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Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years; men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%; diabetes was 34.27%; dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel; 28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36; 95% CI, 1.05 - 5.29; p = 0.036); male gender (OR, 1.6; 95% CI, 0.72 - 3.57; p = 0.24); diabetes (OR, 2.14; 95% CI, 0.96 - 4.75; p = 0.06) and necrosis Q waves (4.75; CI, 0.98 - 23.09; p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, which has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years. Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30 s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06 h 30 min before the COVID-19 pandemic and 42 h06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14 h 30 min before the Covid-19 pandemic and 27 h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.

Despite the growing interest in athlete’s right ventricle and various work carried out, many uncertainties are remaining. The interest of this work resides in the determination of the particularity in right heart of the black athlete subject. We conducted a prospective study from August to October 2016 in the cardiology department of Aristide Le Dantec University Hospital in Dakar. The included patients were divided according to the sporting practice as enduring, resistant and non-athletes. The parameters studied were electrocardiographic (atrial or ventricular hypertrophies), echocardiographic: dimensions of the right cavities, systolic and diastolic functions of the right ventricle. We included 58 subjects: 38 athletes including 28 endurance and 10 resistance and 20 non-athletes. The average age of the endurance athletes was 21.9 ± 3, 75 years, 26.30 ± 4.64 in resistance ones and 24.10 ± 1.89 in the non-athletic group. Two cases of first-degree atrioventricular block were recorded in athletes. On the echocardiographic point, the atrium surfaces, as well as the transverse diameter, were greater in athletes, especially in the endurance group. The mean diameters of the admission chamber and those of the right ventricular flush chamber were larger in the group of endurance athletes. It was the same for the annular and sagittal basal mean diameters of the RV as well as the RV/LV ratio. The anterior wall of the right ventricle was larger in athletes compared to non-athletes. The vena cava was greater in athletes, the pulmonary arterial pressure higher in resistance ones.

Introduction: Precordial pain is a common reason for admission in cardiology, and has many causes. Acute myocarditis in its pseudo-infarctoid form is sometimes difficult to differentiate from myocardial infarction. Cardiac magnetic resonance imaging (MRI) helps to differentiate these two disease entities. We report the respective cases of two young patients, one presenting with myocarditis whilst the other with myocardial infarction. Case Report: We present the cases of two patients. The first who had a recent history of febrile syndrome is a 23-year-old who stopped smoking 3 months prior to presentation whilst the second is a 22-year-old professional footballer with a history of stress with no other cardiovascular risk factors. They were respectively admitted in our emergency department for a constrictive, intense chest pain. Physical examination was normal. The chest pain in both patients was associated with elevated cardiac markers, primary repolarisation abnormalities on ECG, wall motion abnormalities as well as left ventricular systolic dysfunction on transthoracic echocardiography. Coronary angiograms were normal in both patients. In the first patient, MRI concluded with an acute myocarditis with apical akinesia extending to the anterior wall, a T2 hypersignal indicative of myocardial edema, and uptake of a nodular heterogeneous contrast without affecting the sub-endocardial layers on the late enhancement sequences. In the second patient, MRI showed an appearance consistent with acute extensive infarction in the antero-apical region with severe hypokinesia and late quasi-transmural enhancement, impairment of the anterior papillary muscle of the mitral valve and a reduced left ventricular ejection fraction at 33%. In addition to analgesics, the first patient was treated with perindopril and bisoprolol, and the second patient received antithrombotic and anticoagulant treatment. There was clinical improvement in both patients. Conclusion: Cardiac MRI is a useful diagnostic tool for the precise diagnosis of precordial pain with elevated cardiac enzymes, especially in young patients.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Introduction: The Behcet’s disease is deemed to be scarce in Black Africa where data are still scattered. The purpose of our study is to describe the epidemiological, clinical, paraclinic and evolutive particularities of the patients whose presenting symptoms of the Behcet’s diseases were a venous thrombosis. Patients and Methods: It was a descriptive, multicenter, and cross-sectional study lasting 15 months. We brought together all the cases of the Behcet’s disease revealed by venous thrombosis. The diagnosis was based on clinical criteria of the international group of study of the Behcet’s disease in 2007. Results: We have grouped 10 revealing thrombosis cases of the Behcet’s diseases during our study period. The average age was 34. The average wait period between the appearances of the early symptoms and the diagnosis of the very disease was 30 months. The admission motives were the abdominal pain (2 cases), a thrombophlebitis of the lower limb (2 cases), headaches (1 case), coma (1 case), a thrombophlebitis of the upper limb (3 cases). The thrombotic symptoms were exclusively venous-located. The seats of the thrombosis were the vena cava superior in 30% of the cases, the vena cava inferior in 20% of the cases, the veins of the lower limb in 20% of the cases, the cerebral vein in 20% of the cases, and the auxiliary vein in 10% of the cases. The treatment of the deep venous thrombosis consisted in all the cases of an effective anticoagulation associated with the colchicine. Primarily, the corticotherapy with a high dose was used in all the patients. One of them in the comatose stage, manifesting both cerebral thrombophlebitis and aseptic meningitis, had died. Conclusion: Behcet’s disease is a disease of the young adult, but it must be evoked even in old age, with a view to appropriate management, in order to avoid the complications of the disease. Although it is rare in our regions, it should be sought in the etiological assessment of venous thrombosis whatever the location.