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Pulmonary Hypertension in Ibadan, Nigeria: A Report of Two Cases.

OM Sogaolu

OS Ogah

OO Oladapo

A Adebiyi

OO Ogunlade

LO Ogunjimi

K Irojah

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

CASE 1:59 year old engineer was first seen and admitted in our unit on the 02nd December, 2005. Main complaints were breathlessness, fatigue, bilateral leg swelling associated with orthopnoea and paroxysmal nocturnal dsypnoea. An echocardiography finding was in keeping with Cor-pulmonale. LFT showed FeV1 – 2.8L, FVC – 2.9L, FeV1/FVC – 96%, no abnormal findings on chest radiograph. Retroviral screen was negative. He was re-admitted 6 months later with deterioration in clinical state, (Repeat ECHO LVID of 1.5cm, estimated pulmonary artery pressure of 87.1mmHg, and moderate tricuspid regurgitation). Chest CT angiography done showed patent pulmonary arteries. Sildenafil citrate was added to his anti-failure regimen then for about three months till it was discontinued due to severe hypotension. He has since been re-admitted three times for cardiovascular stabilization in the last 4 years. He is currently on hospital admission. Repeat ECHO finding of 14 February, 2012, shows an aneursymal dilation of RA and RV with the RV compressing the LV and severe regurgitation. Estimated RVSP was 81mmHg. Pulmonary artery is 2.8cm in diameter. No intramural clot. ((NYHA class III). He was placed on ionotropic support with dopamine in addition to diuretics, warfarin, and oxygen support. He is fairly clinically stable (blood pressure range of 80/60 to 100/70mmHg).

CASE 2: A 36 year old butcher presented 31st July, 2010 with haemoptysis following a blunt chest injury from a fatal RTA. Haemoptysis resolved after about 2 months on conservative management. However, he represented 13 months later following the injury with history of dizziness and fatigue. Felt occasionally breathless on exertion. Not hypertensive. Essential findings on examination included a soft tricuspid pulmonary regurgitant murmur, CXR findings of prominent pulmonary vessels. Echocardiograph shows a dilated right atrium and ventricle, moderate PR and TR, RVSP of 38mmHg. Retroviral screen was negative. A diagnosis of pulmonary hypertension was made; he was placed on nifedipine 20mg bd. On subsequent review, he felt much better with good effort tolerance. He has since remained well and is scheduled for a repeat echocardiograph on his next appointment

CONCLUSION: The two cases highlight clinical challenges that abound in diagnosis and treatment of pulmonary hypertension with current modalities and monitoring in Nigerian patients. We believe that many patients have died without diagnosis being made. Thus there is need for physicians practising in sub-Saharan Africa to develop capacity in the management of these patients.