Screening of Myocardial Cardiotoxicity Induced by Anticancer Chemotherapy and the Importance of Global Longitudinal Strain

Introduction: The improvement of survival in patients with cancer and the expansion of therapeutic options have led to the emergence of a new profile of cardiotoxicity, specifically associated with antimitotic agents. Our study aimed to assess the incidence of chemotherapy-induced myocardial toxicity in patients with cancer. Patients and Methods: We conducted a looking-forward longitudinal cohort study including all patients admitted to the Cardiology departments of Aristide le Dantec Hospital and Dalal Jamm National Hospital Centre for apre-chemotherapy check-up. The included patients did not undergo any pre-existing cardiopathy. Results: Over a period of two years ranging from January 2019 to December 2021, a total of 37 patients were included in the study. Notably, there was a female predominance (92%) with an average age of 49.7 years ± 13.69. Breast cancer accounted for 70% of the neoplasms. Laboratory findings revealed moderate anemia in 19 patients (51%). At inclusion, the left ventricle (LV) was of normal size (LV diastole at 44.46 ± 4.97 mm). The systolic function of the left ventricle was normal in all patients, with an average ejection fraction (EF) of 63.1% ± 5.80 and a mean global longitudinal strain (GLS) of −20.4% ± 2.58. The most commonly used agents were anthracyclines. During follow-up, 3 patients (8.1%) developed clinical symptoms of left heart failure, and LV dysfunction on echocardiography was observed in 5 (13.5%) patients, with a significant decrease in EF Conclusion: The incidence of cardiac toxicity is not negligible, hence the importance of early screening. Strain imaging is an essential tool that should be performed as part of the assessment before chemotherapy and re-evaluated during treatment.

St-Segment Elevation Myocardial Infarction with Multiple Complications: A Case Report

Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) usually involves complete thrombotic occlusion of a coronary artery and require urgent reperfusion;it is one of the leading cause of global mortality and morbidity worldwide. A variety of mechanical, rhythmic, conductive, embolic or hemodynamic complications can occur following STEMI, especially when the treatment is delayed or inadequate. Clinical presentation: A 58-year-old patient with hypertension was admitted to our department for a circumferential STEMI complicated by an ischemic stroke;received 24 hours after the onset of pain. His blood pressure was 100/60 mmHg, heart rate was 55 beats/min. The examination revealed right central facial paralysis and a slight motor deficit of the right upper limb (muscle strength 4/5). The first electrocardiogram (ECG) showed a significant circumferential ST-segment elevation with Q waves in the same territory, as well as a Luchiani Wenckebach atrio-ven- tricular block. The first echocardiography performed showed apical akinesia along with the presence of an apical thrombus. Coronarography was not performed because it was not available and the patient was given curative low molecular weight heparin combined with dual antiplatelet therapy, an angiotensin converting enzyme inhibitor and high dose statins. Seventy-two hours later, the ECG showed a complete atrioventricular block with narrow QRS and the average ventricular rate was 51 beats/min. The patient was asymptomatic. Another echocardiography was performed to assess new complications and showed a rupture of the left ventricular wall and a moderate amount of circumferential pericardial effusion, without any sign of cavity compression. No particular therapeutic attitude was adopted apart from close monitoring with daily ECG and echocardiography. Ten days later, spontaneous regression of the AV Bloc was noted. Conclusion: ST-Segment Elevation Myocardial Infarction is a major cause of morbidity and mortality worldwide. A variety of complications can occur after myocardial infarction, especially when revascularisation is delayed or inadequate.

Cardiac Rehabilitation in the Elderly

Introduction: The purpose of cardiac rehabilitation is to improve the effects of aging and maintain a good quality of life for older individuals. This study aims to assess how cardiac rehabilitation affects the autonomy and quality of life of older adults. Patients and Method: This was a longitudinal, descriptive and comparative before-and-after cardiovascular rehabilitation study conducted over a two-year period from January 2019 to December 2021. This study was conducted at four cardiac rehabilitation units in Dakar: the Aristide Le Dantec Hospital (HALD), National Dalal Jamm Hospital, and the General Idrissa Pouye Hospital (HOGIP). We compared the degree of autonomy, dependence and quality of life of subjects aged over 65 before and after the cardiac rehabilitation program using the Katz index, the Lowton index and the SF12 quality-of-life questionnaire. Results: Over a two-year period, a total of 345 patients had benefited from a complete cardiovascular rehabilitation program in the four cardiovascular rehabilitation units in Dakar, and 86 patients, or 24.92% of the population, were at least 65 years old. The patients were predominantly male (sex ratio M/F = 4.73). The mean age was 70.35 ± 4.55 years for men and 69.27 ± 4.59 years for women. The main pathology motivating cardiac rehabilitation was ischemic heart disease, which was found in 73 patients (84.88%). Initial assessment revealed exertional dyspnea in 35 patients (40.69%), followed by residual exertional angina in 21 patients (4.41%). Mean functional capacity increased from 5.81 ± 2.38 Mets in pre-cardiac rehabilitation to 8.68 ± 2.28 Mets in post-cardiac rehabilitation (p < 0.001). The mean distance covered in the 6-minute walk test increased from 330.42 ± 170.50 m in pre-cardiac rehabilitation to 524 ± 98.54 m in post-cardiac rehabilitation (p = 0.119). The Lowton dependency index in pre-cardiac rehabilitation was 44.18% versus 36.04% in post-cardiac rehabilitation (p = 0.0156). The mental quality of life score was 42.15 ± 10.27 in pre-cardiac rehabilitation versus 52.94 ± 10.86 in post-cardiac rehabilitation (p Conclusion: This study demonstrates the effectiveness of the cardiac rehabilitation program in elderly subjects. In fact, this well-managed, well-structured and well-supervised program enables this population to regain their autonomy, improve their quality of life and functional capacities, and consequently their prognosis.

Mitral Valve Abnormalities during Hypertrophic Cardiomyopathy: Study on a Cohort in Dakar

INTRODUCTION: Mitral valve abnormalities in hypertrophic cardiomyopathy (HCM) are becoming increasingly well defined, and their role in intra-ventricular obstruction is well defined. The aim of this study was to evaluate mitral valve abnormalities in patients with HCM. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from May 1 to July 1, 2022 in the Cardiology Department of Aristide Le Dantec Hospital. All patients with HCM aged at least 18 years old were included. The parameters studied concerned mainly the mitral valvular apparatus (papillary muscles abnormalities, leaflet length, mitral insufficiency). RESULTS: A total of 10 patients were included. Mean age was 58.3. On Doppler echocardiography, mean interventricular septal thickness was 20.6 mm. The mean maximum intra-ventricular gradient was 21.06 mmHg. Two patients had significant intraventricular obstruction. The mean length of the anterior mitral valve leaflet was 28.7 ± 3.55 mm, with extremes of 22 and 33 mm. The posterior mitral leaflet averaged 14.8 ± 3.16 mm. Nine (9) out of 10 patients had an elongated anterior valve leaflet. Elongation of the posterior leaflet was noted in 6 patients. With regard to papillary muscle position, 6 patients had an anterolateral ascending pillary muscle. These patients had a mean intra-ventricular gradient of 25 mmHg, compared with 16.5 mmHg in the others cases. We found no direct insertion on the mitral valve. Mitral insufficiency was noted in 9 patients, including 5 with mild insufficiency and 4 with moderate one. CONCLUSION: Mitral valve abnormalities in HCM appear to be frequent. They should be analyzed for a better diagnostic and therapeutic approach.

Epidemiological Aspect of ST-Segment Elevation Myocardial Infarction (STEMI) in Saint-Louis of Senegal

Background: Cardiovascular Disease (CVD) has become the largest and most common cause of Non-Communicable Diseases (NCD) related deaths worldwide, accounting for more than 50%. In Senegal, a few studies done on the topic showed a low prevalence of acute coronary syndrome in hospital settings. In the city of Saint-Louis in Northern Senegal, there is little epidemiological data on Acute Coronary Syndrome (ACS) and no study specifically concerned with ST-segment Elevation Myocardial Infarction (STEMI) has been carried out to date. With this in mind, we conducted a study that focused on the analysis of STEMI patients hospitalized in the Cardiology Department of the Regional Hospital of Saint-Louis. The aim of our study was to collect and analyze the epidemiological aspect of STEMI. Results: There were 39 cases of STEMI, (i.e. 82.29% of ACS), giving a hospital prevalence of 8.21%. There was a slight male predominance with a male to female ratio of 1.05. The average age of our patients was 62.93 years ranging from 38 to 90 years. The average time between the onset of pain and arrival at the hospital was 50 hours, ranging from 1 hour to 720 hours. Patients received within the first 12 hours made up 66% (n = 26) of our population, among them, 80.76% (n = 21) (i.e. 53.84% of STEMIs) were able to benefit from thrombolysis. All thrombolysis was performed with Streptokinase. The mean time to thrombolysis was 6 hours ranging from 1 hour and 45 minutes to 11 hours. Arterial hypertension was the most frequent cardiovascular risk factor in our popular with a 43.6% prevalence, followed by diabetes (33.33%), then active smoking (23%). Chest pain was the most frequent symptom, reported in 34 patients (87.17%). The lesions on the Electrocardiogram (EKG) were located in the anterior territory in 64% of the cases (n = 25), in the inferior territory in 28% of the cases (n = 11), in the circumferential territory in 5% of the cases (n = 2), and lateral territory in 5% of the cases (n = 2). Twenty-five patients had a transthoracic echocardiogram, the left ventricular ejection fraction was preserved in 36% of the patients, 40% had moderate ventricular dysfunction and 24% had severe dysfunction. Segmental kinetic disorders of the left ventricle were noted in 18 patients (72%), akinesia in 7 patients (28%) and dyskinesia in 4 patients (16%). The average length of hospitalization was 8.43 days. Seven deaths (17.9%) were recorded during the study. Coronary angiography was performed in six patients (15.38%), and was abnormal in five cases. Conclusion: ST-segment Elevation Myocardial Infarctions remain a major public health issue in Senegal due to their increasing prevalence and poor prognosis due to delayed diagnosis and management.

Compressive Pericardial Teratoma about a Case at Regional Hospital of Saint Louis/Senegal

Introduction: Cardiac tumors in children are rare. Most are discovered in children under one year of age. Echocardiography is the basic examination for the screening, it allows their detection from the fetal stage. Observation: She was a 14-year-old patient with no known history of pathology. She was admitted to our department for the exploration of dyspnea and chest pain. At her admission, she had stable hemodynamics. At cardiac auscultation, heart sounds were muffled. The EKG recorded a sinus rhythm, and negative T-waves from V1 to V4. The chest X-ray showed cardiomegaly and a dense, rounded, heterogeneous left hilar opacity, well limited. Echocardiography objected to a great intrapericardial mass in front of the left cardiac cavities compressing part of the left atrium and left ventricle associated with an important pericardial effusion. The CT scan found a heterogeneous pericardial suspected myxoma mass. The pathological examination confirmed pericardial teratoma. The patient had an excision of the pericardial mass. The evolution after surgery was favorable. Conclusion: Intra-pericardial teratomas are benign tumor. Complete removal of the tumor is curative and without recurrence.

Asymptomatic Mitral Regurgitation Caused by an Isolated Mitral Leaflet Cleft in a Young Adult: A Case Report

We report the case of an 18-year-old young man without previous medical history, who was referred for evaluation of an asymptomatic cardiac murmur. Physical examination found holosystolic 4-5/6 apical murmur with normal ECG. Bidimensionnal (2D) echocardiography revealed severe mitral regurgitation with thin mitral leaflets. Three dimensional (3D) Echocardiography done for better assessment of mitral valve regurgitation mechanism revealed an isolated mitral leaflet cleft, without signs of endocarditis or traumatic lesion. Regarding the absence of symptoms and excellent maximal exercise tolerance at stress echocardiography, a repair surgery wasn’t offered. Isolated mitral leaflet cleft is a rare congenital anomaly, in adults, the cleft may be an incidental finding that remains asymptomatic for years when the leak is well tolerated. 2D combined with 3D echocardiography is key for diagnosis and surgery guidance.