Spectrum of ecg abnormalities seen at the first visit of patients to a cardiology clinic in enugu, nigeria

Objective: Hypertension, heart failure and chest pain are among the commonest indications for referral of patients to cardiologists in Nigeria. Often times these patients present at advanced stages of the illnessess, when cardiovascular complications are already present. It is therefore not surprising that many patients referred to the cardiologists in Nigeria present for the first time with significant ECG abnormalities. We set out to find the common ECG abnormalities seen at the first presentation of patients at a cardiology clinic in Enugu, Nigeria. Design and Method: The case notes of all the patients referred to the Cardiology clinic of Kenechukwu Specialist Hospital, Enugu from January 2012 to April 2022 were retrospectively reviewed. Data obtained from the case notes included age, gender, indication for referral, pulse, blood pressure and ECG findings at first presentation. Data was analyzed using SPSS version 22.0. Results: A total of 356 patients aged 15–100 years were referred to the clinic within the period under review, made up of 223 males (62.6%) and 133 females (37.4%). The mean age of the patients was 55.21 ± 16.8 years. The commonest indications for referrals were hypertension (65.4%), breathlessness (8.4%), and chest pain (6.5%). The commonest structural abnormalities on ECG were left atrial abnormality (19.4%), left ventricular strain pattern (9.8%), and old infarcts (7.9%). The commonest rhythm abnormalities were atrial fibrillation (2.8%), atrial flutter (0.8%), complete heart block (0.6%). First degree atrioventricular block was the commonest conduction abnormality (10.4%), followed by left anterior hemiblock (5.1%) and complete right bundle branch block (4.8%). Conclusion: A good number of patients referred to specialist cardiology clinics in Nigeria are hypertensive, and present with significant electrocardiographic abnormalities at the time of first assessment. This may be explained by the asymptomatic nature of hypertension which makes a lot a patients seek medical attention only when they have symptoms. These symptoms are often from the complications of hypertension, some of which may be produce significant abnormalities on ECGs.