CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 18, ISSUE 6, NOV 2007
  1. Title: Beta-blockers and the treatment of hypertension : it is time to move on : editorial
    Authors: Wiysonge, Charles Shey; Volmink, Jimmy; Opie, Lionel H.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 351-352
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    Abstract: Existing solid scientific evidence with hard outcome data should be the basis for treatment guidelines, and where such evidence is lacking, we must invest in research. A case in point is the initiation of antihypertensive treatment with a beta-blocker.
     
  2. Title: The role of insight into and beliefs about medicines of hypertensive patients
    Authors: Shiri, Clarris; Srinivas, Sunitha C.; Futter, William T.; Radloff, Sarah E.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 353-357
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    Abstract: Objectives: One aim of this study was to determine the level of knowledge and understanding of selected individuals about hypertension, as well as their beliefs and perceptions about medicines. The other purpose was to determine the medicines information provision system that these participants were exposed to.
    Methods: Participants filled in the Beliefs about Medicines questionnaire and one-on-one interviews were conducted. Participants gave informed consent and their health passports were examined. A focus-group discussion was held with some of the nurses at one of the local clinics.
    Results: Participants believed their antihypertensive therapy was necessary for them to maintain their health. However, there was also a high level of concern about the undesirable effects of the medication. Most participants did not understand what hypertension is, however, they were aware of the consequences of uncontrolled blood pressure. There was no structured patient education system at the public clinic investigated.
    Conclusion: A knowledge gap existed which needed to be filled. Participants' concerns about the undesirable effects of antihypertensive therapy needed to be addressed. A structured medicines information provision system is required at the public clinic studied, to ensure that patients receive all the pertinent information about their condition, namely hypertension, and the prescribed therapy.
     
  3. Title: Maternal deaths due to hypertensive disorders in pregnancy : saving mothers report 2002-2004
    Authors: Moodley, J.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 358-361
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    Abstract: Hypertensive disorders of pregnancy (proteinuric hypertension, eclampsia, chronic hypertension, HELLP syndrome) are the commonest direct causes of maternal deaths in South africa. Six hundred and twenty-eight (19.1%) of the 3 406 maternal deaths in a three-year period (2002-2004) were associated with hypertensive disorders of pregnancy. Cerebral complications, mainly cerebral haemorrhage, were the pathological causes of death in approximately 50% of the cases and eclampsia (convulsions in pregnancy associated with high blood pressure) was the commonest clinical condition leading to death from hypertension.
    Avoidable factors, missed opportunities and substandard care in all three categories of patient-related, administrative, and healthcare-related components were found by the assessors of the National Committee on Confidential Enquiries into Maternal Deaths to be prevalent in the majority of the deaths. Prevention of complications by lowering high blood pressure fairly rapidly, early referral of high-risk cases to experts in the field, and the proper use of resuscitation skills should reduce maternal mortality associated with hypertensive disorders of pregnancy.
     
  4. Title: The relationship between level of androgenic hormones and coronary artery disease in men
    Authors: Davoodi, Gholamreza; Amirezadegan, Alireza; Borumand, Mohammad Ali; Dehkordi, Maria Raissi; Kazemisaeid, Ali; Yaminisharif, Ahmad
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 362-366
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    Abstract: Background: Previous studies have shown controversial results on the role of androgens in coronary artery disease (CAD). We performed this study to assess the relationship between androgen levels and selective coronary angiography (SCA) findings.
    Methods: This study was conducted on 502 consecutive men who underwent SCA with different indications in our centre. Medical history and blood samples were taken from all subjects prior to angiography. Free testosterone (FREET) was measured with enzyme-linked immunosorbent assay, and total testosterone (TES) plus dehydroepiandrosterone sulfate (DHEA) were checked with radio-immunoassay. Total cholesterol, high- and low-density lipoprotein cholesterol (HDL and LDL), triglycerides, lipoprotein (a) [Lp(a)] and C-reactive protein (CRP) were also tested in all patients. Angiographic results were reported by two cardiologists and checked for intra- and inter-observer reliability, then interpreted as Gensini score, and on the basis of the number of segments involved. The relationships were assessed with the chi-square test, independent sample t-test, one-way analysis of variances, Pearson's correlation, and univariate and multivariate logistic regression tests.
    Results: Eighty-three (16.5%) of the subjects had single-vessel disease, 108 (21.5%) had two-vesssel, 197 (39.2%) had three-vessel disease, and 114 (22.7%) had normal angiograms or minimal lesions. FREET, TES and DHEA in patients with significant CAD vs normal individuals were 6.69 + 3.20 pg/ml, 16.60 + 6.66 nm/l and 113.38 + 72.9 µg/dl vs 7.12 + 3.58 pg/ml, 15.82 + 7.26 nm/l and 109.03 + 68.19 µg/dl, respectively (p > 0.1). There was no correlation between the Gensini score or the number of involved segments and androgen levels. Triglyceride, total cholesterol, LDL and HDL cholesterol levels also had no correlation with androgenic hormones. However, FREET showed a negative correlation with Lp(a) and CRP (p 0.01, r -0.12; p 0.03, r -0.096, respectively). Moreover, the level of DHEA was lower in diabetics (94.5 + 59.19 µg/dl vs 117.97 + 74.54 µg/dl, p 0.004).
    Conclusions: There was no significant correlation between FREET, TES, DHEA and the presence or severity of CAD. Also, no correlation was found between androgen levels and triglyceride, total cholesterol, LDL and HDL cholesterol levels.
     
  5. Title: Erdosteine ameliorates lung injury induced by transient aortic occlusion in rats
    Authors: Kurtoglu, Tunay; Sacar, Mustafa; Kaan Inan, Bilal; Duver, M. Harun; Guler, Adem; Ucak, Alper; Hulusius, Melih; Yilmaz, Ahmet Tura
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 367-370
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    Abstract: The aim of this experimental study was to evaluate the protective effect of erdosteine on lung injury induced by ischaemia-reperfusion (IR) of the lower extremities of rats. Wistar albino rats (n = 21) were divided into three groups. In the IR group (n = 7), the aorta was cross-clamped for two hours, followed by one hour of reperfusion. In the erdosteine group (n = 7), animals were pretreated with erdosteine 100 mg/kg daily via gastric lavage, starting three days before aortic occlusion. Iin the control group (n = 7), the lungs were removed and blood samples were taken immediately after sternotomy. No treatment was given in the control and IR groups. after both lungs were removed, biochemical parameters were measured and broncho-alveolar lavage (BAL) assessment was made. MDA levels and MPO activities in the lung tissue were significantly reduced in the erdosteine group compared to the IR group. BAL assessment revealed decreased neutrophil counts in the erdosteine-treated group. Pretreatment of animals with erdosteine significantly attenuated transient aortic occlusion-induced remote lung injury, characterised by leukocyte accumulation and lipid peroxidation. The results suggest that erdosteine may be beneficial in amelioration of lung injury caused by IR.
     
  6. Title: Does dipyridamole-induced ischaemia affect NT-proBNP secretion?
    Authors: De Greef, Jacques; Govender, Radha; Vermaak, William; Perumal, Nalini; Libhaber, Elena; Vangu, Mboyo-Di-Tamba
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 371-374
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    Abstract: Background: B-type natriuretic peptide (BNP) and the inactive amino-terminal pro-B-type natriuretic peptide (NT-proBNP) have a prognostic value in heart failure and in myocardial infarction. There has been some evidence that BNP and NT-proBNP can be used in the diagnosis of myocardial ischaemia by improving the sensitivity of exercise-stress testing.
    Objective: To observe the relationship between dipyridamole-induced ischaemia and the secretion of NT-proBNP.
    Methods: A total of 52 consecutive patients, referred for dipyridamole stress 99mTc-sestamibi single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to diagnose reversible ischaemia, were enrolled. NT-proBNP was determined at rest and one hour after infusion of dipyridamole.
    Results: Of the 52 patients, 25 had normal scans, 12 had scans with fixed defects (previous myocardial infarction with no inducible ischaemia) and 15 had reversible perfusion defects (inducible ischaemia). There was no correlation between ischaemia and resting NT-proBNP, post-stress NT-proBNP and the change in NT-proBNP. There was a correlation between ejection fraction, ventricular volumes and resting NT-proBNP.
    Conclusions: NT-proBNP does not add to the diagnosis of myocardial ischaemia in dipyridamole stress MPI.
     
  7. Title: Peri-operative plasma disappearance rate of indocyanine green after coronary artery bypass surgery
    Authors: Sander, Michael; Spies, Claudia D.; Foer, Achim; Syn, Doh-Yung; Grubitzsch, Herko; Von Heymann, Christian
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 375-379
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    Abstract: Splanchnic ischaemia and hepatic dysfunction are severe complications after coronary artery bypass grafting (CABG) and lead to increased morbidity and mortality. Non-invasive determination of the indocyanine green (ICG) plasma disappearance rate (PDR) offers an opportunity for the early diagnosis of hepato-splanchnic hypoperfusion. The aim of this study was to establish the postoperative time course of the ICG PDR in elective uncomplicated CABG surgery.
    After ethical approval and written informed consent, the data of 40 patients were analysed during this prospective study. Measurements of the ICG PDR and cardiac index (CI) in 40 patients undergoing elective CABG surgery were performed immediately after induction of anaesthesia, on admission to the ICU, six hours after admission to the ICU, and on the first postoperative day.
    Prior to surgery, baseline ICG PDR was 17.7 %/min (13.6-20.4) and baseline CI was 2.2 l/min/m2 (1.9-2.4). All measurements after surgery showed a significantly higher PDR and cardiac index compared to the baseline measurements. The only patient with prolonged ICU treatment failed to show this increase in ICG PDR, although the CI did increase after surgery.
    We established normal values of ICG PDR after uncomplicated CABG surgery. The elevated ICG PDR observed in our patients was assumed to be an effect of an increased hepato-splanchnic blood flow due to an increase in the CI. Patients at risk of hepato-splanchnic hypoperfusion, displaying a missed increase or even a decrease in their ICG PDR after surgery might be at risk of hepatic hypoperfusion and in these selected patients the ICG PDR could serve as a tool to guide therapy or to select patients who might benefit from more invasive devices to monitor hepato-splanchnic perfusion and function.
     
  8. Title: False aneurysm of the left ventricle following myocardial infarction : an unusual location : case report
    Authors: Nurozler, Feza; Kutlu, Tolga; Kucuk, Gungor
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 380-382
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    Abstract: A false aneurysm of the left ventricle that is in fact a contained rupture is rare. False aneurysms have been reported to be mostly at the posterior-basal and rarely at the apical segments of the left ventricle. Early surgical intervention is recommended because of the risk of rupture. This report describes the successful surgical management of two patients with false aneurysms of the left ventricle, located at the lateral wall and the inferior wall following a recent inferior and lateral-wall myocardial infarction.
     
  9. Title: A case of takotsubo cardiomyopathy precipitated by lumiracoxib, a selective COX-2 inhibitor : case report
    Authors: Ker, J.; Van Wyk, C.J.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 383-384
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    Abstract: Considerable controversy exists regarding the cardiovascular safety of COX-2 inhibitors, both in patients with and without established cardiovascular disease. Currently, the major focus is on thrombotic complications presenting as myocardial infarction. In this report, we present a case of takotsubo cardiomyopathy, also known as the apical ballooning syndrome, precipitated by the use of lumiracoxib. We are concerned that this might be the first case of COX-2 inhibitor-induced apical ballooning syndrome and that more may follow.
     
  10. Title: Coronary slow-flow phenomenon : case report
    Authors: Paul, Louis C.; Jani, Dinesh; Menete, Alda; Mocumbi, A. Olga; Ferreira, Beatriz
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 385-386
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    Abstract: Slow flow of the contrast in normal coronary arteries is a relatively common finding in patients undergoing routine coronary angiography. The severest form of this phenomenon is known as no flow or TIMI and is uncommon, with life-threatening consequences. We describe a case of slow flow in the left anterior descending artery of a female patient undergoing a diagnostic coronary angiogram.
     
  11. Title: Striving towards the ideal cardiac functional assessment strategy : the contribution of tissue Doppler, strain and strain rate imaging : review article
    Authors: Moolman-Smook, J.C.; Brink, P.A.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 387-392
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    Abstract: In cardiac research, a major goal of prevention of catastrophic events by risk-factor management and earlier detection has, in recent years, led to a proliferation of imaging modalities, moving us from old-fashioned chest X-ray through increasingly sophisticated approaches such as magnetic resonance imaging (MRI) and multi-slice fast computer-aided tomography (CT) scanning. Today, we have the option of using a vast array of invasive and non-invasive approaches, with diverse technical underpinnings, to assess various, and often overlapping aspects of cardiac function.
    Tissue Doppler imaging (TDI) and the related applications of strain and strain rate imaging are new technologies that are now being evaluated in the realm of practical patient care, and the underlying principles remind us that cardiac contractility is a reflection of the integration of muscle fibre architecture, mechanics and metabolism. TDI is the first technology that allowed imaging of motion within the myocardial wall rather than that of the blood pool, and permits analysis of velocities and accelerations from ultrasonic scatterers in muscle. Since its inception, it has been used to evaluate both new cardiac functional parameters as well as conventional function; for some of these, TDI has proven the superior imaging modality, while for others it offers only incremental information over conventional approaches.
     
  12. Title: Surgical management of Takayasu's arteritis in children and adolescents : review article
    Authors: Reddy, Esphiran; Robbs, John V.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 393-396
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    Abstract: There is little information on the surgical management of Takayasu's arteritis in children and adolescents. Information on 30 patients aged between eight and 17 years was culled from a prospectively maintained database on the Vascular Service of the University of KwaZulu-Natal, Durban, South Africa.
    Twenty-one patients had involvement of the descending aorta; in 19, this was confined to the aorta (type 2 disease). One had associated arch disease (type 3) and one had associated cardiac disease (type 4). One patient had isolated axillary artery occlusion (type 5). Eight patients had disease confined to the aortic arch (type 1), 22 had occlusive disease and eight were aneurysmal.
    All patients had operative repairs undertaken. There were no peri-operative deaths in the group who had cerebrovascular reconstruction, and one death (4.5%) in those who had descending aortic replacement. Patients were followed up for between one month and 11 years. Hypertension was improved or cured in 10 of 12 patients. Two died during this period and another five patients (20%) required further surgery for stenosis (three patients) or anastomotic aneurysms (two).
    Conclusion: Bypass surgery yields satisfactory results in this age group in terms of peri-operative and medium-term mortality and morbidity.
     
  13. Title: Warfarin : a dauntingly interactional medication : cardiovascular prescriber
    Authors: Straughan, John L.
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 397-398
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    Abstract: The array of medications that interact with other medications grows apace. No feat of human memory can cope with the available data, nor can dedicated electronic databases keep abreast of the accumulating information. The complexity of the mechanisms of drug-drug interactions is intimidating at every level of investigation.
     
  14. Title: Reducing ocular damage in type 2 diabetes : the FIELD study shows fenofibrate benefits : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 400
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    Abstract: Improved control of blood pressure, lipid levels and particularly of glucose levels has been associated with reduced ocular damage in type 2 diabetes. The early presence of retinopathy in 20% of type 2 diabetic patients at first diagnosis, and patients' fear of blindness due to their diabetes underscores the need to identify individual therapies that can prevent / slow the progression of retinopathy.
     
  15. Title: CORONA study highlights challenges of treating older patients with systolic heart failure : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 18, Issue 6, Nov
    Published: 2007
    Pages: 402, 404
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    Abstract: The trial results of rosuvastatin therapy for older patients with ischaemic systolic heart failure (CORONA) were announced recently at the American Heart Association meeting in Orlando, Florida.
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