Intra‑cardiac masses in adults: A review of echocardiogram records at two echocardiographic laboratories in Enugu, South‑East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra‑cardiac masses in adults, as well as the gender distribution and commonest location of these masses.Results: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra‑cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra‑cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.Keywords: Adults, echocardiography, intra‑cardiac masses, NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Atrial Septal Defects Presenting Initially in Adulthood: Patterns of Clinical Presentation in Enugu, South-East Nigeria

This paper aimed to evaluate the patterns of clinical presentation of adults with atrial septal defects (ASDs) who were diagnosed from transthoracic echocardiographic examination at the echocardiographic laboratory of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria, from February 2002 to June 2010. 2251 new echocardiogram scans, with additional 373 repeat scans, were done within the period. 32 adults had ASDs (1.3%), made up of 9 males and 23 females. Secundum ASD constituted 75% while dyspnoea on exertion was the commonest symptom. Congestive cardiac failure was the clinical syndrome most commonly encountered, and most patients presented in the third decade. This paper demonstrated that ASDs are common congenital heart diseases in adult Nigerians, and that they are important causes of congestive heart failure. All adults with congestive heart failure must be referred for echocardiography for early identification of causes like ASDs, which are often forgotten, before the development of irreversible changes in the lungs

Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis

BACKGROUND: People of Sub Saharan Africa (SSA) and South Asians(SA) ethnic minorities living in Europe have higher risk of stroke than native Europeans(EU). Study objective is to provide an assessment of gender specific absolute differences in office systolic(SBP) and diastolic(DBP) blood pressure(BP) levels between SSA, SA, and EU. METHODS AND FINDINGS: We performed a systematic review and meta-analysis of observational studies conducted in Europe that examined BP in non-selected adult SSA, SA and EU subjects. Medline, PubMed, Embase, Web of Science, and Scopus were searched from their inception through January 31st 2015, for relevant articles. Outcome measures were mean SBP and DBP differences between minorities and EU, using a random effects model and tested for heterogeneity. Twenty-one studies involving 9,070 SSA, 18,421 SA, and 130,380 EU were included. Compared with EU, SSA had higher values of both SBP (3.38 mmHg, 95% CI 1.28 to 5.48 mmHg; and 6.00 mmHg, 95% CI 2.22 to 9.78 in men and women respectively) and DBP (3.29 mmHg, 95% CI 1.80 to 4.78; 5.35 mmHg, 95% CI 3.04 to 7.66). SA had lower SBP than EU(-4.57 mmHg, 95% CI -6.20 to -2.93; -2.97 mmHg, 95% CI -5.45 to -0.49) but similar DBP values. Meta-analysis by subgroup showed that SA originating from countries where Islam is the main religion had lower SBP and DBP values than EU. In multivariate meta-regression analyses, SBP difference between minorities and EU populations, was influenced by panethnicity and diabetes prevalence. CONCLUSIONS: 1) The higher BP in SSA is maintained over decades, suggesting limited efficacy of prevention strategies in such group in Europe;2) The lower BP in Muslim populations suggests that yet untapped lifestyle and behavioral habits may reveal advantages towards the development of hypertension;3) The additive effect of diabetes, emphasizes the need of new strategies for the control of hypertension in groups at high prevalence of diabetes

Congestive heart failure in subjects with thyrotoxicosis in a black community

R C Anakwue, B J C Onwubere, B C Anisiuba, V O Ikeh, A Mbah, S O IkeDepartment of Medicine, College of Medicine, University of Nigeria Enugu CampusIntroduction: Thyroid hormone has profound effects on a number of metabolic processes in virtually all tissues but the cardiovascular manifestations are prominent usually creating a hyperdynamic circulatory state. Thyrotoxicosis is not a common cause of congestive heart failure among black communities.Objectives: To determine the hospital prevalence, clinical characteristics and echocardiographic findings in patients with thyrotoxicosis who present with congestive heart failure (CCF) in the eastern part of Nigeria.Subjects and methods: A total of 50 subjects aged 15 years and above who were diagnosed as thyrotoxic following clinical and thyroid function tests were consecutively recruited. Fifty age- and sex-matched controls with no clinical or biochemical evidence of thyrotoxicosis and no comorbidities were used as controls. Two-dimensional echocardiography was carried out on all the subjects. CCF was determined clinically and echocardiographically.Results: Eight patients (5 females and 3 males) out of a total of 50 thyrotoxic patients presented with congestive heart failure.Conclusion: The study revealed that congestive heart failure can occur in thyrotoxicosis in spite of the associated hyperdynamic condition. The underlying mechanism may include direct damage by autoimmune myocarditis, congestive circulation secondary to excess sodium, and fluid retention.Keywords: thyrotoxicosis, congestive heart failure, echocardiography, black communit

Assessment of cardiac dyssynchrony in Nigerian patients with dilated cardiomyopathy

Background: Interventricular, intraventricular, and atrioventricular dyssynchrony (AVD) have been reported in patients with dilated cardiomyopathy (DCM). However, the causes of DCM vary with the regional distribution in various etiologies, with expected differences in the pattern and frequency of cardiac dyssynchrony. Objective: The aim of this study was to evaluate cardiac dyssynchrony in patients with DCM by conventional echocardiographic assessment. Materials and Methods: Fifteen patients with DCM were studied. All patients underwent conventional Doppler echocardiographic evaluation including septal-to-posterior wall motion delay (SPWMD), interventricular motion delay (IVMD), and diastolic filling period. Results: Cardiac dyssynchrony was present in 13 of the 15 patients (86.7%). The overall frequencies of intra-left ventricular dyssynchrony (intra-LVD), interventricular dyssynchrony (inter-VD), and AVD are 38.5%, 30.8%, and 53.9%, respectively. Conclusion: The prevalence of dyssynchrony in our patients with DCM was significant. This raises the need for the development of local expertise in interventional cardiology including cardiac resynchronization therapy (CRT)

Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease

Raphael C Anakwue,1,2 Basden J Onwubere,2 Vincent Ikeh,2 Benedict Anisiuba,2 Samuel Ike,2 Angel-Mary C Anakwue3 1Department of Pharmacology and Therapeutics, 2Department of Medicine, 3Department of Radiography and Radiological Sciences, Imaging Unit, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria Introduction: Thyrotoxicosis is an endocrine disorder with prominent cardiovascular manifestations. Thyroid hormone acts through genomic and non-genomic mechanisms to regulate cardiac function. Echocardiography is a useful, non-invasive, easily accessible, and affordable tool for studying the structural and physiological function of the heart.Aim: We studied thyrotoxicosis patients in a Nigerian Teaching Hospital and employed trans-thoracic echocardiography to find out if there were abnormalities in the hearts of these patients.Methods: Fifty adult thyrotoxicosis patients diagnosed with clinical and thyroid function tests in the medical out-patient unit of the hospital were recruited and we performed transthoracic echocardiography with a Sonos 2000 HP machine.Results: We documented the presence of abnormalities in the following proportion of thyrotoxicosis patients: left ventricular enhanced systolic function in 30%, enhanced diastolic function in 34%, diastolic dysfunction in 34%, heart failure with preserved ejection fraction in10%, heart failure with reduced ejection fraction in 6%, and left ventricular hypertrophy in 34%.Conclusion: Echocardiography was useful in the stratification of cardiac function abnormalities and is indispensable as a guide in the choice of therapeutic options in patients with thyrocardiac disease. The finding of left ventricular enhanced systolic and diastolic functions signify early echocardiographic detectable cardiac abnormalities in thyrotoxicosis, and the clinical management includes the use of anti-thyroid drugs and ß-adrenoceptor blockade. Diastolic dysfunction in thyrotoxicosis patients asymptomatic for cardiac disease should be treated with anti-thyroid drugs, and ß-adrenoceptor blockade. The judicious application of clinical therapeutics will guide the use of anti-thyroid drugs, diuretics, digoxin, angiotensin inhibitors, and ß-adrenoceptor blockade in the successful management of thyrotoxicosis patients with heart failure and reduced, preserved, or increased ejection fraction: parameters which are derived from echocardiography. Keywords: thyrotoxicosis, left ventricle, echocardiography, therapeutics, thyrocardiac diseas

Cardiac pacemaker treatement of heart block in Enugu: a 5 year review

Background: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation, sometimes after a period of misdiagnosis and inappropriate treatment. Methods: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre, Enugu, between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. Results: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100%). Hypertensive heart disease was present in 65% of the patients and a history of chronic chloroquine usage was positive in 73% of the patients. Predominant pre-treatment pulse rate was in the range of 30-40 per minute (43%) while 21% of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16% had hypotension. Third degree heart block was present in 65% of the patients and 89% of all patients needed pre-pacing haemodynamic stabilization with positive inotropic / chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65% and epicardial pacing in 35% of the patients with equally good response in symptoms, haemodynamic parameters and electrocardiographic features. Conclusion: Permanent artificial cardiac pacing is the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list Nigerian Journal of Medicine Vol. 17 (1) 2008 pp. 7-1