Cardiac arrhythmias and underlying cardiac conditions in patients attending the Uganda Heart Institute, Mulago Hospital, Uganda.

Abstract

BACKGROUND: Cardiac arrhythmias are an important factor for morbidity and mortality among cardiac patients in Mulago hospital. The most important underlying condition to cardiac arrhythmia is a cardiac disease. Furosemide is very often prescribed to cardiac patients attending Mulago Hospital. The role of furosemide in relation to cardiac arrhythmias (through hypokalaemia) is not known. OBJECTIVES: To determine the prevalence and type of cardiac arrhythmia among patients attending the Uganda heart institute ECG diagnostic facilities. To determine the prevalence and type of underlying cardiac condition among patients with arrhythmia To determine the serum K+ and Mg++ levels among these same patients.

DESIGN AND SETTING: This is a cross sectional descriptive study carried out the months of November and December 2000 in the Uganda heart institute, Mulago Hospital. A total of 300 consecutive patients were screened for cardiac arrhythmia from ECG done in the UHI.

RESULTS: A total number of 95 patients were found to have one or more arrhythmias (Prevalence 37.1%). The most common clinical complaint was palpitations but the description of the palpitations by the patient was not a reliable guide to the type of arrhythmia. The most common arrhythmias were those of sinus origin (77%) followed by conduction blocks (72%). The arrhythmias more commonly associated with underlying anatomical cardiac disease were the supraventricular ectopics and conduction blocks. The arrhythmia less likely to be associated with anatomical cardiac disease is PVC. The most common underlying cardiac disease was hypertensive cardiomyopathy.

CONCLUSION: Cardiac arrhythmias are common among Mulago Hospital patients. History of palpitations in the patient may point to the possibility of an arrhythmia but will not in the diagnosis of the type of arrhythmia. Isolated PVC (less than 6 per minute) are not likely to be associated with severe heart disease. On the other hand, supraventricular ectopes and/ or conduction blocks should lead the physician to thorough cardiac investigations to rule out underlying heart disease, especially hypertensive cardiomyopathy. Hypertensive cardiomyopathy is the most important cardiac factor to the development of arrhythmias. Late diagnosis and poor blood pressure control are probably aggravating factors in this population. The public health officials should address all these factors.