Heart Disease Scleroderma Revelators: About a Clinical Case

Scleroderma (or systemic sclerosis) is a disease characterized by abnormalities in the functioning of small blood vessels and the immune system, ultimately leading to inflammation and excessive fibrosis of the skin and various organs, including the heart. Management must be multidisciplinary, to avoid complications that are often serious. We report the case of a 20-year-old patient with no known cardiovascular history who consults for dyspnea, and retrosternal pain associated with a dry cough. On physical examination, she had tachycardia, swelling of the lower limbs, jugular turgidity, and deafening heart sounds. Cardiac Doppler ultrasound shows dilation of the right cavities, paradoxical septum and significant pulmonary arterial hypertension, pericardial effusion of medium abundance. On oral examination, it presents an ulceration of the lips, dermatological examination finds scattered hypo chromic spots in the body, more accentuated in the face. Before the hypo chromic dermatosis, a dermatological consultation was carried out with an autoimmune assessment that came back positive for systemic scleroderma.

Peripartum Cardiomyopathy in the Cardiology Department of the Chu Point G

Objective: This work aimed to evaluate the epidemiological clinical aspects and evolutionary aspects of peri partum cardiomyopathy (PPCM) in the cardiology department of the CHU Point G. Materials and Methods: This was a descriptive cross-sectional study from 01 January 2019 to 31 December 2019, including all patients admitted for heart failure during this period. Results: The study involved 40 patients out of 1187 admissions, a hospital prevalence of PPCM was 3.36%. The average age was 26 years plus or minus 7 years with extremes of 16 years and 38 years. The age group between 16 and 20 years was the most represented with 32.5% of cases. Housewives were in the majority with 87.6%;residing in rural areas 62.5%, with a low socio-economic standard of living 32.5% of cases. Multiparous in our context were dominant 42.5%, followed by pauci pares and primiparous with 32.5% and 25% frequency respectively. All our patients, 100% had their first symptom after childbirth, functional signs were dominated by dyspnea of effort present in 100% of patients, followed cough (40%) and chest pain (27.5%). On physical examination there was Tachycardia in 82.5%, Galop B3 (45%) and auscultatory arrhythmia in 5%. Signs of pulmonary condensation (82.5%) and pleural fluid effusion (25%). Hepatomegaly was present in 72.5% of patients. It was overall heart failure in 72.5% of cases. On the electrocardiogram there was sinus tachycardia (75%) and atrial fibrillation arrhythmia (5%). On cardiac Doppler ultrasound the left ventricle was dilated with a low systolic ejection fraction in 100% of patients, the four cavities were dilated in 32.5%, a left intraventricular thrombus in 7.5% of cases and a pericardial fluid effusion in 5% of cases. Biology noted anemia in 22.5% of patients. Treatment was classic for heart failure. The course was punctuated by complications in 42.5% of cases, such as thromboembolic disease (22.5%), ischemic stroke (12.5%), complete arrhythmia by atrial fibrillation (ACFA 5%) and cardiogenic shock (2.5%). Hospital mortality was 7.5% with 67% of deaths observed in the 16 - 22 age group. Conclusion: PPCM is a common sub-Saharan pathology, low socioeconomic status, young age and multiparity were factors dominant in our context.

Venous Thromboembolic Disease in the Cardiology Department of the Nianakoro Fomba Hospital in Segou (HNF)

Venous thromboembolic disease (VTE) is a nosological group that consists mainly of deep vein thrombosis (DVT) and pulmonary embolism (PE). The objective of our study was to determine the hospital prevalence of VTE in this Nianakoro Fomba Regional Hospital (HNF) in Ségou, Mali, to describe the sociodemographic aspects of these patients and the therapeutic possibilities in this locality. Materials and Methods: We conducted a prospective descriptive study from June 2019 to June 2020 in the cardiology department of the HNF of Ségou. All patients of all ages and both sexes who had VTE on clinical and paraclinical criteria (pulmonary Angio scan and/or venous Doppler echo) during the study period were included. Result: 31 patients were included out of 366 hospitalized patients, with a hospital prevalence of 8.47%. The 41-60 and 61 - 80 age groups were both dominant with 35.48% of cases each. The female sex was the most represented with 58.06% of cases and a sex ratio of 0.97. High blood pressure (hypertension) was the preeminent cardiovascular risk factor in 32.2% of cases and predisposing factors for VTE were dominated by immobilization (41.94%), peripartum (16.13%) and heart failure (16.13%). Dyspnea and chest pain were the frequent reasons for consultation with 93.54% and 83.87% of cases respectively and 6 patients (19.35%) had calf pain. More than 3/4 of the patients had tachypnea or 90.32% and tachycardia in nearly 74.19%. The clinical probability of VTE was intermediate at 51.61% according to the Wells score. D-Dimers were elevated in 38.70%, or all 12 patients who performed it. The electrocardiogram (ECG) recorded a sinus rhythm in 93.54% of cases, a right branch block and atrial fibrillation (AF) in 35.48% and 6.45% of cases, respectively. Dilation of the right ventricle was present in 64.51% of cases with PAH in 61.29% on cardiac Doppler ultrasound. In the majority of cases (82.15%) it was a massive bilateral proximal and distal pulmonary embolism. Treatment was based on low molecular weight heparin (HPBM) and antivitamin K (AVK) in all patients (100%). No bleeding incidents;the average hospital stay was 10 days and an intra-hospital mortality rate of 29%.