall thickness and QRS voltages in Nigerians.

ECG voltage criteria for left ventricular hypertrophy are based on the assumption that a thicker ventricle generates higher QRS voltages. In order to test this assertion, a study of the correlation between echocardiographically determined left ventricular wall thickness and ECG QRS voltages was carried out in 89 subjects, consisting of 35 hypertensives, 20 patients with mitral/aortic valve incompetence, and 34 controls. The results show that there was no statistically significant correlation between QRS voltages and left ventricular wall thickness. This shows that a thicker ventricle does not necessarily generate higher QRS voltages on the electrocardiogram. This may explain the already documented less than satisfactory degree of accuracy of the various ECG voltage criteria for the diagnosis of left ventricular hypertrophy.

Non-invasive cardiac study in diabetic Nigerians using systolic time intervals.

Non-invasive cardiac studies using systolic time intervals were performed on 89 diabetic Nigerians and 45 non-diabetic controls, to investigate possible preclinical abnormality of left ventricular function. There was no significant difference in the pre-ejection period to left ventricular ejection time ratio (PEP/LVET) between the patients and controls: 0.373 +/- 0.011 vs 0.365 +/- 0.013 (P = 0.688). Patients at higher risk for developing significant vascular disease i.e. those with peripheral vascular insufficiency, those in higher socio-economic class and those with disease duration of 10 or more years had the highest mean values of PEP/LVET (0.403, 0.403 and 0.412 respectively). However, these values did not reach a level of significance. There was no correlation between PEP/LVET and age, body mass index, duration of diabetes, total or HDL cholesterol and the HDL to total cholesterol ratio. Because recent reports have related diabetic cardiomyopathy to angiopathic disease in diabetes, these results suggest that Nigerian patients, who like most other black African diabetics show little susceptibility to severe vascular complications of diabetes may enjoy some protection from a preclinical abnormality of left ventricular function as well.

Heart failure in Nigerian hypertensives.

A study of 209 consecutive cases of hypertension, seen at the cardiac unit of the University College Hospital, Ibadan, Nigeria, showed that heart failure occurred more commonly in patients who were in the low socio-economic class. All those who had a haematocrit below 30% had heart failure. The lower the serum albumin, the greater the likelihood of developing heart failure. Hypertensives who were heavy alcohol drinkers were very prone to heart failure while a significant proportion of those who had cardiomegaly or cardiomegaly with aortic unfolding on chest x-ray had heart failure. Age, sex, Hb genotype, obesity and retinal changes had no influence on the development of heart failure. It is concluded that there are other factors, besides hypertension, which precipitate heart failure in Nigerian hypertensives. This may be responsible for the high incidence of heart failure among Nigerian with hypertension.