Cardiovascular Journal of Africa: Vol 26 No 2 (March/April 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015 AFRICA 91
Sudden cardiac death in low-resource settings:
lessons from a resuscitated cardiac arrest
Aimé Bonny, Sylvie Ndongo Amougou, Dominique Noah Noah, Marthe-Liliane Mbenoun, Kamilu Karaye
Abstract
We report on the case of an adult black African who was
resuscitated from several cardiac arrests but suffered behav-
ioural impairment, and discuss diagnostic pitfalls. The aeti-
ology of coronary free lesion myocardial infarction with
depressed left ventricular function was diagnosed when the
patient travelled abroad. The low prevalence of recognised
sudden cardiac arrest (SCA), as well as the lack of diagnostic
and appropriate resuscitation facilities in parts of sub-Saha-
ran Africa lead to the mismanagement of victims. Increased
awareness of SCA and its causes is urgently needed.
Keywords: sudden cardiac arrest, resuscitation, sub-Saharan
Africa
Submitted 8/2/14, accepted 3/2/15
Cardiovasc J Afr 2015; 26: 91–95
DOI: 10.5830/CVJA-2015-020
Several cases of sudden cardiac arrest (SCA) in sub-Saharan
Africa have been reported.1-5 However the real burden of sudden
cardiac death (SCD) in this part of the world is unknown.
Reports of cardiopulmonary resuscitation (CPR) scenarios in
these developing countries are also a matter of curiosity.
SCA management needs specific diagnostic work-up, which
is not widely available in sub-Saharan Africa (SSA). Poor
management of such resuscitated victims could also impact
negatively on the patients’ quality of life (QoL). The following
case report is on an aborted SCA with unusual clinical features,
management and outcomes.
Case report
A 57-year-old black African male living in Cameroon had
experienced several cardiac arrests. He was rescued from his
first attack by bystanders who provided basic life support (BLS)
cardiopulmonary resuscitation (CPR) manoeuvres in the aircraft
during a flight. The patient was on his way from Cameroon to
Morocco to undergo an extensive cardiac work-up for chest pain
from suspected myocardial infarction (MI).
Blood tests and coronary angiography were normal. The
electrophysiological study was normal.
A few months later, he experienced another witnessed cardiac
arrest and was successfully rescuscitated by bystanders. His
blood pressure then was 139/84 mmHg, heart rate was 89 beats/
minute (bpm) and he had no signs of heart failure.
Fasting blood tests showed a glycaemic status of 1.06 g/l (0.59
mmol/l), potassium level of 3.5 mmol/l, creatinaemia of 11.5
mg/l (101.66 mmol/l) and C-reactive protein (CRP) of 12 mg/l.
The electrocardiogram (ECG) displayed a sinus rhythm with a
heart rate of 58 bpm, narrow QRS and negative T wave in the
lateral leads (Fig. 1). A two-dimensional echocardiogram (2D
echo) showed moderate left ventricle dilatation (LV end-diastolic
diameter of 60 mm) with a left ventricular ejection fraction
(LVEF) of 50% and normal wall motion. ECG monitoring
revealed repetitive non-sustained ventricular tachycardia
(NSVT) (Fig. 2, top). Two days later, sustained VT (Fig. 2,
bottom) was aborted by electrical cardioversion. Amiodarone,
loading dose of 200 mg/day, in addition to bisoprolol 5 mg daily
were administered. The patient’s discharge was decided on seven
days later, with the recommendation of further investigations.
Although no event was recorded during four weeks of in-patient
monitoring, the patient refused to be discharged as he was afraid
of dying suddenly at home.
Finally, after an event-free period of eight weeks, the patient
was referred to France for a more detailed work-up. The ECG
there displayed sinus rhythm and negative T waves in the lateral
leads. Blood tests were within normal limits. Two-dimensional
echo showed normal LV diameter, antero-basal hypokinesia and
postero-basal dyskinesia. LVEF was 50% and LV filling pressure
was normal. Right ventricular and pulmonary pressures were
normal.
Cardiac magnetic resonance imaging (MRI) showed normal
cardiac output index (2.53 l/min/m2), antero-lateral, infero-
latero-basal and mild LV akinesia, LVEF of 35%, transmural
late enhancement in the akinetic segments with a thickness of
< 5mm, and sub-endocardial mild anteroseptal late enhancement,
compatible with small sequelae of acute MI. Subsequently, MRI
revealed two MI sizes in the territories of the circumflex and
anterior interventricular arteries (Fig. 3). A coronary computed
tomography angiogram (CTA) showed normal coronary arteries.
The final diagnosis was ischaemic cardiomyopathy with
lesion-free coronary arteries, LV dysfunction and ventricular
tachyarrhythmia-related cardiac arrest. An implantable
District Hospital Bonassama, Douala, Cameroon
Aimé Bonny, MD,
Centre Hospitalier Universitaire de Yaoundé, services de
réanimation, Yaoundé, Cameroun
Sylvie Ndongo Amougou, MD
Service de Gastroentérologie, Hospital Central de
Yaoundé, Cameroun
Dominique Noah Noah, MD
Centre des maladies respiratoires de Douala, Cameroun
Marthe-Liliane Mbenoun, MD
Department of Medicine, Bayero University/Aminu Kano
Teaching Hospital, Kano, Nigeria
Kamilu Karaye, MD