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

28 / 56

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 26 AFRICA
CONGENITAL HEART BLOCK IN A UGANDAN INFANT
Namuyonga Judith*, Lwabi Peter, Lubega Sulaiman
Uganda Cardiac Society, Uganda Heart Institute, Mulago
Hospital, Kampala, Uganda;
Introduction: Congenital heart block is a rare, fatal disorder. It
occurs among one in 22 000 live births and has been associated
with maternal lupus. Most studies have been published as case
reports in developed countries.
Case report: A case of a seven-month-old infant was referred to
our facility, the Uganda Heart Institute, a super-specialised unit
and the main referral for patients with heart conditions within
Mulago National Referral Hospital in Kampala, Uganda. The
baby presented with index generalised seizures with eye rolling,
fatigue upon breastfeeding and apnoea. The baby was weak and
had delayed milestones compared to her siblings. She was a clin-
ically sick infant, small for age (4.8 kg), with oxygen saturation
of 99%, and no oedema. She had severe bradycardia; the pulse
rate was 39 beats per minute, with normal volume and synchro-
nous with other pulses. The baby had respiratory distress, with a
rate of 60 breaths/minute, and no basal crepitations.
Two-dimensional echocardiography revealed dilated heart
chambers, non-compaction of the left ventricle with severe
systolic dysfunction. The electrocardiogram showed severe
bradycardia with third-degree heart block. A haemogram
revealed features of iron deficiency anaemia (Hb 8.1 g/dl, MCV
59 fl), and the white blood cell count was 12.8 × 103.
Renal function and electrolytes were normal, and the mater-
nal anti-nuclear factor, (ANCA) was non-reactive. Treatment
given was intravenous dopamine 3 mg/kg renal protective dose,
captopril and furosemide while the baby awaited pacemaker
implantation. A permanent pacemaker (epicardial pacemaker
generator) was implanted in the left hypochondrium. Six
months after the pacemaker was implanted, the baby had
gained weight, heart rate was 100 bpm, blood pressure 114/60
mmHg and the ECG demonstrated good capture.
Conclusion: The ECG is significant in diagnosing children who
present with severe left ventricular systolic dysfunction. This
is the first case report on successful pacemaker implantation
among children with congenital heart block in sub Saharan
Africa.
HYPERTENSIVEHEART FAILURE INABEOKUTA, NIGE-
RIA. CLINICAL CHARACTERISTICS AND OUTCOME:
LESSONS FROM THE ABEOKUTA HEART FAILURE
REGISTRY
Ogah Okechukwu S*1 , Falase Ayodele1, Stewart Simon2,
Akinyemi Joshua O3, Sliwa Karen4
1Division of Cardiology, Department of Medicine, University
College Hospital, Ibadan, Nigeria;
2Mary MacKillop Institute for Health Research, Australian
Catholic University, Melbourne, Australia
3Department of Epidemiology and Medical Statistics, College
of Medicine, University of Ibadan, Nigeria
4Hatter Institute for Cardiovascular Research in Africa; and
Institute of Infectious Disease and Molecular Medicine, Faculty
of Health Sciences, University of Cape Town, Cape Town,
South Africa
Introduction: Hypertension is the commonest cardiovascular
disease and the major risk factor for heart disease in Nigeria.
There is paucity of information on hypertensive heart failure
from Africa’s most populous country, which necessitated this
study.
Methods: Data from the Abeokuta Heart Failure Registry were
used to determine the clinical characteristics, mode of treatment
as well as intra-hospital outcome of hypertensive heart failure
(HT-HF) patients in Abeokuta, south-west Nigeria. Eligible
subjects were hypertensive patients with new-onset HF or those
with decompensated HF. Standardised data of demographics
and clinical profile, 12-lead ECG, echocardiography, treatment
and outcome were obtained.
Results: Three hundred and twenty subjects with HT-HF (17.8%
with acute decompensated HF) were consecutively studied
comprising 184 (57.5%) men and 136 (42.5%) women aged 58.4
± 12.4 and 60.6 ± 14.5 years, respectively. The majority (n = 290,
90.6%) of subjects were known hypertensives and presented
with a BP of 144 ± 32/91 ± 21 mmHg and heart rate of 96 ±
19 beats/min. Most (80%) presented in NYHA class III or IV
and around one-third (35%) had preserved systolic function.
Overall, the women had a higher body mass index than the men.
Alternatively, cigarette smoking and alcohol consumption were
significantly higher in men. A similar proportion had co-morbid
type 2 diabetes (12.2%) and/or atrial fibrillation (12.8%). The
majority were prescribed ACEI/ARB therapy (319, 99.1%) and/
or spironolactone (81.3%).
Median hospital stay was nine days (IQR 5–21) while
intra-hospital mortality was 3.4%, with minimal gender-based
differences. The 30-, 90- and 180-day mortality rates were 0.9%
(95% CI: 0.2–3.5), 3.5% (95% CI: 1.7–7.3) and 11.7% (95% CI:
7.8–17.5), respectively. In a multiple logistic regression analysis,
only serum creatinine was the independent predictor of mortal-
ity at 180 days (adjusted OR = 1.76, 95% CI: 1.17-2.64)
Conclusion: Hypertension, as a highly preventable condition,
is the commonest aetiological risk factor for heart failure in
Nigeria. Most subjects present in their prime of life with severe
heart failure and secondary valvular dysfunction and significant
in-hospital mortality.
ECONOMIC COST OF HEART FAILURE IN NIGERIA:
DATA FROM THE ABEOKUTA HEART FAILURE REGISTRY
Ogah Okechukwu S1, Stewart Simon 2, Onwujekwe Obinna E3,
Falase Ayodele 1, Adebayo Saheed4, Olunuga Taiwo O4, Sliwa
Karen5
1Division of Cardiology, Department of Medicine, University
College Hospital, Ibadan, Nigeria;
1Mary MacKillop Institute for Health Research, NHMRC CRE
to Reduce Inequality in Heart Disease, Australian Catholic
University
2 Department of Health Administration and Management,