Frequency and Characteristics of Peripartum Cardiomyopathy in Two Referral Centres in Kano, Nigeria
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FREQUENCY AND CHARACTERISTICS OF PERIPARTUM CARDIOMYOPATHY IN TWO REFERRAL CENTRES IN KANO, NIGERIA A DISSERTATION SUBMITTED FOR THE PART TWO (FINAL) PROJECT AS PART OF THE REQUIREMENTS FOR THE AWARD OF FELLOWSHIP OF THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA (FACULTY OF INTERNAL MEDICINE).(CARDIOLOGY) BY DR. AHMAD, NASER ISHAQ MD VINNITSA (UKRAINE) 1998 DEPARTMENT OF MEDICINE AMINU KANO TEACHING HOSPITAL, KANO – NIGERIA MAY 2014 i DECLARATION I humbly declare that the writing and execution of the study contained in this work was carried out by me, and that it is original unless otherwise acknowledged. It has not been presented to any College for award of Fellowship nor has it been submitted elsewhere for publication. Signature…………………………………….. Date………………………………………….. DR. NASER AHMAD ISHAQ ii CERTIFICATION BY SUPERVISORS We hereby declare and certify that this dissertation was carried out by DR. NASER AHMAD ISHAQ under the supervision of PROFESSOR S. ISEZUO and PROFESSOR K. M. KARAYE Signature……………………………… Date…………………………………… PROFESSOR SIMEON ISEZUO (FMCP) Professor of Medicine and Consultant Cardiologist, UsmanDanfodio University Teaching Hospital, Sokoto, Sokoto State. Signature…………………………….. Date………………………………….. PROFESSOR K. M. KARAYE (FWACP, FACC) Professor of Medicine and Consultant Cardiologist, Aminu Kano Teaching Hospital, Kano. iii CERTIFICATION BY HEAD OF DEPARTMENT This is to certify that this work was undertaken by DR. Naser Ahmad Ishaq in the Department of Medicine, Aminu Kano Teaching Hospital, Kano. Signature…………………………….. Date………………………………….. PROFESSOR K. M. KARAYE (FWACP, FACC) Professor of Medicine and Consultant Cardiologist, Aminu Kano Teaching Hospital, Kano (Head of Department) iv DEDICATION This work is dedicated to the memory of my late father Alhaji Ahmad Ishaq and to my mother Hajia Fatimah Ahmad Ishaq. v ACKNOWLEGDEMENT All praise be to Allah the Almighty who made it possible for me to complete this task. To Him is all the glory. My profound appreciation and gratitude go to Prof. S.A Isezuo and Dr. K.M. Karaye for their untiring efforts, guidance and concern. I wish to express my appreciation to all the people that involved in this study and in particular, Dr. Kamilu M. Karaye. I thank all the consultants and fellow residents in the Department of Medicine, Aminu Kano Teaching Hospital (AKTH) Kano, for their assistance and useful comments. My sincere gratitude goes to my wife Sadiya for her prayers, support and understanding during the period of my training. I also deeply appreciate the understanding and patience of my children: Ahmad, Fatima, Hauwa and Amina. I will also like to thank to my mother and siblings for all support and prayers throughout the years of my studies. My special thanks go to Drs. Ahmed MaifadaYakasai, Hadiza Said, Hamza Muhammad, Jamila Ado Yau and Mahmoud Dalhat who were always there to urge and encourage me to continue despite all the difficulties. Their contribution with vital references, useful articles and comments made it possible for me to complete this manuscript. Also worthy of special mention are Drs Mahmoud Sani and M.S Mijinyawa who gave me useful advice and guidance at all stages of my residency training as well as other decisions I took during my residency training. vi I am indebted to Dr M.M Borodo who has helped me during my training and has been a father figure. He offered tremendous help. I thank all other people that contributed in various ways toward the success of this study. To the Almighty Allah belongs all gratitude. Naser Ahmad Ishaq vii TABLE OF CONTENTS TITLE PAGE i DECLARATION ii CERTIFICATION BY SUPERVISORS iii CERTIFICATION BY HEAD OF DEPARTMENT iv DEDICATION v ACKNOWLEDGEMENT vi TABLE OF CONTENTS viii LIST OF TABLES ix LIST OF FIGURES x ABBREVIATIONS xi ABSTRACT xv CHAPTER ONE: INTRODUCTION 1 AIMS AND OBJECTIVES 4 CHAPTER TWO: LITERATURE REVIEW 5 CHAPTERTHREE: METHODOLOGY 22 CHAPTER FOUR: RESULTS 32 CHAPTER FIVE: DISCUSSION 52 CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS 60 REFERENCES 61 APPENDIX ONE–QUESTIONAIRE 74 APPENDIX TWO-CONSENT FORM 81 APPENDIX THREE-ETHICAL APPROVAL 82 APPENDIX FOUR-ELECTROCARDIOGRAM OF A PPCM PATIENT 83 APPENDIX FIVE- ECHOCARDIOGRAM OF A PPCM PATIENT 84 viii LIST OF TABLES TABLE 1Incidence of PPCM in different countries TABLE 2Socio-demographic characteristics of PPCM patients and controls TABLE 3 Clinical characteristics of PPCM patients and controls TABLE 4 Laboratory parameters of PPCM patients and controls TABLE 5 Electrocardiographic characteristics of PPCM patients and controls TABLE 6 Echocardiographic characteristics of PPCM patients and controls TABLE 7 Comparison of risk factors for PPCM between patients and controls TABLE 8 Drug treatment of patients with PPCM TABLE 9 Comparison of clinical and demographic characteristics of the deceased and survivors TABLE10 Comparison of laboratory parameters among the survivors and deceased patients TABLE11 Comparison of electrocardiographic and echocardiographic parameters of the deceased and survivors ix LIST OF FIGURES FIGURE 1 : Summary of proposed pathogenic mechanisms for PPCM. x ABBREVIATIONS ACEI................................................. ...Angiotensin Converting Enzyme Inhibitors ARB...................................................Angiotensin Receptor Blockers AKTH................................................Aminu Kano Teaching Hospital ASE............................................ .......American Society of Echocardiography AV......................................................Aortic Valve BMI....................................................Body Mass Index BP.......................................................Blood Pressure CHF....................................................Congestive Heart Failure CRP....................................................C-reactive protein DCM.................................................. Dilated Cardiomyopathy DNA...................................................Deoxyribonucleic Acid DBP...................................................Diastolic Blood Pressure ECG....................................................Electrocardiography e-GFR..................................................estimated- Glomerular Filtration Rate EF.......................................................Ejection Fraction ESC.....................................................European Society of Cardiology xi FBC.....................................................Full Blood Count FBS......................................................Fasting Blood Sugar HF........................................................Heart Failure IFNγ.....................................................Interferon gamma IL-1......................................................Interleukin-1 IL-6......................................................Interleukin-6 IVSTd...................................................Interventricular Septal Thickness at end diastole IVSTs...................................................Interventricular Septal Thickness at end systole LA........................................................Left Atrium LAE.....................................................Left Atrial Enlargement LV........................................................Left Ventricular LVH.....................................................Left Ventricular Hypertrophy LVIDd...................................................Left Ventricular Internal Dimension at end diastole LVIDs...................................................Left Ventricular Internal Dimension at end systole LVMI....................................................Left Ventricular Mass Index LVPWTd................................................Left Ventricular Posterior Wall Thickness at end diastole LVPWTs...............................................Left Ventricular Posterior Wall Thickness at end systole xii MMSH.................................................Murtala Muhammad Specialist Hospital MV......................................................Mitral Valve NYHA FC...........................................New York Heart Association Functional Class PASP................................................ Pulmonary Artery Systolic Pressure PPCM...................................................Peripartum Cardiomyopathy PV.........................................................Pulmonary Valve PVC.......................................................Premature Ventricular Contraction SBP........................................................Systolic Blood Pressure RV.........................................................Right Ventricular RVOTd..................................................Right Ventricular Outflow Tract in diastole RVOTs...................................................Right Ventricular Outflow Tract in systole SBP........................................................Systolic Blood Pressure SF...........................................................Shortening Fraction SPSS.......................................................Statistical Package for Social Sciences STAT-3...................................................Signal Transduction and Activator of Transcription -3 TAPSE....................................................Tricuspid Annular Plane Systolic Excursion TNF-α.....................................................Tumour Necrosis Factor alpha xiii TV...........................................................Tricuspid Valve U/E/Cr.....................................................Urea/Electrolytes/Creatinine