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Cardiomyopathies and myocardial disorders in Africa: present status and the way forward
1Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. aofalase@gmail.com
Insights
Cardiomyopathies are significant causes of heart disease in Africa, with dilated cardiomyopathy being most common. Hypertension is the leading cause of myocardial disease, while hypertrophic cardiomyopathy is now recognized as genetic.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiomyopathies are major contributors to illness and death in Africa.
- Hypertension is the most frequent cause of myocardial disease, followed by cardiomyopathies.
- Ischemic heart disease remains uncommon in the African population.
Purpose of the Study:
- To review the current landscape of heart diseases in Africa.
- To highlight the prevalence and characteristics of various cardiomyopathies.
- To propose a new classification for myocardial disorders in Africa.
Main Methods:
- A comprehensive review of existing literature on heart diseases in Africa.
- Analysis of epidemiological data and clinical observations.
- Synthesis of findings to identify trends and propose a new classification.
Main Results:
- Dilated cardiomyopathy (DCM) is the most prevalent cardiomyopathy, often linked to hypertensive heart failure.
- Hypertrophic cardiomyopathy, once thought rare, shows global prevalence and is recognized as genetic.
- Endomyocardial fibrosis has decreased in frequency, with an elusive etiology.
- Arrhythmogenic right ventricular cardiomyopathy is reported, but left ventricular non-compaction and ion channelopathies are not.
- Lenegre disease and long-QT syndromes (associated with potassium deficiency) are recognized.
Conclusions:
- Cardiomyopathies remain a critical concern for heart health in Africa.
- Hypertension is a primary driver of myocardial disease.
- A revised classification of myocardial disorders is needed for the African context.
Abstract:
A review of heart diseases in Africa shows that the cardiomyopathies continue to be important causes of morbidity and mortality in the population. Hypertension remains the commonest cause of myocardial disease, followed by the cardiomyopathies. Ischaemic heart disease continues to be rare. Of the cardiomyopathies, dilated cardiomyopathy (DCM) is still the commonest. A large proportion of patients diagnosed with DCM in Africa have been shown to be cases of hypertensive heart failure, with varying degrees of myocardial dysfunction. Hypertrophic cardiomyopathy, which in the past was thought to be rare among Africans, has been shown to have the same prevalence as in other parts of the world. Moreover it is now known to be a genetic disorder. Endomyocardial fibrosis has become rare in communities where it used to be common. Its aetiology continues to be elusive. Arrhythmogenic right ventricular cardiomyopathy has been reported among Africans but there are no reports of left ventricular non-compaction or the ion channelopathies from Africa. Lenegre disease and the long-QT syndromes are well-known entities in clinical practice in Africa although long-QT in Africa is associated with potassium deficiency arising from prolonged treatment with diuretics. Left ventricular non-ischaemic aneurysms still occur but are rare. In view of these, a new classification of myocardial disorders was proposed for Africa.
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