The pattern of cardiac disease and aetiology of cardiac failure among patients attending mulago hospital cardiac clinic and medical wards.

Abstract

BACKGROUND: Changes in the socio-demographic characteristics of people in the developing countries are resulting in an increase in non-communicable conditions like cardiovascular diseases (CVD). However, because of the lingering poverty in these countries, infections, malnutrition and their related cardiovascular complications are still prevalent. The high morbidity and mortality as well as the exorbitant costs of managing CVD necessitate timely prevention. Data on CVD in our setting are to be formulated. This study therefore seeks to document the important causes of CVD in our setting. AIM OF STUDY: The aim of this study was to describe the pattern of heart disease and aetiology of heart failure among patients attending the cardiac clinic and medical wards of Mulago hospital. OBJECTIVES: To describe the clinical and aetiological pattern of heart disease among patients presenting to the cardiac clinic and the general medical wards for the first time during the study period (June 2001- January 2002). To study the prevalence and severity of heart failure among these patients To study the factors that may precipitate or aggravate heart failure in these patients STUDY DESIGN: This study was a cross-sectional study carried out at the cardac clinic and general medical wards of mulago hospital in kampala, Uganda for a period of 7 months from June 2001- January 2002. METHODOLOGY: A sample size of 147 patients was calculated using the Kish and Leslie formula for population survey or descriptive study using random, not cluster sampling. (68) a total of 163 patients were consecutively recruited after they had given informed consent. The patient’s medical history was recorded, a clinical examination carried out, chest radiography, standard 12-lead resting electrocardiogram, echocardiography, full haemogram, erythrocyte sedimentation rate (ERS), urine protein, serum electrolytes and renal function tests were done. RESULTS: There are two peaks at which cardiac disease was found; a small peak among adolescents and young adults and second larger peak in the 60-69 year age group. The most common cardiac diseases were dilated cardiomyopathy (DCM) seen in 37 patients, hypertensive heart disease seen in 37 patients, followed by rheumatic heart disease (RHD) in 35 patients. Seventeen patients had degenerative heart disease, 15 had ischaemic heart diseases and 11 had endomycardial fibrosis. The majority of the patients presented in cardiac failure (86.5%), most with moderate or severe cardiac failure (NYHA II & III). Patients 60-69 years formed the majority with cardiac failure. Uncontrolled systematic hypertension was the most important risk factor for cardiac disease and heart failure. Poor compliance to therapy for cardiac failure and antihypertensive drugs was attributed to lack of money to buy drugs and ignorance about the need to take drugs continuously. DISCUSSION: The pattern of cardiac disease in kampala has changed when compared to earlier studies. Firstly patients are older than in previous studies. Whereas RHD is still common, DCM less common in previous studies has excedded it. Hypertension remains a major causes of cardiac morbidity, while EMF, Which was common in previous studies seems to have declined. Ischaemic heart disease has risen over 10 fold from 0.7% in previous studies to 9.2%. The pattern of CVD in our setting seems to belong to pearson’s ‘’Age of receding pandemics’’ (6) where RHD, infectious and nutritional cardiomyopathies as well as hypertensive heart disease are the pre-dominant CVDs. However a 10-fold increase in ischaemic heart disease should alert us about the next phases of the epidemiological tran0sition such as the ‘’Age of degerative and man-made disease’’ where the predominant CVD is ischaemic heart disease. CONCLUSION: Efforts to control CVD in our setting need to be targeted ti infectious and nutritional causes in young people and to non-communicable diseases modifiable by healthy lifestyles and appropriate drug therapy in the middle aged and elderly.