CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 9 AFRICA HHA patient pathway from January 2016 to February 2023 Submission ID: 5 CASE STUDY WITH AN UNUSUAL CAUSE FOR PAROXYSMAL AFIB MAZAHER JAFFER, P K J PATEL Introduction More than half of the life-threatening arrhythmias are labelled idiopathic without clear identifiable cause. Since 2017, there are studies confirming a large proportion of these cases have an autoimmune origin. There is an estimated global prevalence of 10% for autoimmune disease in general, with an approximate threefold increased risk in arrhythmias within patients suffering from the same. Method An 80-year-old woman who has been suffering from recurrent atopic reactions including recurrent respiratory symptoms, unusual rashes, significant orthostatic symptoms, and a long-standing incidences of recurrent paroxysmal atrial fibrillation attacks, for which she could not use most antiarrhythmic drugs due to atopic reactions and has significant muscle wasting due to prolonged beta blocker usage. She underwent thrombotic CVA and was started on aspirin. She declined use of LABA/ICS for her symptoms and had been on long term follow up with a cardiologist for her symptoms. She underwent testing for autoimmune disease and found multiple markers that led to her commencing of Baricitinib. The results of the same led to a relative resolution of her antibody levels, and most of her symptoms as well as a lack of arrhythmia incidents over a 3-month period. Results Control of the autoimmune condition was associated with control of the arrhythmic events without additional use of antiarrhythmic drugs in this case. Conclusion It is worth screening and controlling for Autoimmune disease in all patients identified with arrhythmia as part of its management of the same. Submission ID: 6 SURGICAL TREATMENT OF HOCM: A KENYAN EXPERIENCE DR. PREMANAND PONOTH THE KAREN HOSPITAL, NAIROBI Background Septal myectomy is currently considered the safest and most durable way to reduce obstruction caused by Hypertrophic Obstructive Cardiomyopathy (HOCM). HOCM is a genetic disorder of the myocardium, characterized by marked myocardial hypertrophy that may lead to the development of symptoms such as dyspnea, angina pectoris, or stress-induced syncopes, with an increased risk of sudden cardiac death, due to obstruction of the left ventricular outflow tract. Methods Between 2020 to 2023 we had 2 cases with hypertrophic obstructive cardiomyopathy which was subjected for septal myomectomy. Age varied between 40 -60.M:F ratio 1:1. Both had significant LVOT mean gradient of more than 60mmof Hg with associated LVH. Septal thickness was more than 25 mm. One patient has mild Systolic Anterior Motion of the Mitral Valve (SAM). Results Both the patient underwent septal myomectomy through aortic approach on Cardio Pulmonary bypass. Procedure was uneventful. Post OP gradient across aortic valve was less than 25mm of Hg at the time of discharge. One patients came back after 2 weeks with fever associated with cough and dyspnoea. On investigation he had massive left pleural effusion, which on ICD drainage, found to be haemorragic. This patient has covid pneumonia few months before the surgery, and a provisional working diagnosis of covid reinfection was made as HRCT showed infiltrative lesion. He died on the 2nd day after readmission. The other patient is doing well and is on regular follow up. Conclusion HOCM can cause the leaflets of the mitral valve elongated.
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