Heart Failure in Lubumbashi: Clinical presentation and putative role of heavy metals

Abstract

In Katanga Copperbelt (KC), among the many known cardiovascular risk factors should also be included the environmental risk. Indeed, copper, the most widespread metal of the region that makes it famous, as well as other metals or metalloids such as arsenic, chromium, cadmium, thallium, and uranium have been associated with dilated cardiomyopathy when their blood and/or urine levels were above a certain threshold. This new risk factor, to be taken into account in KC, therefore calls for more prevention (through the cleansing of the environment) and more comprehensive management, including the systematic dosing of metals for any case of dilated cardiomyopathy and treatment comprising in particular antioxidants and metal chelators. Non-ischemic cardiomyopathies remain the leading cause of heart failure in the KC region. Morbimortality associated with heart failure is very important. The poverty of the population and the country does not allow the organization of the care and follow-up of the patients. Because of this, many become untraceable once they have been released from the hospital. Ventricular arrhythmias (PVC and NSVT) are very common at the time of diagnosis of heart failure particularly in the slightly older patients and those with low systolic blood pressure. Management, including close monitoring and optimal drug therapy, should be instituted for each patient. Finally, many biological disturbances characterize patients with heart failure. Hyperuricemia and hypocalcemia, in particular, have been associated with early mortality. These disturbances require appropriate management to reduce patient mortality.