Management of congestive heart failure in St. Elizabeth Catholic General Hospital Shisong, cardiac centre

Abstract

Heart failure is a major and growing public health problem on a global perspective. In spite of the scarcity of published literature on heart failure in sub-Saharan Africa, there is evidence that the rate of hospital admission for heart failure is comparable with rates from the rest of the world, but the pathophysiology and aetiologies are different [1]. Heart failure seems to be mainly due to systolic dysfunction and occurs as a major complication of high blood pressure in Africa and the first cause of hospital admission in cardiology units. In general internal medicine services, heart failure has been described as the 5th–6th cause of admission [2]. The pattern of this group of disorders however, varies between regions and countries and even within countries. In St. Elizabeth Catholic General Hospital Shisong, cardiac centre, congestive heart failure is due to valvulopathies (35%), followed by cardiomyopathies (32%), then hypertension (15%). Also we had pericarditis (7%), chronic obstructive pulmonary disease (8%), and congenital heart diseases (3%) as aetiological factors of congestive heart failure. According to the age post rheumatic valvulopathies, pericarditis and congenital heart diseases were the main aetiologic factors of congestive heart failure in patients aged from 8 to 40 years old, meanwhile cardiomyopathies, hypertension and chronic obstructive pulmonary disease are themain aetiologic factors of congestive heart failure in adult and elderly (from 41 years old and above). In patients with valvulopathies, post rheumatic valvulopathies were more represented than degenerative. Mitral valve regurgitation was the pathology more encountered. In this cohort of patients, congenital heart diseases were mainly the opened arterial duct 68.7%. Cardiomyopathies were diagnosed as follows: idiopathic dilated (90.2%), HIV associated cardiomyopathy (5.2%), ischemic cardiomyopathy (3%), and hypertrophic (1.6%). In patients with dilated cardiomyopathy there was a diffused dilatation of the four heart chambers with a very poor global and segmentary contractility, a dilatation of the mitral valve annulus, and a very poor left ventricular systolic function with the mean EF being 32.4±6.5% [3]. In patients with chronic obstructive disease of the lungs, the right atrium and ventricle were very dilated (cor pulmonale) with moderate to severe triscupid regurgitation, giving an estimated systolic pressure in the pulmonary artery of 70 to 114 mm Hg. In