The Problem of Rehospitalisation for Heart Failure at the Cardiology Department of the Hôpital National Ignace Deen

Introduction: Despite current therapeutic advances, heart failure in sub-Saharan Africa remains a common, serious and costly disease, particularly due to rehospitalizations. The objective of this work was to determine the proportion of rehospitalizations for heart failure and to identify etiological factors. Methodology: This was a retrospective descriptive study with a duration of 8 months from April 1 to November 30, 2021. This study included all patients rehospitalized in the department for Heart Failure and who agreed to participate in our study. Results: During the period of our study, 437 patients were hospitalized in the HF department, among which we collected 126 cases of rehospitalization for HF with a frequency of 28.83%. The mean age of our patients was 46.32 ± 18.98 years with the extremes of 15 to 84 years. The most affected age group was between 35 and 44 years old in 24 cases, i.e. a frequency of 19%. We observed a female predominance of 64 cases, i.e. a frequency of 50.8% compared to 62 cases, i.e. a frequency of 49.2% with a sex ratio (M/F) equal to 0.96. 98 cases of our patients, i.e. a frequency of 77.8%, were mutual insurance companies who felt they had the necessary support from those around them. In our sample, the underlying heart disease was mainly represented by valvular heart disease in 59 cases, followed by hypertensive heart disease in 42 cases with the respective frequencies of 46.82% and 33.33%. The majority of our patients were rehospitalized (1 - 3) times after a first episode of HF flare-up in 117 cases or 92.9%. Irregularity at control and therapeutic break were the most common decompensation factors with frequencies of 75.8% and 74.2% respectively. The majority of our patients were rehospitalized (1 - 3) times after a first episode of HF flare-up in 117 cases or 92.9%. Irregularity at control and therapeutic break were the most common decompensation factors with frequencies of 75.8% and 74.2% respectively. Conclusion: It appears in this study that rehospitalizations for heart failure are frequent, linked to irregularity in control and the lack of therapeutic education.

Arterial and Venous Thrombosis following Vaccination against COVID-19 with Astra-Zeneca Vaccine Revealing Thrombophilia

Vaccination against COVID-19 is the most recognised means of containing the pandemic. Vaccines are not without side effects, particularly vascular thrombosis. But before blaming the vaccines, a thorough assessment of thrombotic risk factors is necessary. We report a case of arterial and venous thrombosis after vaccination with AstraZeneca revealing an exaggeration of factor VIII in a 37-year-old female patient. The angioscanner showed a venous thrombosis of the right subclavian, a pulmonary embolism and the presence of a thrombus in the aorta. The biology was in favour of a high level of factor VIII. The patient was treated with an antivitamin K, and the clinical evolution was favourable.

Clinical, Therapeutic and Evolutionary Profiles of Hypertensive Emergencies in the Cardiology Department of the Ignace Deen National Hospital (Conakry)

Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hypertensive emergencies in the cardiology department of the Ignace Deen National Hospital. Methods: This was a longitudinal descriptive study of patients admitted to the cardiology department of the Ignace Deen National Hospital for hypertensive emergencies, over a period of six (6) months from 1 October 2020 to 31 March 2021. Results: Among the 638 patients admitted to the cardiology department during the study period, 102 cases of hypertensive emergencies were identified, representing a frequency of 15.99%. The mean age of the patients was 56.65 ± 13.33 years, with extremes of 23 and 90 years, and the sex ratio was 1.91 in favour of men. The associated cardiovascular risk factors were: age (76.47%), smoking (41.18%), sedentary lifestyle (31.37%), obesity (16.67%), dyslipidaemia (12.75%), diabetes (11.76%) and excessive alcohol consumption (11.76%). The various clinical pictures found were: acute pulmonary oedema 39 cases (38.23%), acute coronary syndrome 31 cases (30.39%), stroke 17 cases (16.67%), hypertensive encephalopathy 11 cases (10.78%), acute renal failure 3 cases (2.94%) and aortic dissection 1 case (0.98%). The drugs used on admission were calcium antagonists (Nicardipine 10mg) in 58 cases (56.86%), diuretics (Furosemide 20mg) in 44 cases (43.13%), nitrates (Risordan 20mg) in 39 cases (38.23%) and beta-blockers in 31 cases (30.39%). In terms of outcome, 88 (86.27%) patients had improved. However, 12 (11.76%) deaths were recorded. Conclusion: Hypertensive emergencies are a worrying condition with a high prevalence in the cardiology department of the Ignace Deen National Hospital.

A Very Severe Obstructive Sleep Apnea Syndrome: In a Cause of Resistant Hypertension with One Sample Case

When blood pressure values remain above the target in a hypertensive patient treated concomitantly with three anti-hypertensive drugs including a diuretic, maximum well-tolerated doses, this is a resistant arterial hypertension. In this case, it is advisable to look for a secondary cause such as a drug intake that influencing the blood pressure or the presence of obstructive sleeping syndrome (OSAS). We report a clinical case of a patient with a high cardiovascular risk at the age of 50, hypertensive and diabetic, with dyslipidemia and obesity. He was on anti-hypertensive triple therapy at an optimal dose. Her diabetes was balanced with 6.4% glycated hemoglobin. Dyslipidemia has being treated. Despite healthy diet including a low sodium diet and weight loss, blood pres- sure target was not reached. With self-measurement, the mean arterial pressure was 180/110 mmHg and on ABPM it was 167/113 mmHg. The ventilatory polygraphy finds a severe OSA with an IAH = 56.6. Treatment with PCP (Con- tinuous positive pressure) allowed this patient to control blood pressure. The search for OSA should be systematic in face of resistant hypertension, in par- ticular in overweight or obese patients.

Family Dyslipidemia Revealed by a Cornean Bow in a Guinean

Object: The aim of this study was to describe a familial dyslipidemia revealed by a corneal arch. Familial hypercholesterolemia is a rare and severe hereditary dyslipidemia with an exceptional homozygous form. He was a 43-year-old patient admitted with visual disturbance, xanthomatous papule and orange coloring at the level evolving for 5 years, no personal history of cardiovascular disease, having a family history of lipid disorders in siblings, as a cardiovascular risk factor: age over 50 and the male gender, normal cardio pulmonary examination, blood pressure at 120/80 mmhg, heart rate 78 bpm, in whom the ophthalmological examination shows a yellowish spot on the cornea (Figure 1). We report the case of familial dyslipidemia revealed by a corneal spot in Guinea.More recent studies increasingly suggest that it is much more widespread than previously thought: 1/200 to 1/400. Familial dyslipidemia is a rare and severe metabolic abnormality. It should be screened as early as possible like any other cardiovascular risk factor for atheroma to avoid the occurrence of a major cardiovascular event.

Epidemiological, Clinical and Therapeutic Aspects of Arterial Hypertension at the General Medicine Department of Nzerekore Regional Hospital

Introduction: High blood pressure is a public health problem in Guinea as well as everywhere in Africa. The objective of our study was to assess the epidemiological, clinical and therapeutic aspects of High blood pressure in the general medicine department of the Nzérékoré regional hospital. Methodology:This was a prospective study of a descriptive type, lasting 06 months, from July 1 to December 31, 2014. Results: We recorded 156 cases of High blood pressure among a total of 570 patients, for a hospital frequency of 27%. The 56 - 65 age group was the most affected, at 29.4%, with a predominance of men (sex ratio: 1.5). Alcoholism was the most common cardiovascular risk factor with a frequency of 51.2%, smoking and physical inactivity were found in 35.8% and 30.7% respectively;psychosocial stress was found in 24.3% of patients. The clinic was dominated by headache (100%) and dizziness (57.6%). All our patients were subjected to a healthy diet. Fixed dual therapy was the most widely used treatment regimen, i.e. 91 patients (58.3%) and included a diuretic in 37.1% of cases, a calcium channel blocker in 25% of cases and an ACE inhibitor in 24.3%. Conclusion: This study revealed a high frequency of hypertension in the general medicine department of the regional hospital of N’zérékoré.