Acute Coronary Syndromes in Semi-Urban African Areas: Clinical Aspects and Management in Ziguinchor (Senegal)

Context and Objectives: Acute coronary syndromes (ACS) constitute a major medical emergency. In Senegal, outside the capital Dakar, there is a lack of appropriate care structures. The objective of this work was to study the ACS treatment in the city of Ziguinchor. Methodology: This was a retrospective study of acute coronary syndromes’ cases admitted to the two-level two hospitals in the city of Ziguinchor from January 1, 2016 to December 31, 2019. We included all patients with acute angina pain at rest and/or electrocardiographic changes in at least two contiguous leads. The data were analysed using sphinx V5 software. Results: 57 cases were collected. The average age was 60.1 ± 14.1 years. There was a male predominance with a sex ratio of 3.7. The majority of patients arrived at the hospital by unsafe delivery (70.5%). Symptomatology was dominated by typical angina pain (50.8%). On the electrocardiogram, a majority of acute coronary syndromes with ST segment shift were observed (70.2%). Doppler echocardiography found abnormalities in segmental kinetics in 69.8% of cases. The troponin dosage was performed in 7 patients, i.e. 12.3%. The average time of treatment was 3.4 ± 4.5 days. Medical treatment remained standard and no patient was thrombosed. The average hospitalization period was 5 ± 3.2 days. The hospital lethality was 7.2%. Conclusion: Acute coronary syndromes constitute a medical emergency. Diagnostic and therapeutic means are lacking in a city like Ziguinchor, hence the importance of good prevention.

Cardio-Renal Syndrome at the Cardiology Department of the Hopital De La Paix of Ziguinchor (Senegal)

Context and Objectives: Cardio-renal syndrome is a pathophysiological disorder of the heart and kidneys frequent in hospitalization for cardiology. The objective of this work is to study the frequency, clinical characteristics and treatment of cardio-renal syndrome (CRS) at the Hôpital de la Paix in Ziguinchor. Methodology: This is a retrospective study, from January 16, 2017 to September 16, 2020, including patients hospitalized in the cardiology department for heart failure associated with impaired renal function. Results: 92 patients were included, i.e. a hospital frequency of 9.15% with a predominance of men (sex ratio of 1.19). The average age was 60.05 years. High blood pressure (75%) was the main risk factor. The clinical symptomatology was dominated by dyspnea (69.6%). The average creatinine clearance was 24.40 ml/minute/1.73 m2 and stage 5 renal failure was noted in 39 patients (42.4%). Echocardiography detected systolic dysfunction of the left ventricle in 53 patients (64.6%). The kidney ultrasound was normal in half of the cases. The most observed CRS in our study was type I (60.9%). Therapeutically, the most widely used drugs were diuretics (85.9%) and ACE inhibitors (71.7%). The death rate was 28.3%. The average cost of inpatient care was 149,466 CFA francs. The poor prognosis elements were stage IV dyspnea (p = 0.006), cardiomegaly (p = 0.047) and the presence of pericardial effusion (p = 0.021). Conclusion: Cardio-renal syndrome is a condition to be systematically looked for in cases of heart failure because it is associated with severe mortality.