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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S13
AFRICA
Emergency-NGO Salam Centre for Cardiac Surgery (SCCS), Sudan: Role of remoteness in adherence to Vitamin K Antagonists
(VKA) treatment after heart valve replacement
Nicoletta Erba*, Giulia Pedroni
#
, Lina Mohamed Osman
#
, Lorenzo Valgoi
#
, Alessandro Mocini
#
, Franco Masini#, Martin Langer
#
*Salam Centre for Cardiac Surgery, Emergency-NGO, Khartoum, Sudan. Italian Federation of Anticoagulation Clinics (FCSA).
#
Salam Centre for Cardiac Surgery,
Emergency-NGO, Khartoum Sudan.
Introduction:
The SCCS has been active in Khartoum since 2007 and, up to 31 January 2019, 5 184 patients had received mechanical valve implants
and were started on VKA therapy. VKA treatment is periodically monitored by Prothrombin Time-International Normalised Ratio (INR) in the SCCS-Oral
Anticoagulant Clinic (OAC) or, where necessary, in external laboratories. In this case INR data are sent to the OAC and the VKA prescription is returned to the
patient via phone call, WhatsApp or email. Quality is checked by Time in Therapeutic Range (TTR).(1) Our aim is to compare the TTR of patients living around
Khartoum with those living in Darfur, a region of Sudan far from the SCCS.
Methods:
In this prospective observational cohort study of 6 months (1 August 2018 - 31 January 2019) we analysed and compared data from patients with
different access points to care. Global and individual TTR are extracted from PARMA GTS® (WERFEN), a software dedicated to VKA management. Data are
reported as median and accordingly rated as GOOD (>70% in range), INTERMEDIATE (50% - 70%) and POOR (<50% in range).
Results:
TTR was available for 873 patients living in the Khartoum State (K) and for 519 in Darfour (D).The median TTR was 56 (IQR: 38 - 72) (K) and 47 (IQR: 31
- 65.5)(D) (NS). The quality of treatment was rated as GOOD in 28.3% (K) vs. 21.2% (D), as INTERMEDIATE in 33.6% (K) vs. 24.8% (D) and as POOR in 38.1% (K) vs.
54% (D). Results were significantly worse in Darfur (p<0.001).
Conclusion:
Many factors, including: distance, transport, laboratory availability, phone and internet connections, and drug availability, can interfere with VKA
treatment. The Darfour area is poor and situated far from Salam OAC where patients receive complete monitoring free of charge, counselling and drug supply.
Improvement of VKA treatment in remote and rural regions is a priority for EMERGENCY-NGO.
(1) Rosendaal Thromb Haemost 1993;69:236
A rare case of bilateral pheochromocytoma, paragangliomas and hypertrophic cardiomyopathy
Ellise Gambahaya and Ruchika Meel
Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Introduction:
Pheochromocytoma/paragangliomas are relatively rare catecholamine secreting tumours which are associated with a range of cardiovascular
effects. Notably, pheochromocytoma has been reported to cause cardiomyopathies which include tachycardia induced cardiomyopathy, stress
cardiomyopathy and hypertrophic cardiomyopathy.
Methods:
We report the case of a 20-year-old male patient who presented with bilateral pheochromocytoma, paragangliomas and hypertrophic
cardiomyopathy.
Results:
A 20-year-old man presented with a 3-day history of abdominal pain and vomiting following a forceful blow to the abdomen. On examination his
blood pressure was 145/80mmHg with a tachycardia of 110bpm. Abdominal examination was significant for a tender left upper quadrant mass. Examination
of the cardiovascular system revealed a laterally displaced forceful apical impulse with an ejection systolic murmur heard loudest at the left sternal edge. He
admitted to episodes of palpitations and sweating, however, he denied suffering from headaches or tremors. He also denied any episodes of elevated blood
pressure. Electrocardiogram showed left ventricular hypertrophy with a strain pattern. An echocardiogram was significant for severe concentric left ventricular
hypertrophy (interventricular septal thickness of 20mm and posterior wall thickness of 18mm) with preserved systolic and diastolic function. However,
myocardial global longitudinal strain was reduced at -12%. Systolic anterior motion of the anterior mitral valve leaflet was not demonstrated. Left ventricular
outflow tract peak pressure gradient was 17mmHg at rest. A computed tomography scan of the abdomen revealed bilateral adrenal and para-aortic masses
and computed tomography of the chest showed multiple lung nodules. Urine normetanephrines were elevated (39 251nmol/24hours) as well as urine
vanillymandelic acid (79.6umol/24hours). The patient was commenced on atenolol and doxazosin in preparation for surgical excision.
Conclusion:
We have reported a case of hypertrophic cardiomyopathy with radiological and biochemical evidence of pheochromocytoma and
parangagliomas.
Evaluation of myocardial reperfusion by intravenous thrombolysis in acute coronary syndromes with persistent ST-elevation
Ngoné Diaba Gaye
†
, Aliou Alassane Ngaide*, Malikit Abdoulaye Moctar
#
, Ngoné Diaba Gaye
†
, Maimouna Sow
‡
, Momar Dioum
◊
, Fatou Aw
‡
,
Sérigne Mor Beye
§
, Salimatou Dela Diallo
#
, Simon Antoine Sarr
‡
, Mouhamed Haris
#
and Alassane Mbaye
#
*University Cheikh Anta DIOP of Dakar/General Hospital of Grand Yoff, Dakar, Senegal.
#
General Hospital of Grand Yoff, Dakar, Senegal.
†
Institute of Medico-Social Foresight Hospital, Dakar, Senegal.
‡
Hospital Aristide Le Dantec, Dakar, Senegal.
◊
FANN National Hospital, Dakar, Senegal.
§
Saint Louis General Hospital, Dakar, Senegal
Introduction:
The rapid and effective management of acute coronary syndrome with the ST segment has become a subject of constant challenge with the
importance of speedy management being stressed. The objective of this work was to evaluate myocardial reperfusion by thrombolysis in a cardiology service
in Dakar, Senegal.
Method:
This prospective study was conducted from January - December 2016 in the cardiology department of Grand Yoff General Hospital. We
have included thrombolysed STM + IDMs. The success of fibrinolysis was defined according to clinical criteria (disappearance of chest pain) and
electrocardiography (decrease of AST at least 50%). Data analysis was done using SPSS software version 17.0. A value of p<0.05 was considered significant.
Results:
Of the 145 IDMs seen during the study period, 61 (8.13%) were thrombolysed. Mean age was 59 years and the sex ratio was 2.21. The average
chest pain – thrombolysis time was 5.74 hours. The success rate of fibrinolysis was 59.02%. In multivariate analysis, the independent predictor of successful
fibrinolysis was delayed thoracic pain - emergency arrival less than or equal to 180 minutes. In contrast, diabetes (p=0.05), hypertension (p=0.025) and female
sex (p=0.035) were factors associated with increased time to fibrinolysis. The most common complication was intracerebral haemorrhage (3.30%). Hospital
mortality was 6.6% in relation to cardiovascular collapse and ventricular fibrillation.
Conclusion:
Our study shows that reperfusion delays were long. Fibrinolysis was successful given the short time period.