Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018

AFRICA

keeping with anaemia of chronic diseases. The prostate-specific

antigen level was mildly elevated. Chest radiography revealed a

mildly increased cardiothoracic ratio and hyperinflated lungs.

Unfortunately, the patient refused further hospital management,

including surgery, and died a year later.

Patient 2: The second patient was a 32-year-old male of Indian

descent who presented with a two-month history of abdominal

pain, weight loss and diarrhoea. He had no significant past

medical, surgical, family or occupational history.

His clinical examination revealed features of right heart

failure with severe tricuspid and moderate pulmonary valve

regurgitation. The rest of his examination was unremarkable.

Chest radiography revealed a mildly increased cardiothoracic

ratio and an electrocardiogram revealed sinus rhythm. Blood

results revealed mild pre-renal dysfunction, anaemia of chronic

disease, normal liver function test and normal comprehensive

metabolic panel. Further biochemical results revealed an elevated

5-HIAA level and prior to referral, his private practitioner had

Fig. 1.

Patient 1. (A) Apical four-chamber view showing tricuspid leaflets that are thickened and retracted (arrows). The right ventricle

and atrium are dilated. (B) Colour Doppler with free flow through the tricuspid valve during systole in a parasternal short-axis

view at the level of the aortic valve (arrow).

Fig. 2.

Patient 2. (A) Apical four-chamber view: note the thickened, immobile and retracted tricuspid leaflets and minimally thickened

mitral valve leaflets (arrows), and the dilated right atrium and ventricle. (B) Torrential tricuspid regurgitation (note the arrow).