Epidemiological, Clinical and Etiological Profile of Rhythmic Emergencies at the University Hospital of Brazzaville, Republic of Congo

Objectives: To describe the epidemiological, clinical and etiological aspects of rhythmic emergencies at the University Hospital of Brazzaville. Patients and Methods: This was a retrospective descriptive study conducted in the cardiology and internal medicine department of the University Hospital of Brazzaville from January 1, 2014 to June 30, 2016. Were included, all patients admitted for a severe rhythm disorder diagnosed on the surface electrocardiogram. Rhythmic emergency was defined as a severe rhythm disorder of abrupt onset and required rapid management. Data entry and analysis were performed with Epi Info software version 3.5.1. Results: During the study period, 2269 patients were hospitalized, including 138 for a rhythmic emergency. The frequency of rhythmic emergencies was 6.1%. The patients were divided into 76 women and 62 men (sex ratio = 0.81). The mean age of the patients was 63.1 ± 16.9 years (extremes: 17 and 91 years). The socio-economic level was low for 103 patients (74.6%), medium for 26 (17.7%), and high for nine (6.6%). The average time to consultation was 13.7 ± 12.3 days. On admission, the signs were: heart failure (103 cases;74.6%) including 22 acute cases;dyspnea (94 cases;68%);palpitations (38 cases;27.5%);functional impotence (13 cases;9.4%);collapse (nine cases;6.5%);chest pain (two cases;1.4%). The type of rhythmic emergency was: rapid atrial fibrillation (103 cases;74.6%), ventricular tachycardia (14 cases;10.1%), junctional tachycardia (10 cases;7.2%), rapid atrial flutter (10 cases;7.2%), tachysystole (one case;0.7%). The context of occurrence was: hypokalemia (8 cases;5.8%), drunkenness (two cases;1.4%), acute gastroenteritis (one case;0.7%). Cardiovascular risk factors were: hypertension (62 cases;45.2%), smoking (17 cases;12.1%), dyslipidemia (12 cases;8.7%), diabetes (11 cases;8%), obesity (10 cases;7.2%). Underlying heart disease was: dilated cardiomyopathy (40 cases;29%), hypertensive cardiomyopathy (26 cases;18.8%), valvulopathy (24 cases;17.4%). Ischemic heart disease, chronic pulmonary heart disease, and cardiothyreosis were noted equally (n = 5;3.6%). No heart disease was noted in 24 patients (17.4%). Conclusion: Rhythmic emergencies are frequent in Brazzaville. They are dominated by atrial fibrillation and often occur on heart disease.

Atrial Fibrillation during Cerebral Infarction in Brazzaville: Frequency and Predictive Factors

In order to contribute to the improvement of brain infarction management in Brazzaville, a cross-sectional and analytical study with prospective data collection was conducted in the cardiology and neurology departments of the Brazzaville University Hospital, from February 1 to July 31, 2018. It included patients hospitalized for cerebral infarction confirmed with imaging, and having done an etiological assessment with at least one electrocardiogram at rest and one of long duration. Among these 138 patients included, 11 had atrial fibrillation, equaling?a frequency of 7.9%. The mean age of AF patients was 71 ± 8.8 years. The cardiovascular risk factors found were hypertension in eight cases (72.7%), diabetes in five cases (45.5%), abdominal obesity in four cases (36.4%). AF was permanent in 10 cases (91%), and paroxysmal in one case (9%). It was valvular in three cases (27.3%) and non-valvular in eight cases (72.7%). The cardiopathy involved was hypertensive in seven cases (63.6%), ischemic and valvular in two cases each. The CHA2DS2-VASc score, calculated in eight patients, was an average of 2.2, and ≥2 in more than 80% of patients;HAS-BLED score of 2.4 on average was ≥?3 in more than 72% of patients. Digoxin was prescribed in seven cases (63.6%) and an anti-vitamin K in eight cases (72.7%). In multivariate analysis, age (OR = 20.10, p = 0.023), arterial hypertension (OR = 23.82, p = 0.011), and dyslipidemia (OR = 2.03, p = 0.032) were the predictive factors found. AF is infrequent during brain infarction in Brazzaville. This systematic research raises the problem of age in our context.

Global Cardiovascular Risk of the HIV Positive Patients Receiving Antiretroviral Therapy in Brazzaville

A cross-sectional, descriptive and analytical study was conducted from January to August 2015 at the Brazzaville Ambulatory Treatment Center and at?the National Blood Transfusion Center. The objective was to contribute to improving?the care of people living with HIV under antiretroviral therapy by assessing their global cardiovascular risk (CVR). The variables studied focused on the epidemiological, clinical and biological aspects. The global CVR was assessed?by the Framingham and WHO/ISH scores. There were 135 HIV-positive subjects,?including 64 treated patients and 71 untreated HIV+ subjects. The subjects were divided into 83 men (61.5%) and 52 women (38.5%), with an average age of 42.6 ± 2.9 old years. The subjects were single people (62.2%), of a secondary educational level (63.7%), and civil servants (32.6%). The main risk factors found were dyslipidaemia (60%), obesity (36%), smoking (12.6%), hypertension (5.9%), diabetes (0.7%). The metabolic syndrome was found in seven cases (11.3%). The global CVR according to the score of Framingham, initially moderated at 17.2%, and mean at 1.5% within treated patients, was mean at 9.4% and high at 1.6% of the subjects respectively at the sixth month of treatment (p CVR under antiretroviral therapy. Preventive actions are highly recommended.

Left Ventricular Hypertrophy and Predictive Factors among Congolese Hypertensive Patients

A cross-sectional study of hypertensive patients was carried out in Brazzaville between January 2011 and December 2013.?The objectives of the present study are to determine the different types of left ventricular hypertrophy (LVH)?and to identify the predictive factors of LVH. It included 556 hypertensive patients with LVH, characterized by left ventricular mass index (LVMI) > 135 g/m2?in men, and > 111 g/m2?in women. Patients’ sociodemographic data and echocardiographic parameters were gathered and analyzed. There were 342 males (61.5%) and 214 females (38.5%),?with?mean age 53.5 ± 11.5 years. The indications of the test were hypertension initial evaluation in 402 cases (72.3%), investigation of ischemic stroke in 62 cases (11.2%), heart failure in 58 cases (10.4%), dyspnea and chest pain in respectively 22 and 12 cases. Hypertension, old of 5.2 ± 4.5 years, was associated with overweight/obesity in 408 cases (73.4%), physical inactivity in 325 cases (58.5%), hypertension family history in 274 cases (49.3%), diabetes mellitus in 76 cases (13.7%), dyslipidemia in 63 cases (11.3%), tobacco use in 9 cases (1.6%). The prevalence of LVH was 49.4% and consisted into concentric LVH in 470 cases (84.5%), eccentric LVH in 70 cases (12.6%), and in 16 cases (2.9%),?it was a concentric left ventricular remodeling. Age, male gender, seniority of hypertension and treatment were predictive factors of LVH. The latter is the most predominant abnormality in the echocardiographic profile of Congolese hypertensive patients. Efficient management on hypertension will lead to reducing its morbidity and mortality.

The Erectile Dysfunction among Congolese Hypertensive Patients

The authors conducted an analytical cross-sectional study over a period of 3 months among hypertensive patients, in order to determine the frequency of the erectile dysfunction (ED), and to identify the predictive factors. It included treated hypertensive patients, presenting an ED, defined as the incapacity to obtain or maintain an erection sufficient for satisfactory sexual activity. On 265 hypertensive patients, 172 (65%) presented an ED. The average age was 58.2 ± 9.7 years. The associated cardiovascular risk factors were overweight/obesity in 99 cases (37.4%), sedentariness in 90 cases (34%), diabetes mellitus in 50 cases (19%), dyslipidemia in 12 cases (4.5%), and tobacco addiction in 6 cases (2.3%). Arterial hypertension (HTN), old of 6.7 ± 5.8 years, was treated by bitherapy in 129 cases (48.7%), and tritherapy in 102 cases (38.5%). The principal therapeutic classes used were ACE inhibitors/ARBs in 213 cases (81%), calcium antagonists in 205 cases (78%), thiazides in 137 cases (52.1%), and beta-blockers in 82 cases (31%). ED, severe in 124 cases (72%), and moderate in 48 cases (28%), consisted of a difficulty to maintain the erection in 78 cases (45.3%), to obtain the erection in 30 cases (17.4%), and the two partners in 64 cases (37.2%). In multivariate analysis, only the age, seniority of HTN, and the existence of diabetes mellitus were the predictive factors of ED. The early and effective assumption of responsibility of the AHT, as well as other cardiovascular risk factors whose diabetes, would make it possible to reduce the frequency of it, thus improving quality of life of the hypertensive patients.

Hyperuricemia and Associated Factors during Arterial Hypertension in Brazzaville (Congo)

A longitudinal analytical and comparative study including outpatients was carried between June 1st?and December 31st?2017. The objectives were to determine the hyperuricemia frequency during arterial hypertension, to identify associated factors, and to evaluate its impact on the blood pressure control. We have included, hypertensive patients having a minimum blood test including at least an uricemia. They were divided into two groups according to?whether they have presented a?hyperuricemia (HU) or a normouricemia (NU).?Among?these 202 patients included, 61 (30.2%) presented a hyperuricemia.?The mean age in HU group was 54.6 ± 11.6 years vs 53.6 ± 11 years for NU group (p = 0.573). Following cardiovascular risk factors were more found in the HU group than NU group: overweight/obesity (68.8% vs 46.1%;p = 0.003), metabolic syndrome (42.6% vs 39%;p = 0.021). Diuretics were used in 72.1% of patients in HU group vs 47.5% in NU group (p = 0.002).?Bitherapy was used in 56% of the patients of HU group vs 69% in the NU group (p = 0.295), and the quadritherapy?in 8% and 1% of the patients respectively (p = 0.049). Blood pressure was not controlled in 68.8% of HU group vs 48.9% in the NU group (p = 0.014). In multivariate analysis after logistic regression, factors associated with hyperuricemia were: glucose intolerance or diabetes (p = 0.004;OR = 1.35) and uncontrolled blood pressure (p = 0.006;OR = 2.51). This preliminary study showed that hyperuricemia is commonly found in hypertensive patients and has negative impact on blood pressure control.