CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 13 AFRICA Results We enrolled 729 records with 77.8% (n = 562) being female and 25.6%60-69 years. Makueni mean systolic / diastolic blood pressure was 143/82mmHg (SD 13/8) while Nyeri was 139/84 mmHg (SD 17/7). Makueni performed better in tracking comorbidity screening (p=<0.0001) with regression modelling showing relevance of this in control. Data completeness in Makueni was higher for investigations, body mass index (BMI) and counselling on complications, as well as higher consistency to the Kenya Health Information System reports. Discussion There were improved outcomes and surveillance particularly with comorbidity screening and counselling where the EMR was deployed. Scale-up of EMR systems was recommended. Key Words Hypertension, Electronic Medical Records Systems, Non – Communicable Disease Surveillance, Kenya Submission ID: 14 CASE SERIES ON PROSTHETIC VALVE THROMBOSES TREATED WITH INTRAVENOUS THROMBOLYSIS AT A TERTIARY TEACHING HOSPITAL IN NAIROBI – KENYA JOHN OTIENO ODHIAMBO, SALIM SALIM ABDALLAH, LEONARD MZEE NGUNGA THE AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Introduction Valvular heart disease is a prevalent condition that significantly contributes to the cardiovascular disease burden worldwide, especially in developing countries. Rheumatic heart disease (RHD) is the most common etiology in developing countries. RHD tends to occur among younger individuals aged 5-15. In the past several decades, many patients have undergone valve replacement, with mechanical prostheses being preferred over biological valves due to their longevity. However, complications following valve replacements can either be valve-related or nonvalve-related, with thromboembolism, bleeding, and prosthetic valve endocarditis being common. The incidence of prosthetic valve thrombosis is reported to be 0.03% in bioprosthetic valves and 0.5% to 8% in mechanical valves in the aortic and mitral positions, respectively. The clinical presentation of prosthetic valve thromboses varies among patients and can manifest as heart failure or peripheral embolism features. The commonest precipitants for prosthetic thrombosis are inadequate anticoagulation and poor patient compliance locally. This report presents two cases of patients who presented with heart failure post-valve replacement for rheumatic heart disease. The patients were managed with anticoagulation and fibrinolysis. Cases Case 1: 42 – year old female who had a mitral valve replacement for RHD in 2016 and had been on torsemide 10mg OD, bisoprolol 2.5mg OD, and warfarin 4mg BID. In December 2022, she was admitted with dyspnoea and productive cough. A few weeks earlier, she had been evaluated at a gynaecology clinic for heavy menses and her warfarin dose was reduced. On evaluation, she had features of heart failure. Her INR was 1.29. Transesophageal echo done confirmed presence of thrombus in the mitral valve. She was thrombolysed with alteplase 100mg infusion over 2 hours on day 5 admission. Thereafter, she had tremendous clinical improvement. Case 2: 37-year-old male with RHD status post Aortic valve replacement in 2004 on warfarin since then. He was admitted in March 2023 with NYHA III dyspnea associated with chest pains, fever, and chills. He had an antecedent history of diarrhoeal illness. On evaluation, he was hypotensive, mildly hypoxic requiring minimal oxygen supplementation, and had a grade IV systolic ejection murmur over the right upper sternal border with radiation to the carotids, and grade II diastolic murmur best heard at the left lower sternal border with the patient leaning forward. His INR was at 1.54. The INR was at 2.1 one month prior to the presentation. 2D Echo showed severe aortic regurgitation and high gradient across the aortic valve mechanical prosthesis. He subsequently underwent a transesophageal echocardiogram, which showed severe prosthetic valve regurgitation and an immobile prosthetic aortic valve. A mass concerning for thrombus was seen on one of the leaflets. LV systolic function was preserved with EF 55-60%. The patient was thrombolysed with alteplase 100mg infusion over 2 hours. Thereafter, his symptoms improved and his blood pressure got better. Discussion The predisposing factor in the first case was the alteration of the dose of warfarin while in the second case, there was reduced warfarin bioavailability of the warfarin in the background of an already borderline INR. Conclusion Suspected valve thrombosis requires prompt treatment with thrombolysis which be lifesaving. Alteplase was used successfully without any significant adverse events. Submission ID: 15 THE EFFECTS OF BETA VULGARIS JUICE ON THE COMMON CAROTID ARTERY OF AN ALBINO RAT (RATTUS NORVEGICUS) FOLLOWING PROLONGED ADMINISTRATION OF A HIGH SALT DIET JIMMY GAKURE NJOROGE, KHULUD NURANI, JEREMIAH MUNGUTI Background High salt diets have been linked to an increase in the incidence of hypertension in Africa. African societies have reported inadequate access to conventional antihypertensive care, raising the need for a cheaper mode of control. The red beetroot (Beta vulgaris) has been shown to have beneficial effects in cardiovascular disease. However, changes in vascular composition associated with Beta vulgaris use remain unexplored. Materials and methods Thirty-eight (38) male rats aged two months were used for this study. Two (2) rats were used to demonstrate baseline anatomy of the common carotid artery. Fifteen (15) rats were used in each of the experimental groups (High salt and high salt + beetroot) while six (6) rats were used in the control (Standard rat chow and water) group. Beta vulgaris juice was administered by oral gavage at a dosage of 10 ml/kg. Thereafter, at week 2, 5 and 8, 5 rats from each of the experimental groups and 2 rats from the control group were euthanized, perfused with formal saline and their common carotid arteries (CCAs) harvested and processed. The variables measured were carotid intima- media thickness, elastic fiber density and vascular smooth muscle cell density. GROUP CIMT MEDIANS + IQR (µm) WEEK 0 WEEK 2 WEEK 5 WEEK 8 P Value (BASELINE) Control 26.44 27.88 32.96 37.15 p=0.083 (25.98-26.89) (27.41-28.34) (32.12-33.80) (36.81-37.45) HS - 33.80 43.37 53.09 p=0.002* (32.16-34.25) (36.50-44.53) (51.23-54.66) HS+B - 32.17 35.96 43.85 p=0.006* (32.05-33.22) (31.75-33.66) (42.68-44.96) P value - p=0.90 p=0.018* p=0.009* TABLE: CAROTID INTIMA-MEDIA THICKNESS RESULTS
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