WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hyperte...WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hypertensive woman with a history of ischemic stroke. She presented with hyperkinetic palpitations without hemodynamics instability on admission. The electrocardiogram recorded a complete tachyarrhythmia by pre-excitation atrial fibrillation, with a mean rate of 300 beats per minute. Electrophysiological investigation revealed an accessory pathway located at the ostium of the coronary sinus, which was successfully ablated by radiofrequency. A drug treatment based on flecaine 100 mg was introduced. The patient was asymptomatic after one month of outpatient follow-up.展开更多
Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-ol...Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.展开更多
Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve ca...Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve cardiac function and the quality of life of patients. However, in Sub-Saharan Africa, very few studies have been done on cardiac resynchronization which is in its infancy. The aim of this study is to report the local data from our hospital. Method: It was a transversal, descriptive and analytical study conducted from November 2019 to September 2022 at the Cardiology Department of the Principal Hospital of Dakar. Results: Twelve patients were implanted for Cardiac Resynchronization Therapy (CRT). The sex ratio was 8 males/4 females. The average age was 67 ± 11 years. Ten patients had non-ischemic heart disease and the two others had ischemic one. All of them had NYHA III or IV scores before CRT. The Quality of Life (QOL) was judged as poor by all of the patients. The average duration of QRS was 156 ± 9 ms. 27.9% ± 5% was the mean Left Ventricular ejection fraction (LVEF). Complications occur in 3/12 patients (25%). It was one CS vein dissection, one micro LV lead dislodgement and one phrenic nerve stimulation. Nine patients, who were considered as responders, had an improvement of QOL and NYHA, the LVEF increased and the end-diastolic dimension, and the duration of the QRS interval all decreased. Two patients do not respond and one (1) who had permanent atrial fibrillation, was a secondary responder after an atrioventricular junction ablation. Conclusion: Cardiac resynchronization is a therapy that improves the QOL of patients, the LVEF and reduces the duration of the QRS interval. However, this procedure is not without risk of complications. In sub-Saharan Africa, the major challenge is to improve the financial accessibility of this therapy for the population.展开更多
Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic co...Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1<sup>st</sup>, 2018 to December 31<sup>st</sup>, 2019) in the Cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclusion: Our study shows that screening for chronic coronary disease should be done especially in diabetics, elderly subjects and those with previous angioplasty taking into account symptoms and pretest probability to avoid unnecessary invasive procedures.展开更多
<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascula...<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. <b>Methods:</b> We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 201</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. <b>Results: </b>Overall, one</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> with a sex</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ratio of 1.28. Patients’mean age was 66.33 ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""></span><span style="white-space:normal;font-size:10pt;font-family:;" "="">13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">.</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes rang</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ing</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">for </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five (35) accounting for 39% were female patients and fifty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">as </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dys</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">lipidemia, physical inactivity, obesity and recurrent ischemic stroke. <b>Conclusion:</b> Long</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">term prognosis of ischemic stroke remains unclear in Senegal. </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">Therefore</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> a strategy for primary prevention is highly crucial and </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">it </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">requires the control of risk factors in general and that of high blood pressure in particular.</span>展开更多
文摘WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hypertensive woman with a history of ischemic stroke. She presented with hyperkinetic palpitations without hemodynamics instability on admission. The electrocardiogram recorded a complete tachyarrhythmia by pre-excitation atrial fibrillation, with a mean rate of 300 beats per minute. Electrophysiological investigation revealed an accessory pathway located at the ostium of the coronary sinus, which was successfully ablated by radiofrequency. A drug treatment based on flecaine 100 mg was introduced. The patient was asymptomatic after one month of outpatient follow-up.
文摘Inadvertent Lead Malposition in Left Ventricle is a rare and underdiagnosed incident, which may occur during implantation of cardiac electronic devices and may remain asymptomatic. We reported the case of a 71-year-old man who was implanted with a ventricular single-chamber pacemaker for a slow atrial fibrillation with syncope and whose routine transthoracic echocardiography 23 months after implantation displayed a malposition of the pacemaker lead into the Left Ventricle through a patent foramen oval. The patient was asymptomatic. The electrocardiogram showed right bundle branch block QRS-paced morphology with a positive QRS pattern in V1, a median paced QRS axis on the frontal plane at -120°, a Precordial transition on V5. At the lateral Chest X-ray the lead curved backwards to the spine. Given the age of this old patient who already received oral anticoagulant for Atrial Fibrillation and the Lead malposition discovered 23 months after pacemaker’s implantation, we decided to maintain the lead in LV and continue anticoagulation.
文摘Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve cardiac function and the quality of life of patients. However, in Sub-Saharan Africa, very few studies have been done on cardiac resynchronization which is in its infancy. The aim of this study is to report the local data from our hospital. Method: It was a transversal, descriptive and analytical study conducted from November 2019 to September 2022 at the Cardiology Department of the Principal Hospital of Dakar. Results: Twelve patients were implanted for Cardiac Resynchronization Therapy (CRT). The sex ratio was 8 males/4 females. The average age was 67 ± 11 years. Ten patients had non-ischemic heart disease and the two others had ischemic one. All of them had NYHA III or IV scores before CRT. The Quality of Life (QOL) was judged as poor by all of the patients. The average duration of QRS was 156 ± 9 ms. 27.9% ± 5% was the mean Left Ventricular ejection fraction (LVEF). Complications occur in 3/12 patients (25%). It was one CS vein dissection, one micro LV lead dislodgement and one phrenic nerve stimulation. Nine patients, who were considered as responders, had an improvement of QOL and NYHA, the LVEF increased and the end-diastolic dimension, and the duration of the QRS interval all decreased. Two patients do not respond and one (1) who had permanent atrial fibrillation, was a secondary responder after an atrioventricular junction ablation. Conclusion: Cardiac resynchronization is a therapy that improves the QOL of patients, the LVEF and reduces the duration of the QRS interval. However, this procedure is not without risk of complications. In sub-Saharan Africa, the major challenge is to improve the financial accessibility of this therapy for the population.
文摘Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1<sup>st</sup>, 2018 to December 31<sup>st</sup>, 2019) in the Cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclusion: Our study shows that screening for chronic coronary disease should be done especially in diabetics, elderly subjects and those with previous angioplasty taking into account symptoms and pretest probability to avoid unnecessary invasive procedures.
文摘<strong>Aims:</strong><span style="white-space:normal;font-size:10pt;font-family:;" "=""><strong> </strong>To determine the cardiovascular and cerebrovascular prognosis at 5 years of patients who underwent an ischemic stroke in Senegal. <b>Methods:</b> We performed a descriptive, retrospective and exhaustive study conducted at Principal Hospital of Dakar. We included all patients hospitalized at Principal Hospital of Dakar from 2013 to 201</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> for an ischemic stroke confirmed by a cerebral CT-Scanner or by magnetic resonance imaging, and who survived the acute phase. <b>Results: </b>Overall, one</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">hundred and seventy-one (171) patients were gathered. Ninety-six (96) male patients account for 56.14% and seventy-five (75) female patients account for 43.86%</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> with a sex</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ratio of 1.28. Patients’mean age was 66.33 ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""></span><span style="white-space:normal;font-size:10pt;font-family:;" "="">13.99 years. Twenty-one (21) young patients (12.35%), aged less than 50 years, presented with an ischemic stroke. Myocardial infarction was found in a female patient (0</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">.</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">6%) 3 months after she experienced an ischemic stroke, nine (9) patients (5.29%) underwent a recurrence of the ischemic stroke with a mean recurrence period of 8 months and extremes rang</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">ing</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> from 1 to 24 months. Five (5) patients (2.92%) developed dementia with a score less than 28. A 30 years old patient presented with epilepsy 12 months after the ischemic stroke accounting </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">for </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">0.58%. We registered ninety (90) deaths that occurred in a mean period of 24 months ±</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">9.8 after they presented their ischemic stroke, standing for 52.63% amongst which thirty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five (35) accounting for 39% were female patients and fifty</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">five patients (55) representing 61% were male patients. Mortality-related factors included: advanced age, past medical history of heart surgery, known </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">as </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">dys</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">lipidemia, physical inactivity, obesity and recurrent ischemic stroke. <b>Conclusion:</b> Long</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">-</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">term prognosis of ischemic stroke remains unclear in Senegal. </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">Therefore</span><span style="white-space:normal;font-size:10pt;font-family:;" "="">,</span><span style="white-space:normal;font-size:10pt;font-family:;" "=""> a strategy for primary prevention is highly crucial and </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">it </span><span style="white-space:normal;font-size:10pt;font-family:;" "="">requires the control of risk factors in general and that of high blood pressure in particular.</span>
