CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 23 AFRICA survival and reduce hospitalization rates in patients with ATTR CA [5, 12, 15]. Importantly, the definitive confirmation of the amyloid subtype (AL or ATTR) typically requires histopathological examination of affected tissues [3, 6, 9, 11]. The amyloid deposits are usually confirmed by their apple-green birefringence when stained by the Congo red stain and then viewed under polarized light [4, 9]. Nonetheless, in some cases, the clinical presentation, noninvasive imaging findings, and supportive laboratory results can strongly suggest a specific subtype. Timely recognition allows for appropriate management without the need for invasive procedures that may have fatal complications [9]. Conclusion With probable previous underdiagnosis, physicians should be increasingly aware and have a high index of suspicion about the presence of the disease. Furthermore, with the advancement in non-invasive diagnostic measures, the previous underdiagnosis and delayed diagnosis may be averted. With the approval of a few pharmacological agents like Tafamidis, early diagnosis and management would alter disease progression and even mortality from heart failure. Hopefully, ongoing research and advancements in medical therapies hold promise for further improving the management of this complex condition. Abbreviations LVH- Left ventricular hypertrophy RVH- Right ventricular hypertrophy CA- Cardiac amyloidosis LVEF- Left ventricular ejection fraction, CMR- Cardiac magnetic resonance imaging, sFLC- serum free light chains LGE - Late gadolinium enhancement References 1. Bejar, D., Colombo, P., Latif, F., & Melana, Y. (2015). Infiltrative Cardiomyopathies. Infiltrative Cardiomyopathies, 9(Suppl 2), 29-38. doi:10.4137/CMC.S19706 2. Cao, Z., Jia, Y., & Zhu, B. (2019). BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine. Int J Mol Sci, 20(8), 1820. doi:10.3390/ijms20081820 3. Donnelly, J. P., & Hanna, M. (2017). Cardiac amyloidosis: An update on diagnosis and treatment. Cleveland Clinical Journal of Medicine, 84(3), 12-26. 4. Edwards, A., Paulsen, M., Lasky, B., & Ramanathan, V. (2021). Cardiac amyloidosis: A Case review series. Open Access Text. doi:10.15761/JIC.1000114 5. Elliot, P., Drachman, B., Gottlieb, S., Hoffman, J., Hummel, S., Lenihan, D., . . . Shah, S. (2022). Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy. Circ Heart Fail., 15(1), e008193. doi:10.1161/ CIRCHEARTFAILURE.120.008193 6. Falk, R., Alexander, K., Liao, R., & Dorbala, S. (2016). AL (Light-Chain) Cardiac Amyloidosis: A Review of Diagnosis and Therapy. Journal of the American College of Cardiology, 68(12), 1323-1341. doi:10.1016/j.jacc.2016.06.053 7. Karam, C., Dimitrova, D., Christ, M., & Heitner, S. (2019). Carpal tunnel syndrome and associated symptoms as first manifestation of hATTR amyloidosis. Neurol Clin Pract., 9(4), 309-313. doi:10.1212/CPJ.0000000000000640 8. Mahalingam, H., Chacko, B., Irodi, A., Joseph, E., Vimala, L., & Thomson, V. (2018). Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability. Indian J Radiol Imaging., 28(4), 427-432. doi:10.4103/ijri.IJRI_84_18 9. Merlini, G. (2017). AL amyloidosis: from molecular mechanisms to targeted therapies. Hematology Am Soc Hematol Educ Program., 1, 1-12. doi:10.1182/ asheducation-2017.1.1 10. Miao, H., Zou, C., Yang, S., Chia, Y., Tay, J., Wang, T., . . . Zhang, Y. (2022). Targets and management of hypertension in heart failure: focusing on the stages of heart failure. J Clin Hypertens (Greenwich)., 24(9), 1218-1225. doi:10.1111/jch.14553 11. Oerlemans, M., Rutten, K., Minnema, M., Raymakers, R., Asselbergs, F., & de Jonge, N. (2019). Cardiac amyloidosis: the need for early diagnosis. Netherlands Heart Journal, 27, 525-536. 12. Paeng, J., & Choi, J. (2021). Nuclear Imaging for Cardiac Amyloidosis: Bone Scan, SPECT/CT, and Amyloid-Targeting PET. Nucl Med Mol Imaging., 55(2), 61-70. doi:10.1007/s13139-020-00681-4 13. Pantazis, A., Vischer, A., Perez-Tome, M., & Castelleti, S. (2015). Diagnosis and management of hypertrophic cardiomyopathy. Echo Res Pract., 2(1), R45-R53. doi:10.1530/ERP-15-0007 14. Penugonda, N. (2010). Cardiac MRI in Infiltrative Disorders: A Concise Review. Curr Cardiol Rev., 6(2), 134-136. doi:10.2174/157340310791162668 15. Stern, L., & Patel, J. (2022). Cardiac Amyloidosis Treatment. Methodist Debakey Cardiovasc J, 18(2), 59-72. doi:10.14797/mdcvj.1050 16. Tosi, P., Tomassetti, S., Merli, A., & Polli, V. (2013). Serum free light-chain assay for the detection and monitoring of multiple myeloma and related conditions. Ther Adv Hematol., 4(1), 37-41. doi:10.1177/2040620712466863 17. Xu, B., Zhou, J., Zhang, P., & Li, H. (2017). Disease spectrum of abnormal serum free light chain ratio and its diagnostic significance. Oncotarget, 8(47), 82268–82279. doi:10.18632/oncotarget.19391 Submission ID: 34 REACHING THE UNREACHED: HOW THE MATER HOSPITAL IN KENYA IS BRIDGING A HUGE GAP IN RHEUMATIC FEVER (RF) AND RHEUMATIC HEART DISEASE (RHD) PREVENTION, DIAGNOSIS AND TREATMENT CHITIRA AGNES. MATER HOSPITAL, CATHLAB. Background The Global burden of rheumatic heart disease in poor and marginalized population continues to be high with lack of basic primary prevention resources and modalities leading to late presentation including heart failure and high-risk surgical candidates. In Kenya diagnostic and curative services for established RHD is only available in a few counties. To address this disparity outreach programs aimed at community education and participation of preventive RF/RHD was emphasized and education pamphlets left with local administrative authorities for continuity. Method A school based rheumatic fever and rheumatic heart disease prevention outreach program which offers educational, preventive, diagnostic and curative services to school children in RF/RHD endemic parts of Kenya. Results The Program has been running for the last 15 years from 2008 to date. Out of 47 counties in the region 32 of them have been covered (68%). Screening was done in 84 schools and 5 regional hospitals. A total of 140141 children were screened of which 16119 (11.5%) received primary prophylaxis whereby children were examined and treated for pharyngitis and dental carries, 202 (0.14%) required secondary prophylaxis. Of the 2837(2%) who required echocardiography a total of 433(15.2%) had established rheumatic Fever / rheumatic heart disease and were referred for close follow up and surgical intervention. Conclusion Analysis from the outreach program showed a high prevalence of RHD /RF of 15.2%. Certain localities have been identified as “hot spots” subsequently informing local government budget prioritization. Recognition and targeting of rheumatic fever hot spots for escalation of rheumatic fever prevention. Education involved recognition and treatment of sore throat, attitude change to recognize sore throat as something potential and not to ignore pharyngitis. Prompt treatment was given to the affected. Follow up camps and contact follow ups of the affected patients. Pamphlets and posters were issued to hot spot areas for continued education. Submission ID: 35 TAKAYASU ARTERITIS PRESENTING AS ACUTE ISCHEMIC STROKE AND CORONARY ARTERY DISEASE ALBERT NYANGA AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Background Takayasu arteritis is a chronic granulomatous large vessel vasculitis, that particularly the aorta and its proximal branches. It is a rare disease, most prevalent among females between the ages of 10 – 40 years. Case description 36-year-old male presented to the ER, with a 3-day history of chest pain and a 2-hour history of sudden onset left sided body weakness. His past medical history included Takayasu arteritis diagnosed in 2012.
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