CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
552
AFRICA
Review Articles
Cardiomyopathies and myocardial disorders in Africa:
present status and the way forward
AYODELE O FALASE, OKECHUKWU S OGAH
Abstract
A review of heart diseases in Africa shows that the cardio-
myopathies continue to be important causes of morbidity
and mortality in the population. Hypertension remains the
commonest cause of myocardial disease, followed by the
cardiomyopathies. Ischaemic heart disease continues to
be rare. Of the cardiomyopathies, dilated cardiomyopa-
thy (DCM) is still the commonest. A large proportion of
patients diagnosed with DCM in Africa have been shown to
be cases of hypertensive heart failure, with varying degrees
of myocardial dysfunction. Hypertrophic cardiomyopathy,
which in the past was thought to be rare amongAfricans, has
been shown to have the same prevalence as in other parts of
the world. Moreover it is now known to be a genetic disorder.
Endomyocardial fibrosis has become rare in communities
where it used to be common. Its aetiology continues to be
elusive. Arrhythmogenic right ventricular cardiomyopathy
has been reported amongAfricans but there are no reports of
left ventricular non-compaction or the ion channelopathies
from Africa. Lenegre disease and the long-QT syndromes
are well-known entities in clinical practice inAfrica although
long-QT in Africa is associated with potassium deficien-
cy arising from prolonged treatment with diuretics. Left
ventricular non-ischaemic aneurysms still occur but are rare.
In view of these, a new classification of myocardial disorders
was proposed for Africa.
Keywords:
cardiomyopathy, Africa, sub-Saharan Africa
Submitted 6/7/10, accepted 5/6/12
Cardiovasc J Afr
2012;
23
: 552–562
DOI: 10.5830/CVJA-2012-046
For the past 60 years, reports from all parts of Africa have shown
a remarkable unanimity in the pattern of heart diseases among
black Africans.
1,2
While ischaemic heart disease is the dominant
cardiovascular disease in the Western world, it is rare in black
Africans.
The typical pattern of heart failure in the sixties in a black
African hospital is shown inFig. 1A.
1
Fromthis figure, it is obvious
that the commonest cause of heart failure was hypertension. This
was followed by diseases that primarily affected the myocardium
(
labelled myocardial disease in the illustration), then rheumatic
heart disease, followed by endomyocardial fibrosis. Recent
data (Fig. 1B) among the same ethnic group show that the
prevalence of hypertension has doubled, there is no difference
in the prevalence of dilated cardiomyopathy, the prevalence of
Division of Cardiovascular Medicine, Department of
Medicine, University College Hospital, Ibadan, Oyo State,
Nigeria
AYODELE O FALASE, MD, FWACP, FMCP, FRCP, aofalase@gmail.
com
OKECHUKWU S OGAH, MB BS, MSC, FWACP
Fig. 1A. Causes of heart failure in Nigerians at the
University College Hospital, Ibadan between 1968 and
1969 (
Carlisle and Ogunlesi 1972). B. Causes of heart fail-
ure in the same ethnic group in the year 2010 compared
with the 1972 data.
3
HHF
=
hypertensive heart failure;
RHDX
=
rheumatic heart disease; DCM
=
dilated cardio-
myopathy; EMF
=
endomyocardial fibrosis; CP
=
cor
pulmonale; IHDX
=
ischaemic heart disease.
80
70
60
50
40
30
20
10
0
HHF DCM RHDX EMF CP IHDX Others
Carlisle 1972
Ogah 2009
66.7
27.6
14 12.7 12.6
2.2
8.5
1.3
6.6 8
1.5 0.7
8.4
21.9
A
B
Others
CP
EMF RHDX
DCM
HHF
IHDX
