CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 25 AFRICA significantly between physicians. At six months follow-up, 43.8% of patients had been readmitted at least once and 8.8% had died. Conclusion There is need to design interventions to increase adherence to GMDT guidelines, with special attention to MRA and SGLT2i drug classes. The variations in adherence rates between physicians requires follow-up studies on individual practices regarding GDMT prescription and uptitration. Keywords (MeSH): Heart failure with reduced ejection fraction, guideline-directed medical therapy, guideline adherence Submission ID: 37 A NORMAL CORONARY INTERVENTION TURNED IN TO A NIGHTMARE & HOW WE CAME OUT WILLY MUCYO Background 50 years male presented with acute AWMI ECG-SNR, ST elevation in anterior leads with reciprocal changes. ECHO-AWMA in LAD territory, EF = 45%, normal RV function Methods CAG-CAD-Double vessel disease Primary PCI to LAD done, after stenting diagonal branch got occluded. Wired with fielder FC, at the time of Ostial diagonal ballooning the LAD vessel got occluded with thrombus that extended to left main LCX, major diagonal. Patient went in to VT reverted with cardio version followed by CPR. Intubated, started inotropes. Left main was reengaged with EBU 3.5-6F catheter and wired the vessels during CPR. Milking of Balloon was done in in LM, LAD, & LCX Results TIMI-II flow in LAD & TIMI-III flow in LCX & Diagonal Tirofiban infusion started. Patient shifted to CCU with inotropes and Mechanical Ventilator. Extubated successfully after 2 days Now am following up the patient with normal LV function. Conclusion It was a real nightmare with a simple primary PCI to LAD to unexpected propagated thrombus to left main without any surgical backup in a region. Submission ID: 38 DUCHENNE MUSCULAR DYSTROPHY K. MWAZO, AISHA A, J. MKILO, S. KIWO, B. NDUATI Background Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness due to alterations of a muscle protein called dystrophin, it occurs primarily in males, though in rare cases may affect females. Clinical presentation is associated with dilated cardiomyopathy (heartdisease) with little or no clinical skeletal, or voluntary, muscle disease. Early signs may include delayed motor milestones. Diagnosis of DMD is based on the symptoms, clinical exam, Muscle biopsy under a microscope. The genetic testing may also help differentiate from other muscular dystrophies. Methods We present a 16-year-old male patient diagnosed with a muscular dystrophy and dilated cardiomyopathy. He had a normal milestone up to the age of 4 then developed muscle weakness finally becoming wheelchair bound by the age of 11. He is the last born of 4 siblings DMD pedigree Patients Pedigree with the second born boy dying at the age of 15years from a similar illness, two other siblings a boy and a girl are clinically normal with a normal screening echocardiograms. On enquiry there is a maternal male cousin with muscular dystrophy. Blood tests done revealed a normal blood count, thyroid profile and antinuclear antibody test. Iron levels were low with an elevated CRP, PRO-BNP, and creatinine kinase. The Electrocardiogram revealed sinus mechanism with a narrow QRS complex,2D Echocardiogram revealed dilated cardiomyopathy with severe reduced systolic function LVEF 15-20%. Conclusion The commonest cause of cardiomyopathies causes in Africa are hypertension, diabetes, Alcohol, Ischaemic heart disease and Etc. Other genetic causes are hypertrophic cardiomyopathy and muscular dystrophies. Therefore, a Cascade screening for affected family members. Submission ID: 39 A CASE REPORT ON THE MANAGEMENT OF CARDIAC DISEASE IN PREGNANCY IN A PUBLIC HOSPITAL IN KENYA. SHEILA MUKARYE, KIERAN MWAZO Background Cardiac disease in pregnancy is common in Kenya with almost a ten-fold increase in mortality. Rheumatic Heart Disease is the commonest etiology affecting women in the reproductive age almost precluding pregnancy. There is relative increase in access to cardiac care, with more open heart surgery and mechanical prosthetic valves being implanted, necessitating use of warfarin which is the better anticoagulant although with risk of fetal embryopathy in a dose dependent manner. Pre-pregnancy planning is a rarity, with most women presenting unbooked. Structured evaluation and monitoring by a multidisciplinary team can guarantee good outcomes.
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