Open Access Case Study

Infantile Cardiac Rhabdomyoma–Pearls Inside the Heart

Prem Krishna Anandan, Basavaraj Baligar, J. S. Patel, Prabhavathi Bhatt, Cholenahally Nanjappa Manjunath, C. Dhanalakshmi

Cardiology and Angiology: An International Journal, Page 61-64
DOI: 10.9734/CA/2015/18422

Cardiac rhabdomyoma is the most common primary pediatric tumor of the heart. We report a 1-month old male infant who presented to our institute for routine cardiac evaluation since he was diagnosed to have a cardiac mass in the right ventricle (RV) in utero. After he was born, an echocardiogram showed two large cardiac masses occupying entire RV cavity and origin of right ventricular outflow tract (RVOT). Although our patient was asymptomatic, surgical removal of these two masses was done due to its proximity to RVOT and also because it was almost obliterating the entire RV cavity.

Open Access Original Research Article

Learning Bayesian Networks Using Heart Failure Data

Muzeyin Ahmed Berarti, Ayele Taye Goshu

Cardiology and Angiology: An International Journal, Page 43-50
DOI: 10.9734/CA/2015/17792

Background: Several factors may affect heart failure status of patients. It is important to investigate whether or not the effects are direct. The purpose of this study was learning Bayesian networks that encode the joint probability distribution for a set of random variables.

Methods: The design was a retrospective cohort study. The target population for this study was
heart failure patients who were under follow- up at Asella referral teaching Hospital from February, 2009 to March, 2012. Bayesian Network is used in this paper to examine causal relationships between variables via Directed Acyclic Graph (DAG).

Results: Death of patients can be determined using HIV, hypertension, diabetes, anemia, renal inefficiency and sinus. Hypertension and sinus were found to have direct effects while TB had only indirect effect. Age did not have an effect.

Conclusion: Anemia, HIV, diabetes mellitus renal inefficiency and sinus directly affect the death of heart failure patient. Death is conditionally independent on TB and age, given all other variables.


Open Access Original Research Article

Congestive Heart Failure among the Libyan Population (North Africa); A Community Based Survey of Risk Factors and Complication

Mohamed Kaled A. Shambesh, Taher Mohamed Emahbes, Zeinab Elmehdi Saleh, Iman Mohamed Shambesh, Malik Abdurrazag A. Elosta

Cardiology and Angiology: An International Journal, Page 51-60
DOI: 10.9734/CA/2015/19203

Congestive Heart failure (CHF) is a very common medical disorder and a major health problem in Libya. CHF is associated with an increase in the risk of stroke and hospitalization.

Objectives: To estimate and describe the main risk factors and complications of CHF among people with a particular interest in Libyan community.

Methodology: This project is classified as a community based descriptive cross-sectional study using the CHADS2 questionnaire as well as the local Libyan classification called the Community Stroke Risk Classification (CSRC).

Area; North Africa (North of Libya, the capital Tripoli).

Time; five years from 2010-2014

Population: Convenient sampling was done from a large cohort of individuals living in the Libyan community. 7497 individuals were screened for risk factors of stroke. CHF was one such factor which was studied in detail among the sample population and was diagnosed by taking detailed histories (including treatment), medical examinations and previous hospital confirmations.

Results: The prevalence of CHF among our participants (7497 individuals) was 15.2% (1139 patients) among the sample population as a total with males and females being 51.2% and 48.8% respectively (P=0.87). Among different age groups, females had higher rates than the males except for age interval from 60 to 79 where males had higher rates. The male to female ratio among the total population screened for CHF was 7.8%: 7.4% (583:556 respectively with males being higher).

CHF prevalence increased with the progress of age, with higher rates among age groups of over 40 (P <0.0001).

68.3% of CHF patients had hypertension (778 patients), 54.3% had DM (618 patients), 38.7% had transient ischemic attach (TIA) (441 patients), 27.2% had atrial fibrillation (AF) (310 patients), 25.9% had prior stroke (PS) (295 patients), All of these risk factors accompanying CHF increased with age (P<0.0001). 

99.92% of CHF patients had risk points of stroke in CHADS2 scores (0.08% had no risk points), from whom 27.1% had intermediate scores (1-2 Risk Points) and 72.9% had high scores (≥3 risk points) (P<0.0001). 

Results of the CSRC scores showed that 99.91% had risk factors of stroke (0.09% had no risk factors), from whom 29.5% had intermediate scores (1-2 Risk Factors) and 70.5% had high scores (≥3 risk factors) (P<0.0001). 

Conclusion: CHF is a major risk factor of stroke among the Libyan population in North Africa of whom had very high CHADS2 risk scores. These scores are defined as a combination of six different risk points; 0 points being low risk, 1-2 being intermediate, and a score of 3 or more risk points is defined as being high risk. CHF appeared to dominate the high scores (≥3 risk points). Almost all  CHF patients had risk factors of stroke on the CSRC scoring system of whom expressed intermediate and high scores with a significant proportion of high scores (≥3 risk factors of stroke). Hypertension, DM, AF and being aged of over 40 years were very important risk factors contributing to CHF. Both genders of male and female had similar chances of developing CHF in the Libyan community. CHADS2 & CSRC classification scores are very useful and simple tools to be used to classify and describe the risk factors of stroke in populations living within a community.


Open Access Original Research Article

Factors Influencing the Risk of Death among Patients with Heart Failure

Muzeyin Ahmed Berarti, Ayele Taye Goshu

Cardiology and Angiology: An International Journal, Page 65-79
DOI: 10.9734/CA/2015/17793

The purpose of this study was to investigate the impact of risk factors on the death of patients with heart failure in a cohort of patients hospitalized with heart failure disease. In this paper we used chi-square tests with the aim of studying the relationship of each factor with survival. Generalized Additive Models (GAM), particularly Generalized Additive Logistic Regression Model, was used to examine the impact of risk factors on the death of patients with heart failure out of 263 patients considered in the analysis, 18.6% patients died of heart failure. A death proportion for female was 19.6% and that of male patients was 17.5%. From the GAM analysis the predictors: age, anemia, Tuberculosis, HIV status, renal inefficiency, diabetes, hypertension and sinus were found to significantly affect the death status of a patient. Being older age, anemic, renal inefficient, TB positive, HIV positive, diabetic, hypertensive and sinus positive increase the risk of death of a heart failure patient.


Open Access Original Research Article

Effects of Smoking on Arterial Stiffness in Male Adolescents in Lusaka, Zambia

Chikopela Theresa, M. Goma Fastone

Cardiology and Angiology: An International Journal, Page 80-89
DOI: 10.9734/CA/2015/19292

Background: Tobacco smoke is harmful to health. In the acute phase it causes changes in the cardiovascular system that result in increase in blood pressure (BP). An increase in arterial stiffness due to arteriolar endothelial dysfunction has been cited among the causes. Pulse Wave Velocity (PWV) and Arterial Stiffness Index (ASI) are used as measures of arterial stiffness in the adult population.

Aim: To determine the acute effects of tobacco smoke on arterial stiffness in black male adolescents in Lusaka, Zambia.

Study Design: This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December 2014.

Methodology: Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Complior Analyse Unit (V1.9 Beta Version 2013; ALAM-Medical, France) protocol was used to obtain the carotid-femoral PWV (cfPWV) and carotid-femoral ASI (cfASI) starting 15 minutes before smoking, on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking. ASI was a surrogate measure of the loss of elasticity in the arteries.

Results: The mean baseline cfPWV was 7.9±1.94 m/s and cfASI was 26.1±6.0 m/s. Smoking two tobacco cigarettes (2.8 mg Nicotine) in 15 minutes caused an increase in mean cfPWV and cfASI from their baseline values to cfPWV of 8.5±1.87 m/s and cfASI of 28.6±6.19 m/s respectively. These values reverted to baseline within 15 minutes post-smoking cessation. There was further reduction in both cfPWV and cfASI to more stable values at 45th and 60th minutes which were statistically significantly lower than the peak values recorded.

These alterations in vascular compliance may predispose these individuals to developing hypertension and other cardiovascular complications. There is need for further investigation of this phenomenon.