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.

Therapeutic Education of Heart Failure: Prospective Study in the Cardiology Department of the Dalal Jamm National Hospital Center in Dakar

Context: Heart failure (HF) is a common pathology requiring many types of treatments, including therapeutic education, which has demonstrated a major benefit in terms of reducing re-hospitalization and mortality from HF or all other causes. Objective: The aim of this study was to evaluate the contribution of therapeutic education (TPE) in patients with heart failure. Methodology: This was a single-centre, interventional, non-randomized, before-and-after type study. It focused on hospitalized heart failure patients aged 18 and over. We evaluated the effect of TPE on therapeutic compliance, knowledge, practical attitudes, patient perceptions and quality of life. Results: Our study included 41 patients prior to therapeutic education: 17 men (41%) and 24 women (59%). The mean age was 54.7 ± 16.2 years. After the TPE sessions we evaluated 32 patients: The patients with good compliance increased from 75% to 90.63%, and patients with a low level of compliance (90.6%) decreased to 34.4%. An increase in the number of patients who had an attitude adapted to not exceeding the recommended amount of salt (6 before TPE and 22 after TPE), as well as in the number of patients who had an attitude adapted to physical activity (12 before TPE and 16 after TPE). There was also an increase in the number of patients who were confident about the outcome of their disease (12 before TPE and 16 after TPE), and a decrease in those who were hopeless (8 before TPE and 5 after TPE), an improvement in the quality of life score (45.03 before TPE and 15.78 after TPE). Conclusion: This study shows the beneficial effect of therapeutic education in patients hospitalized for heart failure in improving their level of knowledge, compliance with treatment, lifestyle habits and quality of life.

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.