Contributions of pulmonary hypertension to HIV-related cardiac dysfunction

AbstractBackground/AimTo evaluate the prevalence of pulmonary hypertension among patients living with HIV/AIDS and to determine its contribution to cardiac dysfunction.MethodA hospital based cross sectional study was carried out over a 6-month period at the Jos University Teaching Hospital. The subjects were 200 confirmed HIV positive patients, ≥18 years of age who consented to the study. Physical examination, laboratory investigations, 2 dimensional and Doppler echocardiography were conducted on the subjects.ResultsThe mean age of the patients was 38 ± 9 years, and there were 142 females (71%).Females were younger, mean age 36 ± 8 years versus 41 ± 10 years for males (p-value <0.01). The median CD4 cell count was 312 cells/μl, there were no homosexual or intravenous drug user among the subjects.Eight of the subjects had pulmonary hypertension, with a case prevalence of 4%, and this had no relationship to CD4 cell count. Both systolic and diastolic functions were worse in subjects with pulmonary hypertension, with a negative correlation between mean pulmonary arterial systolic pressure (mPASP) and parameters like ejection fraction (r = −0.28, p-value 0.0003), fractional shortening (r = −0.21, p-value 0.003), deceleration time (r = −0.13. p-value 0.09).ConclusionImmune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients

Role of Pre-eclamptic Toxaemia or Eclampsia in Hypertensive Women Attending Cardiac Clinic of Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Patients with pre-eclampsia and eclampsia constitute a special high risk group for future hypertension. They require a long term follow up to be able to detect and treat emerging hypertension early enough to prevent complications. Unfortunately, this is not so. This study was undertaken to find out the incidence of history of pre-eclamptic toxaemia (PET) in our female hypertensive patients attending cardiac clinic and to also determine the incidence of complications of hypertension in those with previous history of PET. Methods: Fifty consecutive female hypertensive patients seen in cardiac clinic were recruited. Detailed history including full obstetric and family history was taken. A full clinical examination was done including blood pressure and a search for complications of hypertension. Findings were then analyzed and various frequencies determined. Results: Forty-nine patients were studied. The mean age was 47.29\ub111.46 years. The mean SBP, DBP and MAP were 143.18\ub125.05, 90.49\ub114.19 and 108.12\ub116.71mmHg respectively. Between the last child birth and the time of established hypertension in those who had PET ranged from 3-25 years. Sixteen, (32.7%) of the 49 patients had history of PET and 7(43.75%) of these 16 patients had complications of hypertension. Conclusion: The incidence of history of PET in our female hypertensive patients attending cardiac clinic is significant (32.7%). Also the 43.8% incidence of complications of hypertension seen in those patients with history of PET in this study is high. PET patients, therefore, constitute a special risk group for future hypertension. Therefore collaboration between the Obstetricians and the Cardiologists is important for patients with PET and eclampsia.Contexte: Les patientes ayant une tox\ue9mie gravidique ou une \ue9clampsie sont un groupe \ue0 haut risque d\u92hypertension ult\ue9rieure. Elles n\ue9cessitent un suivi a long terme afin de d\ue9tecter et traiter une hypertension \ue9mergente suffisamment t\uf4t afin de pr\ue9venir les complications. Cela ne se passe malheureusement pas ainsi. Cette \ue9tude a \ue9t\ue9 initi\ue9e afin de d\ue9terminer l\u92incidence des ant\ue9c\ue9dents de tox\ue9mie gravidique chez nos patientes hypertendues consultant \ue0 la clinique de cardiologie. Il s\u92agissait \ue9galement de d\ue9terminer l\u92incidence des complications hypertensive chez celles pr\ue9sentant un ant\ue9c\ue9dent de tox\ue9mie gravidique. M\ue9thode: Nous avons recrute de mani\ue8re cons\ue9cutive cinquante patientes hypertendues re\ue7ues a la clinique de cardiologie. L\u92histoire de la maladie a \ue9t\ue9 d\ue9taill\ue9e en insistant sur les ant\ue9c\ue9dents obst\ue9tricaux et familiaux. Un examen clinique complet a \ue9t\ue9 effectue incluant la mesure de la pression art\ue9rielle et la recherche de complications de l\u92hypertension.les donn\ue9es recueillies ont \ue9t\ue9 ensuite analys\ue9es et les diff\ue9rentes fr\ue9quences d\ue9termin\ue9es. R\ue9sultats: Quarante neuf patientes ont \ue9t\ue9 \ue9tudi\ue9es. L\u92\ue2ge moyen \ue9tait de 47,29\ub111,46 ans. Les moyennes de pression art\ue9rielle systolique, diastolique et moyenne \ue9taient respectivement de 143,18\ub125,05 ; 90,49\ub114,19 and 108,12\ub116,71mmHg. Le d\ue9lai entre le dernier accouchement et le diagnostic d\u92hypertension chez celles qui avaient un ant\ue9c\ue9dent de tox\ue9mie gravidique s\u92\ue9tendait de 3 a 25 ans. Seize (32,7%) des 49 patientes avaient un ant\ue9c\ue9dent de tox\ue9mie gravidique et 7 (43,75%) ; parmi eux 16 ont eu des complications hypertensives. Conclusion: L\u92incidence des ant\ue9c\ue9dents de tox\ue9mie gravidique chez nos patientes hypertendues consultant a la clinique de cardiologie est significative (32,7%). L\u92incidence de complications hypertensive (43,8%) observ\ue9e dans le groupe de patientes ayant un ant\ue9c\ue9dent de tox\ue9mie gravidique dans cette \ue9tude est \ue9lev\ue9e. Les patientes pr\ue9sentant une tox\ue9mie gravidique constituent de ce fait un groupe particulier \ue0 risque pouvant d\ue9velopper une hypertension art\ue9rielle. La collaboration entre obst\ue9triciens et cardiologues est de ce fait importante pour les patients ayant une tox\ue9mie gravidique et une \ue9clampsie

Ebstein's anomaly of tricuspid valve with pericardial disease: a case report

Ebstein's anomaly is a rare congenital cardiac malformation that affects the tricuspid valve commonly, but its association with pericarditis is even rarer. We report a 35-year-old nulliparous lady who presented with symptoms and signs of right-sided cardiac failure and poorly developed secondary sexual characteristics. Electrocardiography and chest radiograph suggested pericardial effusion and cardiomegaly. A diagnosis of Ebstein's anomaly of the tricuspid valve with pericarditis was confirmed using echocardiography. Annals of Nigerian Medicine Vol. 1(1) 2005: 27-2

Estimation of weight in adults from height: a novel option for a quick bedside technique

Abstract Purpose In critical care situations, there are often neither the means nor the time to weigh each patient before administering strict weight-based drugs/procedures. A convenient, quick and accurate method is a priority in such circumstances for safety and effectiveness in emergent interventions as none exists in adults while those available are complex and yet to be validated. We aimed to study the correlation and accuracy of a quick bedside method of weight estimation in adults using height. Method The technique is estimated body weight—eBW(kg) = (N − 1)100, where ‘N’ is the measured height in metres. Adult undergraduates were enrolled 10/09/2015. Their heights and weights were measured while the formula was used to obtain the estimated weight. The SPSS version 21.0, Chicago, IL, USA was utilised for data analysis. Results We analysed 122 participants aged 21–38 years with height = 1.55 m–1.95 m. The actual body weight range = 48.0 kg–91.0 kg, mean = 65.3 kg ± 9.7 kg and S.E. = 2.0 while eBW = 55 kg–95 kg, mean = 69.1 kg ± 8.4 kg and S.E. = 1.5. On BMI classes, a positive predictive value of 94.7% for the ‘normal’ category and 95.5% for ‘overweight’. Correlation coefficient at 99% confidence interval yielded (r) = + 1, (P = 0.000) while the linear regression coefficient (r 2) = + 1 at 95% confidence interval (P = 0.000). The strength of agreement/precision was established by the Bland-Altman plot at 95% ± 2 s (P = 0.000) and kappa statistic with value = 0. 618. Conclusion This unprecedented statistical characterisation of the two weight estimate measures to have a good agreement scientifically proposes the utility of our method with the formula eBW(kg) = 100(N−1) in critical care and ATLS protocol

Descriptive evaluation of holter recordings at a teaching hospital in central Nigeria

Background: Holter monitoring is a cardiovascular test available in few centres in Nigeria. It is indicated when cardiac rhythm disorders are suspected and standard electrocardiogram is not helpful. A simple overview of this test could give an idea of what cardiovascular complications are common. We evaluated the indications and simple results of outcome of Holter monitoring in a teaching hospital.Methods: This descriptive cross-sectional study evaluated the indications and findings of patients that had a 24 hour Holter recording at the Jos University Teaching Hospital over a four year period between January 2011 to December 2014, utilizing routinely collected hospital data.Results: A total of 113 subject hah Holter monitoring over the study period. The population had an age range 4-90 years, consisting of consisting of 60 (53%) male and 7 (6%) children. The main indications for Holter monitoring were palpitation (28%) and hypertensive heart disease (26%). Common findings following evaluations were tachycardia 49.5% and bradycardia 17.9%. Wide QRS complex tachycardia was detected in 20.4%, ST segment depression in 47.8% and atrial fibrillation in 28.7%. Asystole was seen in 18% of subjects with a mean duration of 2.17secs, arrest was recorded in 26.7% of those with asystole. The longest duration was 7.58secs. Premature atrial ectopics were seen in 56.7%, premature ventricular ectopics in 44.6% and multiple ventricular ectopics in 32.9% of subjects.Conclusions: Palpitation and hypertensive heart diseases were the two most common indications for Holter monitoring test. Tachycardia and premature atrial contractions were the most common rhythm abnormalities seen.Keywords: Holter monitoring, ambulatory electrocardiographic recording, arrhythmia, Jos, Nigeri

Role of Pre-eclamptic Toxaemia or Eclampsia in Hypertensive Women Attending Cardiac Clinic of Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Patients with pre-eclampsia and eclampsia constitute a special high risk group for future hypertension. They require a long term follow up to be able to detect and treat emerging hypertension early enough to prevent complications. Unfortunately, this is not so. This study was undertaken to find out the incidence of history of pre-eclamptic toxaemia (PET) in our female hypertensive patients attending cardiac clinic and to also determine the incidence of complications of hypertension in those with previous history of PET. Methods: Fifty consecutive female hypertensive patients seen in cardiac clinic were recruited. Detailed history including full obstetric and family history was taken. A full clinical examination was done including blood pressure and a search for complications of hypertension. Findings were then analyzed and various frequencies determined. Results: Forty-nine patients were studied. The mean age was 47.29±11.46 years. The mean SBP, DBP and MAP were 143.18±25.05, 90.49±14.19 and 108.12±16.71mmHg respectively. Between the last child birth and the time of established hypertension in those who had PET ranged from 3-25 years. Sixteen, (32.7%) of the 49 patients had history of PET and 7(43.75%) of these 16 patients had complications of hypertension. Conclusion: The incidence of history of PET in our female hypertensive patients attending cardiac clinic is significant (32.7%). Also the 43.8% incidence of complications of hypertension seen in those patients with history of PET in this study is high. PET patients, therefore, constitute a special risk group for future hypertension. Therefore collaboration between the Obstetricians and the Cardiologists is important for patients with PET and eclampsia.Contexte: Les patientes ayant une toxémie gravidique ou une éclampsie sont un groupe à haut risque d hypertension ultérieure. Elles nécessitent un suivi a long terme afin de détecter et traiter une hypertension émergente suffisamment tôt afin de prévenir les complications. Cela ne se passe malheureusement pas ainsi. Cette étude a été initiée afin de déterminer l incidence des antécédents de toxémie gravidique chez nos patientes hypertendues consultant à la clinique de cardiologie. Il s agissait également de déterminer l incidence des complications hypertensive chez celles présentant un antécédent de toxémie gravidique. Méthode: Nous avons recrute de manière consécutive cinquante patientes hypertendues reçues a la clinique de cardiologie. L histoire de la maladie a été détaillée en insistant sur les antécédents obstétricaux et familiaux. Un examen clinique complet a été effectue incluant la mesure de la pression artérielle et la recherche de complications de l hypertension.les données recueillies ont été ensuite analysées et les différentes fréquences déterminées. Résultats: Quarante neuf patientes ont été étudiées. L âge moyen était de 47,29±11,46 ans. Les moyennes de pression artérielle systolique, diastolique et moyenne étaient respectivement de 143,18±25,05 ; 90,49±14,19 and 108,12±16,71mmHg. Le délai entre le dernier accouchement et le diagnostic d hypertension chez celles qui avaient un antécédent de toxémie gravidique s étendait de 3 a 25 ans. Seize (32,7%) des 49 patientes avaient un antécédent de toxémie gravidique et 7 (43,75%) ; parmi eux 16 ont eu des complications hypertensives. Conclusion: L incidence des antécédents de toxémie gravidique chez nos patientes hypertendues consultant a la clinique de cardiologie est significative (32,7%). L incidence de complications hypertensive (43,8%) observée dans le groupe de patientes ayant un antécédent de toxémie gravidique dans cette étude est élevée. Les patientes présentant une toxémie gravidique constituent de ce fait un groupe particulier à risque pouvant développer une hypertension artérielle. La collaboration entre obstétriciens et cardiologues est de ce fait importante pour les patients ayant une toxémie gravidique et une éclampsie