Cardiovascular journal of Africa
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Acute myocardial infarction (AMI) is a rare but often catastrophic event during pregnancy, delivery or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis and coronary dissection. ⋯ Evidence suggests that pregnancy itself is an independent risk factor for MI, conferring a three- to four-fold higher risk than that of nonpregnant women matched for age, possibly due to the unique physiological changes required to meet the demands of a growing foetus. We report a case of a 27-year-old woman with familial hyperlipidaemia presenting with myocardial infarction six days after caesarean delivery, secondary to severe left main coronary stenosis (LMCA), who was treated with emergency coronary artery bypass grafting (CABG).
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Observational Study
Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital.
Rheumatic heart disease (RHD) frequently occurs following recurrent episodes of acute rheumatic fever (ARF). Benzathine penicillin (benzapen) is the most effective method for secondary prophylaxis against ARF whose efficacy largely depends on adherence to treatment. Various factors determine adherence to therapy but there are no data regarding current use of benzapen in patients with RHD attending Mulago Hospital. The study aims were (1) to determine the levels of adherence with benzapen prophylaxis among rheumatic heart disease patients in Mulago Hospital, and (2) establish the patient factors associated with adherence and, (3) establish the reasons for missing monthly benzathine penicillin injections. ⋯ The level of non-adherence was significantly high (46%). Residence in a town/city and having at least a secondary level of education was associated with better adherence, while the painful nature of the benzapen injections and lack of transport money to travel to the health centre were the main reasons for non-adherence among RHD patients in Mulago.
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Comparative Study
Comparison of results of autologous versus homologous blood transfusion in open-heart surgery.
The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods. ⋯ Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.
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To determine early haemodynamic changes in preeclampsia (PE) using tissue Doppler echocardiography and brain natriuretic peptide (BNP), and to relate these changes to obstetric outcomes. ⋯ In pregnancies complicated by pre-eclampsia, BNP levels were increased in comparison to normotensive pregnancies and this was accompanied by early changes in left ventricular diastolic function as determined by the tissue Doppler Em/Ea ratios. These changes reverted to baseline values, as indicated by return of BNP levels in the pre-eclamptic group to levels seen in the normotensive group. These changes were associated with an increased Caesarean section rate and lower birth weights in pre-eclamptic mothers.
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Wasp stings have been demonstrated to cause a wide spectrum of allergic reactions from localised reactions to anaphylaxis. Acute coronary syndromes have been described as potential complications of anaphylactic reactions or some of the drugs used for the treatment of anaphylaxis. We know of only a few cases reported of acute myocardial infarction (MI) following corticosteroid administration or anaphylaxis in subjects with normal coronary arteries. If it exists, underlying subclinical coronary atherosclerosis may become clinically evident. ⋯ Although reduced coronary perfusion, local histamine release-induced coronary vasospasm or severe hypoxia have been suggested, the pathophysiology remains unclear. Acute STEMI may be a rare but clinically important complication of a wasp sting, anaphylaxis or the corticosteroid used for its treatment, even in young adults with normal coronary arteries. Therefore, physicians should be aware of such serious complications in order to diagnose them early.