Sexual dysfunction in hypertensive patients: implications for therapy

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients\' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient\'s drug regimen may help patients overcome specific sexual side effects experienced with certain drugs. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure and at the same time preserves patients\' quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.Keywords: sexual dysfunction, hypertension, treatment RésuméDysfonction sexuelle associée à l\'hypertension ou aux thérapies antihypertensives pourrait provoquer la capacité des patients de rester sur la thérapie et mener à la détérioration de la qualité de vie des patients. Donc, il est important que les praticiens se familiarisent avec des variations diverses des effets secondaires sexuels de médicament produit par des agents d\'antihypertensif et de discuter la fréquence potentielle de ces effets secondaire avec leur patients. À bien des cas, un changement dans le régime de la drogue de patient pourrait aider les patients à vaincre les effets secondaires sexuels spécifiques expérimentés avec certaines drogues. Les praticiens devraient considérer le choix d\'une thérapie antihypertensive qui est extrêmement efficace de baisser la tension artérielle et en même temps préserver la qualité de vie des patients. Les effets du médicament sur la fonction sexuelle reste controversés. Quelques tests aveugles raportent peu différence entre placebo et médications spécifiques, tandis que des autres études montrent que des médicaments d\'antihypertensive augment la dysfunction sexuelle, qui a une influence sur la qualité de vie. Des preuves récentes suggèrent que losatan, un angoitensine II antagonist, n\'est pas associé typiquement au développement de la dysfonction sexuelle et pourrait en fait positivement avoir un impact sur des indices divers de fonctionnement sexuel (fonction érectile, satisfaction sexuelle, et la fréquence d\'activité sexuelle) aussi bien que la qualité de vie perçue. Donc, angiotensine II antagonist pourrait donner une option thérapeutique pour éviter ou corriger la dysfonction érectile chez des patients atteints de l\'hypertension. Des effets favorables de ces agents sur la fonction sexuelle pourrait être semblable d\'un côté, pour leur capacité de bloquer angiotensine II, qui est tout récemment acceptable comme un médiateur important de détumescence et peut-être dysfonction érectile.Mots clés: dysfonctions sexuelles, hypertension, thérapieAnnals of African Medicine Vol. 4(2) 2005: 46–5

Continuing Education: Atrial fibrillation: Current trends in management

Quite a number of dramatic interventional advances in the treatment of cardiac arrhythmias such as catheter ablation and implantable cardiac defibrillators for serious ventricular arrhythmias have held the limelight over the last few years. The treatment of atrial fibrillation (AF), which remains the commonest arrhythmia affecting 0.5% of people aged 50-59 years increasing to 12% at age above 74years, has received relatively little attention. There is however, a recent resurgence of interest following some important experimental and therapeutic advances. This article reviews the current understanding of the nature of atrial fibrillation (AF) and some recent developments in the pharmacological and alternative therapeutic approaches. Key Words: Atrial fibrillation, treatment Annals of African Medicine Vol.3(2) 2004: 98-10

Combined mitral and tricuspid stenosis in 47-year old rheumatic valvular heart disease patient: a case report

Rheumatic valvular heart disease is a common complication of rheumatic fever; however combined mitral and tricuspid stenosis is an extremely rare form of multi-valve disease presentation. Case Presentation: We report a case of combined mitral and tricuspid stenosis from rheumatic heart disease (RHD) in a 47-year-old woman who was being managed for hypertensive heart disease (HHDx) on anti-hypertensives for 2yrs prior to presentation. However, on further review with transthoracic echocardiography (TTE), she was found to have thickened mitral valve and hockey stick appearance with dilated left atrium (dimension of 60mm) and reduced left ventricular ejection fraction (LVEF) of 45%. A repeat TTE done 8 years after the first one showed a severely dilated left atrium (LAD 71mm) with estimated area of 55.4cm2; moderate mitral stenosis and severe tricuspid stenosis with moderate TR. The LVEF was 29% with a severe right ventricular (RV) systolic dysfunction (TAPSE of 9mm). Patient is being managed conservatively due to economic constraints and the likelihood of very poor surgical outcome due to severe biventricular dysfunction. Conclusion: The case is reported for its rarity as well as the importance of interval evaluation of unaffected valves in a setting of single valve disease for early detection and possible prompt treatment and intervention

Tuberculous dilated cardiomyopathy: an under-recognized entity?

BACKGROUND: Tuberculosis (TB) is a common public health problem in many parts of the world. TB is generally believed to spare these four organs-heart, skeletal muscle, thyroid and pancreas. We describe a rare case of myocardial TB diagnosed on a post-mortem cardiac biopsy. CASE PRESENTATION: Patient presented with history suggestive of congestive heart failure. We describe the clinical presentation, investigations and outcome of this case, and review the literature on the involvement of myocardium by TB. CONCLUSION: Involvement of myocardium by TB is rare. However it should be suspected as a cause of congestive heart failure in any patient with features suggestive of TB. Increasing recognition of the entity and the use of endomyocardial biopsy may help us detect more cases of this "curable" form of cardiomyopathy

PERIPHERAL FACIAL PARALYSIS AS A MANIFESTATION OF HIV INFECTION: A REPORT OF THREE CASES

Three cases of infranuclear facial nerve palsy associated with infection by the human immunodeficiency virus type 1 are reported. All were previously asymptomatic and had no other symptom suggestive of HIV infection. Two patients had typical Bells palsy while one had a facial diplegia. CD4 cell counts were above 100 cells/mm3 in all cases. A review of the literature confirmed that peripheral facial nerve palsy could occur at any stage of HIV infection and in various clinical contexts. It is suggested that adult patients presenting with peripheral facial paralysis should be counseled, and screened for HIV Infection. Key words: Peripheral facial paralysis, HIV (Annals Af Med: 2002 1(1): 28-30

Mitral valve prolapse in Zaria: clinical and echocardiographic features

Background: Mitral valve prolapse (MVP) symptomatology and presentation are said to be of questionable significance. Method: A prospective study of 10 patients with mitral valve prolapse seen at Ahmadu Bello University Hospital in two years. Results: There were six females and four males. Their ages ranged from 5 to 35 years with a mean of 17.80 +/- 10.24. Four patients were suspected as having MVP before the echocardiographic scan (1/3). Six patients (60%) were found to have associated rheumatic heart disease (RHD). The commonest prolapsing leaflet was the anterior mitral valve leaflet found in 80% of the cases. Eight patients (80%) had classical MVP and the remaining two had non-classical MVP. There were significant difference between those with MVP and RHD compared with those without RHD in cardio-thoracic ratio (CTR) and end diastolic volume (EDV). Three patients who had RHD and MVP, had cardiomegaly clinically and on chest radiography. Hypertension and other disorders associated with MVP did not feature in our patient population. Conclusion: Recent reports have highlighted the past over estimation of the syndrome based on ambiguous criteria and use of M-mode echocardiography. The most recent criteria by Freed have put the prevalence at 2.4 %. Key words: Mitral valve, prolapse, features (Annals Af Med: 2002 1(2): 84-91

Awareness, Treatment and Control of Hypertension among Hypertensives in Zaria

Background: Blood pressure control is a global challenge. Adequate and appropriate health education is a potentially useful tool. This study was carried out to investigate the content of health education received by patients with hypertension in relation to their treatment compliance and blood pressure control. Methodology: Two hundred and two consecutive subjects with systemic hypertension attending a tertiary health facility in Zaria, Nigeria were seen in a cross-sectional prospective study. Clinical information and content of health information they had received on issues of awareness and control of their disease were obtained and analyzed. Results: Their mean age was 52.6±10.7 years, mean BMI 28.5±0.1 kg/m2 while the duration of hypertension ranged from 0.3- 40 years, median of 7.0 years. 12.4% of the patients had BP controlled, 49.5% were in stage 1 and 38.1% in stage 2. 71.1% of the subjects had had health education from their primary physician, 80.5% were consistent with follow up and 67.3% reported compliance with their medication. Knowledge of the names of their medication and need for dietary salt restriction was significantly higher in those with health information. (X2 = 9.85, p=0.002 and X2 = 9.20, p=0.01 respectively). Awareness rate did not seem to have affected blood pressure control. (X2 = 0.82, p=0.36). Only 46.9% of the total population showed some understanding of health information. Conclusion: This study shows a fair hypertension awareness rate but poor blood pressure control. Emphasis should be placed on content and coverage of health information in hypertension management at all levels of healthcare.Key Words hypertension, awareness, treatment, control

Spectrum of rheumatic heart disease in Zaria, Northern Nigeria

Background: Rheumatic heart disease (RHD) is a disease that is still prevalent in the developing countries and still poses a major medical and cardio-thoracic surgery challenge in Nigeria. Method: A study of data from echocardiography laboratory from October 1999 – September 2002. Results: Forty-seven (47) out of 600 echocardiography scans had a diagnosis of rheumatic heart disease from October 1999 to September 2002. They were made up of 32 females and 16 males (female/male ratio of 2:1). The ages of the patients ranged from 5 to 52 years with a mean of 19.51 +/- 1.4. There was no statistically significant difference in the mean age of female and male patients. Nearly 90 % of the referring Physician made the correct diagnosis of rheumatic heart disease. Forty eight percent of the patients had depressed left ventricular function (EF < 50%). The mitral followed by the aortic valves were the most commonly affected. Sixteen percent of the patients had severe mitral stenosis. Mitral valve disease whether pure regurgitation, stenosis or combined disease was more common in patients below the age of 25 years. The mean Wilkins score of patients with severe mitral stenosis was 6.8 +/- 1.2. Two patients had aortic valve disease and were above the age of 25 years. The complications included mitral valve prolapse in 19.6%, atrial fibrillation, endocarditis, pericardial effusion and rupture of chordae tendinae. Only 0.7% had surgical intervention but the rest were managed medically. Percutaneous transluminal balloon mitral commissurotomy is not part of management armamentarium. Conclusion: The mitral and the aortic valves are most commonly affected valves. Patients with critical mitral stenosis have a favourable anatomy for PTMC but it is not available, and a negligible number have the opportunity to have surgical intervention. The need to develop some cardio-thoracic centres as matter of urgency is recommended so as to alleviate the patients' suffering. Key Words: Rheumatic, heart, disease, spectrum Annals of African Medicine Vol.3(1 ) 2004: 17-2

Left Ventricular Function in Nigerians With Type 2 Diabetes Mellitus With and Without Hypertension

Background. Diabetes mellitus is an established risk factor for  cardiovascular events and has been found to be independently associated with abnormal left ventricular function. We therefore decided to embark on this study to assess the left ventricular function in our diabetic patients.Method. The study design was cross-sectional and conducted among patients attending out patient clinic of the Obafemi Awolowo UniversityTeaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. It comprised 75 consecutive patients with type 2 diabetes mellituswith or without hypertension and 50 apparently healthy age- and sex- comparable controls. Using a structured pre-evaluated questionnaire, thedemographic and clinical data were obtained. All subjects had two-dimensional (2D) M-mode, and Doppler echocardiography using Sonoline G60s Ultrasound imaging system with 4.2 MHZ transducer equipped with simultaneous ECG tracing.Results. A total of 125 consecutive subjects were recruited comprising 75 patients with type 2 diabetes mellitus with or without hypertension and50 apparently healthy age-and-sex comparable controls. There were no significant difference in left ventricular ejection fraction and fractionalshortening between the patients and controls. The ratio of early trans-mitral flow to late atrial filling of the left ventricle (E/A ratio), isovolumic leftventricular relaxation time, and left ventricular deceleration time were predominantly prolonged among the study patients compared to the controls.Conclusion. This study showed that left ventricular systolic function was preserved among patients with type 2 diabetes mellitus. The abnormal diastolic function noted was predominantly that of impaired relaxationcompared with controls. This is particularly more in hypertensive-diabetics than normotensive-diabetics.Keywords: Diabetes mellitus, Left ventricular function