Heart Failure with Preserved Ejection Fraction: A Report about 64 Cases Followed at the Heart Institute of Abidjan

Objective: To describe the epidemiological and etiological features of heart failure with preserved ejection fraction in our context. Materials and Methods: This is a retrospective study that was carried out over a 12-monthperiod, from 1 January 2015 to 31 December 2015, in the hospitalization department of the Heart Institute of Abidjan. It was about patients hospitalized for heart failure who had received a dose of NT-proBNP and who had had an electrocardiogram, and a Doppler echocardiography. Heart failure with preserved ejection fraction (HFPEF) was defined from the symptoms and signs of heart failure, the level of NT-proBNP and from echocardiography data based on the left ventricular ejection fraction (LVEF) > 50%, the dilatation of the left atrium. The diastolic dysfunction of the left ventricle was assessed by the ratio E/E’ > 13. We defined as heart failure with decreased ejection fraction (HFDEF) symptoms and signs of heart failure and left ventricular dysfunction LVEF 40%. A computer file was completed. It included epidemiological and etiological data. Results: The study involved sixty-four patients with heart failure with preserved ejection fraction out of 257 patients with heart failure that is a prevalence of 25%. The mean age was 57.3 ± 16 years. There was a male predominance that is 52% of cases. Congestive heart failure was predominant in 67%. NT-proBNP levels were 365 pg/ml on average. The average length of stay was 5.5 ± 3.1. Intra-hospital deaths were 4.6%. The etiologies are dominated by high blood pressure in 85.9%, followed by obesity in 28.1%, then by ischemic heart disease in 4.6%. There were no diabetic patients in this group. Conclusion: Heart failure with preserved ejection fraction is characterized in our regions by its occurrence in?young male subjects. Congestive heart failure prevailed. The dominant etiology was high blood pressure.

Traditional Medicine Followed at the Heart Institute of Abidjan

Objective: To determine the prevalence of the use of traditional medicine in?hypertensive patients and to identify the socio-demographic characteristics of these patients. Materials and Methods: This is a single cross-sectionalstudy with descriptive purpose that was carried out over a 4 month-period, from 1 January 2017 to 30 April 2017, in the outpatient department of the Heart Institute of Abidjan. It involved patients who consulted during this period for high blood pressure. An informed questionnaire was submitted to patients. A pre-test was performed on 20 patients prior to the start of the survey. Results: The prevalence was 34%, with a slight male predominance (52.4%). The average age of our patients was 51.7 years ± 20 years. Males (52.4%) and females (47.6%) were roughly in the same proportions in our study with a slight male predominance. Patients with a higher level of education used traditional medicine in 30.6% that is about one third of the cases. Nearly one third of the patients had a monthly income above 300,000 FCFA (28.5%). Almost half of the patients (45%) had social insurance coverage. Conclusion: The use of traditional medicine by hypertensive patients is a practice that exists and is growing rapidly. The profile of hypertensive patients using traditional medicine can be summarized as a young subject, a male with a higher education level, a high monthly income and social coverage. It is the place to insist on the therapeutic education of our hypertensive patients’ only way for a good control of the blood pressure figures.

Cardio-Renal Syndrome: Frequency and Associated Factors in the Abidjan Heart Institute’s Medical Department

Introduction: Cardio-renal syndrome (CRS) is a pathophysiological disorder of the heart and kidneys in which acute or chronic dysfunction of one organ can lead to acute or chronic dysfunction of the other. In Africa, particularly in C?te d’Ivoire, the incidence of cardio-renal syndrome is not precisely known. The aim of this study was to assess the frequency of CRS and to contribute to a better understanding of the condition in the medical department of the Abidjan Heart Institute. Materials and Methods: We conducted a prospective analytical study including all patients with heart failure hospitalised in the medicine department of the Abidjan Heart Institute from March to October 2020. Data were analysed using SPSS software version 22. Results: We included 111 patients in the study. The incidence of CRS was 64%, with a predominance of males (sex ratio 1.8). The mean age was 53 ± 15 years. Patients’ medical history was dominated by hypertension (56.8%), diabetes (15%), dyslipidaemia (18%), obesity (17.1%) and smoking (14.4%). The main causes of heart failure were dilated cardiomyopathy (22.8%) and ischaemic heart disease (21.4%). Symptomatology was mainly congestive heart failure (42.8%). Mean evaluated clearance (MDRD) was 39.9 ± 17.1 ml/min/m2. Doppler echocardiography showed a decrease in left ventricular ejection fraction in 74.3% of patients. Factors statistically associated with the occurrence of cardio-renal syndrome were: age > 60 years (p = 0.04), diabetes (p = 0.03), arterial hypertension (p = 0.001) and Hb Conclusion: The cardio-renal syndrome is a reality and marks an important point in the evolution of cardiac and renal diseases. It is highly frequent in the medical department of the Abidjan Heart Institute, as well as a high rate of CKD.

Caudal Anesthesia: Experience in the Post-Operative Analgesia in Pediatric Ambulatory Surgery at the University Hospital of Treichville

Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.