Correlation between Echocardiographic Left Ventricular Hypertrophy and various Electrocardiographic Criteria of Left Ventricular Hypertrophy among Black Hypertensives.

BACKGROUND: Systemic hypertension remains an important risk factor for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the correlation of ECG criteria in the diagnosis of left ventricular hypertrophy among hypertensives and almost all the previous studies on ECG LVH used only one or two criteria. This study sets out to determine the correlations between various ECG criteria of LVH and echocardiographic LVH among patients with hypertension using six ECG LVH criteria. METHODS: One hundred and seventy-eight hypertensives and eighty- nine age and sex matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using Sokolow-Lyon, Cornell voltage, Goldberger, Massoleini, Romhilt-Estes and Cornell duration product ECG criteria. RESULTS: Sokolow-Lyon and Cornell voltage criteria had significant positive correlation with echocardiographic LVH (p=0.001 and 0.003, respectively). Although Goldberger and Massoleini criteria had positive correlation coefficients, these were not statistically significant. CONCLUSION: There are significant correlations between echocardiographic LVH and ECG LVH determined by Cornell voltage and Sokolow-Lyon criteria.

CONTEXTE: L'hypertension systémique reste un facteur de risque important pour les maladies cardiovasculaires et un problème majeur de santé publique mondiale. L'hypertrophie ventriculaire gauche (HVG) est une complication reconnue de l'hypertension systémique et prédit fortement la morbidité et la mortalité cardiovasculaires. Au Nigeria, peu d'études ont évalué la corrélation des critères ECG dans le diagnostic de l'hypertrophie ventriculaire gauche chez les hypertendus et presque toutes les études précédentes sur l'ECG HVG n'utilisaient qu'un ou deux critères. Cette étude vise à déterminer les corrélations entre divers critères ECG de l'HVG et l'HVG échocardiographique chez les patients hypertendus à l'aide de six critères ECG LVH. MÉTHODES: Cent soixante-dix-huit hypertendus et quatre-vingtneuf témoins appariés selon l'âge et le sexe ont été recrutés consécutivement dans l'étude. Tous les participants, y compris les hypertendus et les sujets témoins, ont eu une échocardiographie alors que seuls les sujets hypertendus ont eu à la fois une échocardiographie et un ECG. ECG L'HVG a été déterminée en utilisant les critères ECG de produit de durée de Sokolow-Lyon, de tension de Cornell, de Goldberger, de Massoleini, de Romhilt-Estes et de Cornell. RÉSULTATS: Les critères de tension de Sokolow-Lyon et de Cornell avaient une corrélation positive significative avec l'HVG échocardiographique (p=0,001 et 0,003, respectivement). Bien que les critères de Goldberger et Massoleini aient des coefficients de corrélation positifs, ceux-ci n'étaient pas statistiquement significatifs. CONCLUSION: Il existe des corrélations significatives entre l'HVG échocardiographique et l'HVG ECG déterminées par le voltage de Cornell et les critères de Sokolow-Lyon. MOTS-CLÉS: Corrélation; échocardiographie; électrocardiographie; Hypertrophie ventriculaire gauche; Hypertendus noirs.

Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report.

BACKGROUND: There is limited information on the availability of health services to treat cardiac arrhythmias in Africa. METHODS: The Pan-African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force conducted a survey of the burden of cardiac arrhythmias and related services over two months (15 October to 15 December) in 2017. An electronic questionnaire was completed by general cardiologists and electrophysiologists working in African countries. The questionnaire focused on availability of human resources, diagnostic tools and treatment modalities in each country. RESULTS: We received responses from physicians in 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as anti-arrhythmics and anticoagulants prevails. Non-vitamin K-dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of the sub-Saharan African (SSA) countries do not have a registered cardiologist and about one-third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200-fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low, with a median of 0.14 (0.03-6.36) centres and 0.10 (0.05-9.49) operators per million population. Less than half of the African countries have a functional catheter laboratory with only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic treatment for cardiac conduction disturbances. CONCLUSION: The lack of diagnostic and treatment services for cardiac arrhythmias is a common scenario in the majority of SSA countries, resulting in sub-optimal care and a subsequent high burden of premature cardiac death. There is a need to improve the standard of care by providing essential services such as cardiac pacemaker implantation.

Idiopathic scrotal calcinosis; a rare scrotal tumour: a case report and review of literature.

Idiopathic scrotal calcinosis is a rare benign disease characterized by multiple, asymptomatic and painless nodules on the scrotum. We herein report this rare disease in a Nigerian adult male and briefly review the relevant literature.

Krukenberg's tumour.

BACKGROUND: Krukenburg's tumour, a metastatic cancer to the ovary can pose difficulties in early diagnosis. The paucity of reports from our environment coupled with the difficulties we encountered makes it imperative that we report this case. METHODS: We present a 32-year-old lady who presented with mucoid and bloody diarrhoea associated with menstrual irregularity, weight loss and lower abdominal pains 2 years after surgical treatment for gastric cancer. Literature on Krukenburg's tumour was also reviewed. RESULTS: While serum level of CEA was found to be elevated and colonoscopy showed an ulcerated mass obliterating the lumen of the sigmoid colon, abdominal CT scan revealed bilateral adnexal masses. The histology of the colonic lesion showed signet ring carcinoma while the enlarged ovaries turned out to have evidence of metastatic adenocarcinoma. CONCLUSION: Early diagnosis of KT can be difficult. Periodic surveillance is, therefore, essential especially in those who have had a gastrointestinal malignancy.

Anaemia and its response to treatment with recombinant human erythropoietin in chronic kidney disease patients.

BACKGROUND: The introduction of erythropoietin has transformed the management of anaemia in CKD, with considerable benefits which includes enhanced quality of life, increased exercise capacity and improved cardiac function. There is paucity of data on the beneficial effects of this treatment from this environment. OBJECTIVE: The aim of this work was to study the pattern and response of anaemia and its response to treatment with recombinant human erythropoietin(r-HuEpo) in CKD patients in Nigeria. METHODS: This was a prospective study in which 20 CKD patients who satisfied the inclusion criteria were recruited consecutively. Subcutaneous r-HuEpo was administered to each of the study patients, starting with a weekly dose of 50 iu per kg and titrated according to haemoglobin (Hb) response, which was monitored fortnightly throughout the study period with the aim of achieving a target Hb of 11g per dl. RESULTS: The patients studied were anaemic with mean Hb of 7.36(1.05) g/dl. The anemia was normocytic normochromic in 85% of the patients. All the patients responded to treatment with r-HuEpo with the mean Hb rising from 6.74(0.70)g per dl to 11.64(0.37) g/dl and 7.64(1.19) to 11.98(0.45) g/dl in those on maintenance haemodialysis and pre-dialysis patients respectively. The patients reached the target Hb of 11g/dl within 8 weeks in predialytic CKD patients and within 10 weeks in those on maintenance haemodialysis. CONCLUSION: Anaemia is mostly normocytic normochromic in CKD patients in our environment and r-HuEpo therapy is effective in correcting the anaemia.

Blood pressure control among treated hypertensives in a tertiary health institution.

BACKGROUND: Goal blood pressure (BP) was defined by the JNC VI and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. It is well established that adequate BP control characterizes only a fraction of treated hypertensive patients. The importance of tight BP control has been established in preventing cardiovascular morbidity and mortality METHODS: We performed cross-sectional studies on the current status of BP control among treated hypertensive in our center. One hundred consecutive patients with essential hypertension who have been attending the out patient hypertension clinic and have been on treatment for at least 6 months were recruited. The pre treatment BP and BP records in the previous 2 visits were noted. Patients were said to have good BP control if their BPs are < 140/90 mmHg (<130/80 mmHg for high risk patients) at the time of the study and in the last visit. RESULTS: There were 49 males and 51 female (M: F; 1:1), aged 26 to 85 (mean 52.33 +/- 12.29) years. The duration of hypertension ranged 6 months to 30 (mean 7.37 +/- 7.1) years. The duration of treatment in our centre was 6 months to 10 (mean 3.22 +/- 2.23) years. Blood pressure was controlled in 33 (33%) of the patients. Pre-treatment mean blood pressure was significantly higher than the BP value at the time of the study (155.87 +/- 26.02/97.81 +/- 11.89 mmHg versus 143.40 +/- 24.14/86.53 +/- 12.71 mmHg) (p<0.05). Diuretics were the commonest antihypertensive prescribed either alone or in combination (69%), followed by a calcium antagonist (56%) and centrally acting drugs (38%). Twenty seven were on single antihypertensive, 43 (43%) on 2, 25(25%) on 3 and 5 (5%) on 4 classes of antihypertensive. Blood pressure control was associated with taking more than one antihypertensive medication and compliance. CONCLUSION: Control of BP in patients receiving antihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors. Adherence to medication should be encouraged.

The impact of income on the echocardiographic pattern of heart diseases in Kano, Nigeria.

BACKGROUND: The aims of the present study were to assess the echocardiographic pattern of heart diseases, and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1), with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2), in Kano, Nigeria. METHODS: the study was retrospective in design. The records of patients aged > or =15 years for a one year period (July 2006-June 2007) were reviewed. RESULTS: Hypertensive heart disease (in 56.7%) was the most common heart disease, more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2%), more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7%) heart disease in the study, more common than rheumatic heart disease (in 8.3%). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3%). CONCLUSION: The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners. The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria.

Post kidney transplant tuberculosis in Nigeria: a case report.

BACKGROUND: Tuberculosis has been reported to be one of the most serious bacterial infections after transplant and occur up to 20 times more frequently in transplant recipients than in the general population. Renal transplant is available in few centers in the country and the post transplant population is increasing, but to our knowledge no case of post transplant tuberculosis has been reported in this environment. METHOD: The case report of a 35 year old Nigerian who had live related kidney transplant and later developed post transplant disseminated Tuberculosis is presented and the relevant literature is reviewed. RESULTS: A 35 year old university graduate had a live related kidney transplant in our center. He had stable allograft function on immunosuppressive regimen consisting of Cyclosporin, Azathioprine and Prednisolone, and presented with features of disseminated tuberculosis involving the cervical lymph nodes and chest with associated deterioration of allograft function. He was successfully treated with 2 months initial phase of quadruple anti tuberculosis drugs including Isoniazid, Rifampicin, Pyrazinamide and Ethambutol and four months continuation phase with Isoniazid and Rifampicin. He showed remarkable clinical improvement and reversal of the allograft dysfunction. CONCLUSION: This case illustrates one of the post transplant infectious complications seen in our environment and its successful treatment, and highlighted the need for Tuberculosis prophylaxis in transplant recipients in countries with high incidence of tuberculosis.

Electrocardiographic Abnormalities in Patients with Heart Failure : Cardiovascular Topics

Background : The morbidity and mortality from heart failure (HF) differ between patients with reduced ( 50) and with preserved ( 50) left ventricular ejection fraction (LVEF) on account of many factors; including abnormalities detected in the electrocardiogram (ECG). The aim of this study was to determine and compare the ECG abnormalities between HF patients with reduced and with preserved LVEF. Methods : The study was cross-sectional in design and carried out in Aminu Kano teaching hospital and Murtala Mohammed specialist hospital; Kano; Nigeria; from April 2005 to June 2006. We studied the resting electrocardiograms of all HF patients aged 15 years and older who were referred to the two centres for echocardiography. Results: A total of 113 patients were studied and 98.2of them had abnormal ECGs. Forty-two patients (37.2) had preserved LVEF while the remaining 71 (62.8) had reduced LVEF. Left ventricular hypertrophy ( LVH) was the commonest ECG abnormality; found among 55 patients (77.5) with reduced LVEF; and 21 patients (50) with preserved LVEF (p = 0.0026). The commonest arrhythmia was atrial fibrillation; found among 10 patients (14.1) with reduced LVEF and eight patients (19.1) with preserved LVEF (p = 0.486). Prolonged corrected QT interval was found among 30 (71.4) and 56 patients (78.9) with preserved and reduced LVEF; respectively (p = 0.370). Conclusion: Most of the patients with heart failure studied in Kano; Nigeria had abnormal electrocardiograms; and the most common abnormality was LVH

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria

A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria.

BACKGROUND: The pattern of morbidity and mortality reflects the burden of disease in a particular community. This pattern shows geographic variations between communities and countries. The knowledge of the pattern of diseases and their contribution to mortality in a given country is very important in evaluating its health care delivery system. Such knowledge is important for health planning and for improving the healthcare services in that particular nation. We set out to study the mortality pattern in our medical wards. MATERIALS AND METHODS: This is a retrospective study that reviewed the causes of death in the medical wards of Aminu Kano Teaching Hospital (AKTH) Kano between January 2001 and December 2003 (three years). The data were obtained from the admission and discharge/death register, patients' case records, the weekly as well as quarterly mortality reviews. The SPSS version 10 was used to analyse the data. RESULTS: A total of 3369 patients were admitted over the 3 year study period. Of these 2518 (74.7%) were discharged or referred and 851 patients died, giving an overall mortality rate of 25.3%. The male to female admission ratio was 1.6:1. Majority of deaths, 714 (83.9%) occurred after 24 hours of admission. The most important causes of death were infectious diseases other than HIV/AIDS (17.9%), cerebrovascular disease (17%), HIV/AIDS (13.6%), chronic renal failure (12.5%) and diseases of the circulatory system (11.9%). CONCLUSION: Mortality in the medical wards reflects the emerging trend of mixed disease spectrum burden comprising communicable and non communicable diseases. Public health education, raising the socio-economic status of our people as well as improving the standards of our health care facilities and personnel would prevent a large proportion of deaths from medical wards.

Prevalence and pattern of rheumatic heart disease in the Nigerian savannah: an echocardiographic study.

BACKGROUND: Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, as many as half of the 2.4 million children affected by RHD globally live on the continent. RHD accounts for a major proportion of all cardiovascular disease in children and young adults in African countries. While acute rheumatic fever is on the decline even in the developing world, there are still a large number of chronic rheumatic heart disease cases, often complicated by chronic congestive heart failure and recurrent thrombo-embolic phenomena, both posing greater challenges for management. We report on the prevalence and pattern of valve involvement in RHD using echocardiography from our centre. METHODS: In this retrospective study, transthoracic echocardiography (TTE) data collected from two echocardiography laboratories in Kano over a period of 48 months (June 2002 to May 2006) were reviewed. Patients with a diagnosis of rheumatic heart disease were selected. Information obtained from the records included the age, gender, clinical diagnosis and echocardiographic diagnoses. RESULTS: A total of 1 499 echocardiographic examinations were done in the two centres over the four-year study period. One hundred and twenty-nine of the 1 312 patients (9.8%) with abnormal results had an echocardiographic diagnosis of RHD. There were 47 males and 82 females (ratio 1:1.7) and their ages ranged from five to 60 (mean 24.02 +/- 12.75) years. Mitral regurgitation was the commonest echocardiographic diagnosis present in 49 patients (38.0%). Thirty-six (27.9%) patients had mixed mitral valve disease, 25 (19.5%) had mixed aortic and mitral valve disease, 10 (7.8%) had pure mitral stenosis and four (3.1) had pure aortic regurgitation. Complications of RHD observed included secondary pulmonary hypertension in 103 patients (72.1%), valvular cardiomyopathy in 41 (31.8%), and functional tricuspid regurgitation was seen in 39 (30.2%). CONCLUSION: Our data show that RHD is still an important cause of cardiac morbidity and a large proportion of the patients already had complications at diagnosis. There is an urgent need to implement the ASAP programme of the Drakensberg declaration to avert this scourge.

Cardiac morbidity in subjects referred for echocardiographic assessment at a tertiary medical institution in the Nigerian savanna zone.

Cardiovascular diseases constitute a major public health problem both in the developed and developing countries. The profile of morbidity and mortality however, varies between regions and countries and even within countries. The importance of recognizing the cardiovascular conditions that prevail in a particular area is very important in health planning and for improving healthcare services. We therefore set out to describe the cardiac morbidity pattern from our echocardiographic data. Between August 2002 and September 2004 (24 months), we reviewed the echocardiographic diagnosis of all patients aged 15 years referred for echocardiography. Information obtained from the records included age, gender, names of referring hospital/physician, clinical diagnosis and echocardiogram findings. Data was analyzed using SPSS version 10.0 software. A total of 594 persons were referred for echocardiographic examination in the 2 year study period. Of these, 489 (82.3%) had an abnormal echocardiogram. We analyzed those with abnormal echocardiograms. There were 272 males and 217 females. The male to female ratio was 1.3:1. Hypertensive heart disease was the commonest echocardiographic diagnosis, present in 228 (46.6%) of the patients. This is followed by dilated cardiomyopathy seen in 82 (16.8%) and then rheumatic heart disease in 55 (11.2%). Other findings were Non dilated cardiomyopathy (6.1%), Hypertrophic cardiomyopathy (5.7%), pericardial diseases (3.7%), Ischemic heart disease (4.7%), Cor pulmonale (1.4%) and Endomyocardial fibrosis (0.4%) of patients. It was noted that majority of the cases were advanced with irreversible myocardial damage. Systemic hypertension remains the most important cause of CVD morbidity in savanna region of Nigeria. Addressing the major cardiovascular risk factors especially systemic hypertension will go a long way in reducing the burden of cardiovascular diseases.

Physical exercise and health: a review.

BACKGROUND: Physical activity results in increased exercise capacity and physical fitness, which may lead to many health benefits. Individuals who are more physically active appear to have lower rates of all-cause mortality, probably due to a decrease in chronic diseases including coronary artery disease (CAD). This may result from an improvement in cardiovascular risk factors in addition to enhanced fibrinolysis, improved endothelial function, decreased sympathetic tone, and other yet undetermined factors. METHODS: We reviewed the literature on physical activity and health with particular reference to the benefits derivable by engaging in regular physical activity. The MEDLINE/PUBMED and bibliographic searches for English language studies were used. RESULTS: Physical inactivity is now considered a risk factor for Cardiovascular diseases (CVD). Regular exercise results in an increase in exercise capacity and lower myocardial oxygen demand leading to cardiovascular benefits, including lower mortality rates. Physically active individuals suffer from fewer ailments than do less-active individuals. Physical activity reduces cardiovascular risk through lowering of blood pressure, improved glucose tolerance, reduced obesity, improvement in lipid profile, enhanced fibrinolysis, improved endothelial function and enhanced parasympathetic autonomic tone. CONCLUSION: Physical exercise has many health benefits and the evidence for this continues to accumulate. Health care professionals should incorporate counselling to patients for physical exercise in their daily clinical practice, while health policy makers and community physicians should see to implementation of this at the community level.

Ischaemic heart disease in Aminu Kano Teaching Hospital, Kano, Nigeria: a 5 year review.

BACKGROUND: Socio-economic changes and rural urban migration have led to emergence of non-communicable disease including ischaemic heart disease (IHD) and many others. The actual prevalence of IHD in Nigeria is not known. The non communicable disease (NCD) survey sought to determine the prevalence of major risk factors, rather than the prevalence of the disease itself. The prevalence is generally considered low in Nigeria but the current impression about its importance stems mostly from anecdotal reports. We therefore set out to describe the prevalence as well as the spectrum of IHD at Aminu Kano Teaching Hospital, Kano. METHOD: Between July 2000 and June 2005, we reviewed the prevalence as well as the spectrum of presentation of IHD in Aminu Kano Teaching Hospital. Information was obtained from the medical records of patients in the medical unit of the hospital. Age, sex, diagnosis, risk factors for IHD, other relevant clinical and laboratory data and outcome of patients for myocardial infarction (MI) were extracted from the records. Data was analyzed using SPSS version 10.0 software. RESULTS: There were 5124 medical patients admitted over the period under review, out of which 1347 had cardiovascular diseases. Forty six patients were diagnosed to have IHD giving it a prevalence of 0.9% of medical conditions and 3.4% of all cardiovascular cases. There were 33 males and 13 females (M : F = 2.5:1). Twenty two patients (47.8%) had myocardial infarction, 14 (30.4%) had ischemic cardiomyopathy and 10 (21.7%) had angina. The patients consist of 41 (89.1%) Nigerians, 3 (6.5%) Lebanese, 1 (2.2%) Indian and 1 (2.2%) Pakistani. The risk factors found were Hypertension in 37 (80.4%) of patients, diabetes in 16 (34.8%), and Dyslipidaemia in 20 (43.5%). Others were cigarette smoking and obesity. CONCLUSION: IHD is an important cause of morbidity and mortality in our population. There is need for us to be on the alert and prepare ourselves to manage these cases. Focus should be on preventive cardiology.

Heart disease in HIV/AIDS. How much is due to cachexia?

HIV/AIDS affects the heart through different mechanisms. Before the advent of HIV/AIDS, cachexia had been established as a cause of cardiac morbidity. Interestingly when HIV/AIDS affects the heart, not much role is ascribed to cachexia; one of the major criteria for diagnosis. As most electrocardiographic (ECG) changes in HIV/AIDS are also seen in cachexia, it became necessary to look at the ECG changes in HIV/AIDS in relation to body mass index (BMI). This was to see if any relationship existed. One hundred, 78 and 80 full blown AIDS, HIV positive asymptomatic and HIV negative subjects underwent 12 lead resting ECG respectively. Their BMI were determined from the heights and weights. BMI was least in the first group and highest in the last group. The mean differences achieved statistical significance. Systolic and diastolic blood pressures significantly fell from HIV negative to the AIDS patients. This was as BMI fell. Systolic and diastolic blood pressures fall significantly with cachexia. The following indices on ECG: heart rate, corrected QT interval, ST segment depression and T wave inversion increased from the HIV negative to the full blown AIDS patients. This was also the direction of reduction in BMI. Since these ECG changes have long been known with cachexia, it is being suggested that the cachexia associated with HIV/AIDS contributes to the heart disease in them.

Epidemiology and pathogenesis of human immunodeficiency virus (HIV) related heart disease: a review.

BACKGROUND: There is a clear and growing body of evidence for cardiac dysfunction in a significant portion of patients with HIV disease. An increased number of HIV-infected individuals may present with cardiac complications in the future as more patients with this disease survive longer because of modern therapy. Heart involvement in AIDS may be well characterized cardiac disease occurring coincidentally in AIDS patients, a complication of the disease or its treatment or possibly a direct insult to the heart by the HIV itself. METHODS: We reviewed the literature on heart disease in HIV infection and AIDS with particular reference to epidemiology and pathogenetic mechanisms that may play a role in diagnosis, management, and therapy of these complications. The MEDLINE/PUBMED and bibliographic searches forEnglish language studies were used. RESULTS: A variety of potential aetiologies have been postulated in HIV-related heart disease, including myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. CONCLUSION: An increased number of HIV-infected individuals present with cardiac complications as chronic viral infection, co-infections, drug therapy, and immunosuppression. Understanding the nature and course of cardiac illness related to HIV infection may allow appropriate monitoring, early intervention and therapy

Structural heart diseases in Nigerian children.

BACKGROUND: Cardiovascular diseases both in adults and children constitute a major public health problem and structural heart diseases are an important group of disorders in children worldwide. The pattern of this group of disorders however, varies between regions and countries and even within countries. Recognizing the structural cardiac conditions that prevail in a particular area is important in health planning and for improving health care services. The present survey sets out to describe the pattern of structural heart diseases among children in Aminu Kano Teaching Hospital, Kano from our echocardiography data. METHODS: The echocardiographic reports of all children seen in Aminu Kano Teaching Hospital, Kano between August 2002 and September 2004 (24 months) were reviewed. Information obtained from the records includes age, gender, clinical diagnosis and echocardiographic findings. Data was analyzed using SPSS version 10.0 software. RESULTS: A total of 108 children, aged between two weeks and eighteen years, were referred for echocardiographic examination in the 2-year study period. Of these, 88 had an abnormal echocardiogram. There were 55 boys and 31 girls, giving a male and female ratio of 1.8:1. Congenital heart diseases accounted for 55 (62.5%) of the studied subjects while acquired heart diseases were responsible for 33 (37.5%). Isolated ventricular septal defect (VSD) was the commonest congenital heart disease. Rheumatic valvular heart diseases were the commonest acquired structural heart disease. CONCLUSION: With the establishment of tertiary healthcare institutions in Nigeria, availability of echocardiographic facilities as well as increasing number of paediatric cardiologists, more of these cases are likely to be seen in the future. There is an urgent need for the government to establish a well equipped cardiothoracic surgical centre to cater for these patients either free or at highly subsidized rates.