CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 2, March/April 2011
AFRICA
73
cance (for DBP
<
60 mmHg) was reached for the age group
20–35 years (
p
<
0.005). Parity however did not affect DBP.
Systolic blood pressure (SBP) was normal in both groups, rang-
ing between 90 and 120 mmHg without any significant differ-
ence between the two groups.
On physical examination, findings ranging from grades
1–3 tricuspid systolic murmurs to loud P
2
sounds were found
in 41.2% of the pregnant group, whereas only grade 1 apical
systolic murmur and occasional missed beats were found in
12.9% of the control group (RR
=
3.156, CI
=
1.610–6.189,
p
=
0.0005). Expected gestational age did not affect clinical findings
(
p
=
0.738), even when EGA grouping based on trimester was
used (
p
=
0.391) (Table 3).
All patients in both groups were in sinus rhythm. Sinus
arrhythmia was found only in two non-pregnant patients. Mean
ECG heart rate in the pregnant and control groups were 88.34
±
11.46 and 75.16
±
12.22 bpm, respectively. Sinus tachycardia
was rare in both groups (8.7% in pregnant vs 2.9% in controls).
However, the increase in ECG heart rate in the pregnant group
compared with the controls was significant (RR
=
–13.18, CI
=
–17.15 to –9.21,
p
=
0.020). The mean ECG heart rate and
pulse rate were higher among the pregnant subjects than controls
(88.34
±
11.46; 84.03
±
11.05 vs 75.16
±
12.22; 75.27
±
8.51
bpm,
p
<
0.05 respectively).
The frontal-plane QRS axis was normal in all pregnant
patients and non-pregnant controls. LVH using Sokolow-Lyon
criteria revealed no significant difference in prevalence between
the two groups; however using Araoye’s criterion in blacks (RI
>
12 mm), the pregnant subjects had a higher prevalence of LVH
than the normal controls (0.087, CI
=
0.019–0.155,
p
=
0.0189).
The LVH regressed in one of the two patients who reported for
follow up eight weeks post partum; the other five patients were
lost to follow up.
Non-specific intraventricular conduction defect was found in
5.8% of the pregnant group in the form of Rsr
′
, mostly in lead
III, against 14.3% in the control group. Similarly Rsr
′
was found
in lead avF in 20.3% of the pregnant group, against 5.1% of the
control (RR
=
3.551, CI
=
1.230–10.252,
p
=
0.0105).
Isolated atrial and ventricular ectopics were found in 7.3% of
the pregnant group and 5.8% of the controls. First-degree atrio-
ventricular block (PR
>
0.20 s) was rare in both the pregnant
and control groups (1.5 vs 2.9%, respectively). No other form of
arrhythmia was found in either group.
Mild ST-segment elevation (J junction of the ST segment aris-
ing from within 1 mm of the isoelectric line, otherwise known
as one of the ‘normal variants’ or the ‘normal Negroid pattern’
in blacks
11
) was found in 2.9% of the pregnant patients, against
24.3% in the control group (RR
=
0.119, CI
=
0.029–0.497,
p
<
0.0005). Isoelectric ST segment was also commoner in the preg-
nant subjects than the controls (97.1 vs 75.7%, RR
=
1.283, CI
=
1.116–0.473,
p
<
0.0005). Incidence was however less in the
patients in the parity group above three (60%) when compared
TABLE 3. DISTRIBUTION OF SIGNIFICANT FACTORS IN PREGNANT GROUPACCORDINGTOTRIMESTER OF PREGNANCY
3rd trimester
2nd trimester
1st trimester
p
-value
(Yates’ chi-square)
Normal
Abnormal
Normal
Abnormal
Normal
Abnormal
Mean pulse rate
7
1
26
2
31
2
0.942 (0.119)
Mean ECG heart rate
7
1
25
3
31
2
0.945 (0.114)
Diastolic blood pressure
4
4
19
9
21
12
0.866 (0.287)
Cardiac findings
4
4
18
10
17
16
0.752 (0.571)
LVH (RI
>
12 mm)
8
0
25
3
29
4
0.911 (0.186)
All LVH criteria
8
0
22
6
28
5
0.651 (0.86)
Rsr
′
in aVF
3
0
19
9
28
5
0.417 (1.75)
ST-segment isoelectric line
8
0
28
0
28
5
0.196 (3.259)
Mild ST elevation (Negroid pattern)
8
0
26
2
33
0
0.564 (1.15)
T-wave inversion – lead III
8
0
21
7
24
9
0.494 (1.41)
Tall and broad T waves in V
2
–V
6
8
0
26
2
32
1
0.932 (0.14)
TABLE 4. DISTRIBUTION OF SIGNIFICANT FACTORS IN PREGNANT GROUPACCORDINGTO PARITY STATUS
0 parous
1–3 parous
>
3 parous
p
-value
(Yates’ chi-square)
Normal
Abnormal
Normal
Abnormal
Normal
Abnormal
Mean pulse rate
21
2
39
2
4
1
0.925 (0.155)
Mean ECG heart rate
21
2
38
3
3
2
0.317 (2.292)
Diastolic blood pressure
16
7
27
14
3
2
0.984 (0.033)
Cardiac findings
13
10
22
19
3
2
0.971 (0.058)
LVH (RI
>
12 mm)
21
2
36
5
5
0
0.978 (0.044)
All LVH criteria
20
3
33
8
5
0
0.856 (0.31)
Rsr
′
in aVF
18
5
32
9
5
0
0.843 (0.34)
ST-segment isoelectric line
23
0
41
0
3
2
<
0.005 (13.50)
Mild ST elevation (Negroid pattern)
23
0
39
2
5
0
0.599 (1.023)
T-wave inversion – lead III
18
5
30
11
5
0
0.730 (0.63)
Tall and broad T waves in V
2
–V
6
21
2
39
2
5
0
0.909 (0.191)
