Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 AFRICA 17
a standard resting 12-lead ECG recorded as per the British
Cardiovascular Society clinical guidelines. The prevalence of
ECG abnormalities was analysed using descriptive statistics and
presented as proportions with 95% confidence interval (CI). The
association between various ECG abnormalities and NYHA
class was determined using the chi-square test.
Results: In total, 216 patients were studied, mean age 53.3 years,
and 52.3% were female. NYHA distribution was: I: 16.7%,
II: 54.6%, III: 24.5% and IV: 3.7%. The prevalence of ECG
abnormalities was 100% of the patients. The most common
ECG abnormality was atrial fibrillation (31.5%), followed by
left bundle branch block (LBBB) (30.6%). Other common
abnormalities included first-degree AV block (17.6%), long QT
interval (9.7%), second-degree AV block (9.3%), LVH (8.8%),
third-degree AV block (3.7%), and SVT (2.3%). The prevalence
of ECG abnormalities that were shown to have therapeutic and
prognostic significance, i.e. atrial fibrillation, LBBB, second-
and third-degree AV block, atrial flutter and SVT, was 83.6%.
There was a statistically significant correlation between NYHA
class and atrial fibrillation and LBBB.
Conclusion: The high prevalence of ECG abnormalities makes
ECG an important rule-out tool in diagnostic work-up, espe-
cially in resource-poor settings. There is a high prevalence of
ECG abnormalities with implications for therapeutic interven-
tions, such as anticoagulation in atrial fibrillation and resyn-
chronisation therapy in LBBB. The ECG therefore is an impor-
tant and cheap tool in the management of DCM.
AN ISOLATED SINGLE CORONARY OSTIUM IN A
PATIENT WITH DILATED CARDIOMYOPATHY
Gunertem Eren*, Mola Serkan, Erkengel Ibrahim, Afsar
Ferhat, Urcun Salim
Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas
Education and Research Hospital,
Cankaya, Ankara, Turkey;
Case report: A 52-year-old woman was sent to an orthopaedist
because of left arm pain over the previous four days. An elec-
trocardiogram (ECG) was planned with the suspicion of cardiac
pathology and it revealed a left bundle branch block (LBBB).
The patient was referred us because of this. Her age was the
only coronary risk factor. Physical examination revealed no
pathological findings. Her blood pressure was 110/70 mmHg,
and heart rate was regular with a mean of 70 beats/minute.
Transthoracic echocardiography revealed depressed left ventric-
ular ejection fraction of 40%, moderate mitral valve insuffi-
ciency, a dilated left ventricle and segmental wall motion abnor-
malities. In the light of these findings, the patient underwent
coronary angiography.
During the angiography session, a single coronary artery
originating from the right sinus of Valsalva was seen. There was
no significant coronary artery stenosis. We interpreted these
echocardiographic findings in favour of dilated cardiomyopathy
and started her on an angiotensin converting enzyme inhibi-
tor and furosemide therapy with acetylsalicylic acid. However
six months later another transthoracic echocardiography was
performed and showed decreased ejection fraction and enlarged
heart chambers compatible with dilated cardiomyopathy.
Discussion: Patients with congenital coronary artery anomalies
can be asymptomatic and these anomalies are only incidentally
found during routine angiography. Coronary arteries originat-
ing from a single coronary ostium in the aorta are rare and
occur in less than 0.03% of the general population. Hyrtl
reported the first case of a single coronary artery in 1841. Single
coronary artery anomalies are classified according to the site
of origin, anatomical distribution on the ventricular surface,
and according to its relationship with the ascending aorta and
the pulmonary artery. Despite the relatively low incidence of
atherosclerotic heart disease in young patients with coronary
anomalies, there are some reports in the literature in which
patients have congenital coronary artery anomalies with coro-
nary artery disease. Karaagac and his colleagues presented a
63-year-old woman whose coronary angiography for typical
chest pain revealed an isolated single coronary artery with a
significant flow-limiting lesion in the right coronary artery that
was successfully treated with percutaneous coronary interven-
tion. The prognosis in patients with a single coronary artery
varies according to the anatomical distribution. The left main
coronary artery travels between the aorta and pulmonary arter-
ies and this can cause sudden cardiac death in young people,
especially during heavy physical exercise.
Conclusion: We present a rare case of a patient who had a single
coronary ostium in the right sinus of Valsalva with dilated
cardiomyopathy. It should be recognised as potentially danger-
ous and may present unexpected results such as sudden death.
We want to remind physicians of this rare condition that is often
asymptomatic and detected incidentally.
A RAPID ETHNOGRAPHIC ASSESSMENT APPROACH
TO EXPLORING PATIENT AND PROVIDER EXPERI-
ENCE IN RHEUMATIC HEART DISEASE
Hermanus Tayla* 1, Shato Thembekile2, Engel Mark1, Liesl
Zühlke2, De Vries Jantina1
*Department of Medicine, Faculty of Health Sciences,
University of Cape Town, South Africa; tayla.hermanus@uct.
2 Department of Paediatrics, Faculty of Health Sciences,
University of Cape Town, South Africa
Introduction: Rheumatic heart disease (RHD), while negligible
in high-income countries, remains prevalent in low- and middle-
income countries and is associated with poverty, social inequal-
ity and poor access to healthcare. Understanding and address-
ing the lack of awareness and education is key in the prevention
and control of RHD and its antecedent, acute rheumatic fever
(ARF). Our goal was to develop an approach to generate quali-
tative data in different RHD-endemic communities. Here we
report our approach to developing a rapid ethnographic assess-
ment (REA) to examine the patient and provider experiences
of RHD. While REA has not been used in RHD previously, it