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.

Child’s Cardiopathies at the Hospital De La Paix in Ziguinchor (Senegal)

Introduction: Childhood heart disease consists of congenital and acquired heart disease. The aim of this study was to describe the epidemiological profile and the clinical and aetiological characteristics of childhood heart disease at the H?pital de la Paix in Ziguinchor. Method: This was a retrospective study from 1 January 2016 to 1 June 2020 in the cardiology and paediatrics departments of the H?pital de la Paix in Ziguinchor. We included in the study all patients aged 0 - 18 years, hospitalised with heart disease confirmed by cardiac ultrasound. Results: In total, we included 57 patients in the study. The hospital prevalence was 1.6%. The average age was 67.85 ± 65 months. The predominance was male with a sex ratio of 0.96. The majority of mothers (50%) were between 15 and 30 years old. In our study, 8.85% of patients had a history of previous angina. Trisomy 21 was present in 12.35% of our patients. Severe acute malnutrition was found in 21.05% of cases. Lower limb oedema (82.4%) and dyspnoea (59.6%) were the most frequent clinical signs. On cardiac ultrasound, 52.6% of patients had congenital heart disease and 47.4% of patients had acquired heart disease. Ventricular septal defect (33.33%) was the most common congenital heart disease. Among the acquired heart diseases, mitral insufficiency predominated with 70.8% of cases. Infective endocarditis was the main complication observed. Management was mainly drug-based with diuretics and ACE inhibitors. No patient had undergone surgery. The in-hospital evolution was favourable in 85.9% of cases and the mortality rate was 10.5%. Conclusion: Our study showed that congenital heart disease was more frequent than acquired heart disease and that management, particularly surgery, was lacking.

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.