CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE
7, AUGUST 2012
Nephrology Congress Book of Abstracts
2012
• ePub Version - For Apple iPad / iPhone (iBooks) / Tablet Devices
• Mobi Version - For Kindle Devices & Kindle apps on tablet devices
• PDF Version - For readers that will be using their laptop/pc devices
This journal is now available to be viewed via our eJournal publication viewer.
• ePub Version - For Apple iPad / iPhone (iBooks) / Tablet Devices
• Mobi Version - For Kindle Devices & Kindle apps on tablet devices
• PDF Version - For readers that will be using their laptop/pc devices
This journal is now available to be viewed via our eJournal publication viewer.
- Title: New impact factor and PubMed
Central Service from the Cardiovascular Journal
of Africa : from the editor's desk
Authors: Brink, Andries
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 364
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
Abstract: The Cardiovascular Journal of Africa is pleased to announce an increase in its 2011 impact factor to 0.767, as provided by Thompson Reuters (ISI). Currently, we rank 161 out of 273 indexed journals in the field of cardiology and cardiovascular medicine throughout the world, according to the Scopus journal-rating system. The Cardiovascular Journal of Africa is truly entrenched in Africa and worldwide.
- Title: Management of acute coronary
syndrome in South Africa : insights from the
ACCESS (Acute Coronary Events - a Multinational
Survey of Current Management Strategies)
registry : cardiovascular topics
Authors: Schamroth, Colin
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 365-370
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-017
Abstract: Background : The burden of cardiovascular diseases is predicted to escalate in developing countries. While many studies have reported the descriptive epidemiology, practice patterns and outcomes of patients hospitalised with acute coronary syndromes (ACS), these have largely been confined to the developed nations.
Methods : In this prospective, observational registry, 12 068 adults hospitalised with a diagnosis of ACS were enrolled between January 2007 and January 2008 at 134 sites in 19 countries in Africa, Latin America and the Middle East. Data on patient characteristics, treatment and outcomes were collected.
Results : Of the 642 patients from South Africa in the registry, 615 had a confirmed ACS diagnosis and form the basis of this report; 41% had a discharge diagnosis of ST-segment elevation myocardial infarction (STEMI) and 59% a diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS), including 32% with non-ST-segment elevation myocardial infarction (NSTEMI) and 27% with unstable angina (UA).
During hospitalisation, most patients received aspirin (94%) and a lipid-lowering medication (91%); 69% received a beta-blocker, and 66% an ACE inhibitor/angiotensin receptor blocker. Thrombolytic therapy was used in only 18% of subjects (36% of STEMI patients and 5.5% of NSTE-ACS patients). Angiography was undertaken in 93% of patients (61.3% on the first day), of whom 53% had a percutaneous coronary intervention (PCI) and 14% were referred for coronary artery bypass surgery. Drugeluting stents were used in 57.9% of cases. Clopidogrel was prescribed at discharge from hospital in 62.2% of patients.
All-cause death at 12 months was 5.7%, and was higher in patients with STEMI versus non-ST-elevation ACS (6.7 vs 5.0%, p < 0.0001). Clinical factors associated with higher risk of death at 12 months included age ≥ 70 years, presence of diabetes mellitus on admission, and a history of stroke/transient ischaemic attack (TIA).
Conclusions : In this observational study of ACS patients, the use of evidence-based pharmacological therapies for ACS was quite high. Interventional rates were high compared to international standards, and in particular the use of drug-eluting stents, yet the clinical outcomes (mortality, re-admission rates and severe bleeding episodes at one year) were favourable, with low rates compared with other studies.
- Title: Social drift of
cardiovascular disease risk factors in Africans
from the North West Province of South Africa :
the PURE study : cardiovascular topics
Authors: Pisa, P.T.; Behanan, R.; Vorster, H.H.; Kruger, A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 371-378, e379-e388
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-018
Abstract: Objective : This study examined whether the association between socio-economic status (SES) and cardiovascular disease (CVD) risk factors in black South Africans from the North West Province had shifted from the more affluent groups with higher SES to the less affluent, lower SES groups over a period of nine years.
Method : Cross-sectional baseline data of 2 010 urban and rural subjects (35 years and older) participating in the Prospective Urban and Rural (PURE) study and collected in 2005 were analysed to examine the relationship of level of education, employment and urban or rural residence with dietary intakes and other CVD risk factors. These relationships were compared to those found nine years earlier in the Transition and Health during the Urbanisation of South Africans (THUSA) study conducted in the same area.
Results : The results showed that urban women had higher body mass index (BMI), serum triglyceride and fasting glucose levels compared to rural women and that both urban men and women had higher blood pressures and followed a more Westernised diet. However, rural men and women had higher plasma fibrinogen levels. The more highly educated subjects (which included both urban and rural subjects) were younger than those with no or only primary school education. Few of the risk factors differed significantly between education groups, except that more highly educated men and women had lower BMIs, and women had lower blood pressure and triglyceride levels. These women also followed a more prudent diet than those with only primary school education. Employed men and women had higher BMIs, higher energy intakes but lower plasma fibrinogen levels, and employed women had lower triglyceride levels. No significant differences in total serum cholesterol values were observed.
Conclusion : These results suggest a drift of CVD risk factors from groups with higher SES to groups with a lower SES from 1996 to 2005, indicating that interventions to prevent CVD should also be targeted at Africans living in rural areas, those with low educational levels, and the unemployed.
- Title: Target-organ damage and
cardiovascular complications in hypertensive
Nigerian Yoruba adults : a cross-sectional study
: cardiovascular topics
Authors: Oladapo, O.O.; Salako, L.; Sadiq, L.; Shoyinka, K.; Adedapo, K.; Falase, A.O.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 379-384
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-021
Abstract: Background : Hypertension is a major challenge to public health as it is frequently associated with sudden death due to the silent nature of the condition. By the time of diagnosis, some patients would have developed target-organ damage (TOD) and associated clinical conditions (ACC) due to low levels of detection, treatment and control. TOD and ACC are easy to evaluate in a primary healthcare (PHC) setting and offer valuable information for stratifying cardiovascular risks in the patient. The aim of this study was to evaluate the prevalence and correlates of TOD and established cardiovascular disease (CVD) in hypertensive Nigerian adults.
Methods : A cross-sectional study was conducted on 2 000 healthy Yoruba adults between 18 and 64 years who lived in a rural community in south-western Nigeria. Participants diagnosed to have hypertension were examined for TOD and ACC by the presence of electrocardiographically determined left ventricular hypertrophy (LVH), microalbuminuria or proteinuria, retinopathy, or history of myocardial infarction and stroke.
Results : A total of 415 hypertensive participants were examined and of these, 179 (43.1%) had evidence of TOD and 45 (10.8%) had established CVD. TOD was associated with significantly higher systolic (SBP) and diastolic blood pressure (DBP). The prevalence of LVH was 27.9%, atrial fibrillation 16.4%, microalbuminuria 12.3%, proteinuria 15.2%, hypertensive retinopathy 2.2%, stroke 6.3%, congestive heart failure (CHF) 4.6%, ischaemic heart disease 1.7%, and peripheral vascular disease 3.6%. Compared with those with normal blood pressure (BP), the multivariate adjusted odds ratios (95% confidence interval) of developing TOD was 3.61 (0.59-8.73) for those with newly diagnosed hypertension; 4.76 (1.30-13.06) for those with BP ≥ 180/110 mmHg; and 1.85 (0.74-8.59) for those with diabetes mellitus.
Conclusions : This study provides new data on TOD and its correlates in a nationally representative sample of hypertensive adults in Nigeria. In this low-resource setting, attempts should be made to detect hypertensive patients early within the community and manage them appropriately before irreversible organ damage and complications set in. The methods used in this study are simple and adaptable at the primary healthcare level for planning prevention and intervention programmes.
- Title: William Nelson ECG quiz
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 384, 409
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
Abstract: William Nelson ECG quiz
- Title: Prevalence of cardiac
dyssynchrony and correlation with atrio-ventricular
block and QRS width in dilated cardiomyopathy :
an echocardiographic study : cardiovascular
topics
Authors: Anzouan-Kacou, J.B.; Ncho-Mottoh, M.P.; Konin, C.; N'Guetta, A.R.; Ekou, K.A.; Koffi, B.J.; Soya, K.E.; Tano, M.E.; Abouo-N'Dori, R.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 385-388
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-032
Abstract: Introduction : Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block and atrio-ventricular dyssynchrony (AVD), and between impaired intra-ventricular conduction and the existence of inter-ventricular dyssynchrony (inter-VD) and intra-left ventricular dyssynchrony (intra-LVD).
Methods : We included 40 patients in New York Heart Association stage III or IV, admitted consecutively with DCM with severe left ventricular dysfunction (left ventricular enddiastolic diameter ≥ 60 mm and/or ≥ 30 mm/m2) and left ventricular ejection fraction < 35%. Electrocardiographic and echocardiographic data were evaluated in all patients. Patients were divided into two groups: group 1: eight patients, with a QRS duration ≥ 120 ms, and all presented with left bundle branch block; group 2: 32 patients with a narrow QRS < 120 ms.
Results : Overall, the mean age was 54.7 ± 16.8 years and patients in group 1 were older (67.2 ± 13.6 vs 51.5 ± 15.8 years, p = 0.01). The prevalence of atrio-ventricular dyssynchrony (AVD), inter-VD and intra-LVD was respectively 40, 47.5 and 70%. Two patients (5%) did not exhibit dyssynchrony. AVD was present with a similar frequency in the two groups (37.5% in group 1 vs 40.6% in group 2, p = 0.8). There was no correlation of the magnitude of AVD with the duration of the PR interval (from the beginning of the P wave to the beginning of the QRS complex) (r2 = 0.02, p = 0.37) or the QRS width (r2 = 0.01, p = 0.38). A greater proportion of patients with inter-VD was observed in group 1 (87.5 vs 60%, p = 0.03). There was a trend towards a more important inter-ventricular mechanical delay according to QRS width (r2 = 0.009, p = 0.06). The proportion of intra-LVD was similar in all groups, with a high prevalence (87.5% in group 1 and 65.6% in group 2, p = 0.39).
Conclusion : The assessment of cardiac dyssynchrony is possible in our country. Intra-ventricular mechanical dyssynchrony had a high prevalence in patients with DCM, irrespective of the QRS width. These data emphasise the usefulness of echocardiography in the screening of patients.
- Title: Different lipid profiles
according to ethnicity in the Heart of Soweto
study cohort of de novo presentations of heart
disease : cardiovascular topics
Authors: Sliwa, Karen; Lyons, Jasmine G.; Carrington, Melinda J.; Lecour, Sandrine; Marais, A. David; Raal, Frederick J.; Stewart, Simon
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 389-395
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-036
Abstract: Background : Historically, sub-Saharan Africa has reported low levels of atherosclerotic cardiovascular disease (CVD). However as these populations undergo epidemiological transition, this may change.
Methods : This was an observational cohort study performed at Chris Hani Baragwanath Hospital in Soweto, South Africa. As part of the Heart of Soweto study, a clinical registry captured detailed clinical data on all de novo cases of structural and functional heart disease presenting to the Cardiology unit during the period 2006 to 2008. We examined fasting lipid profiles in 2 182 patients (of 5 328 total cases) according to self-reported ethnicity. The study cohort comprised 1 823 patients of African descent (61% female, aged 56 ± 16 years), 142 white Europeans (36% female, aged 57 ± 13 years), 133 Indians (51% female, aged 59 ± 12 years) and 87 of mixed ancestry (40% female, aged 56 ± 12 years).
Results : Consistent with different patterns in heart disease aetiology, there were clear differences in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides across ethnicities (p < 0.001): patients of African descent had the lowest TC and LDL-C levels and Indians the highest. However, there were no significant differences in high-density lipoprotein cholesterol (HDL-C) levels between ethnicities (p = 0.20). Adjusting for age, gender and body mass index, patients of African descent were significantly less likely to record a TC of > 4.5 mmol/l (OR 0.33, 95% CI: 0.25-0.41) compared to all ethnic groups (all p < 0.001).
Conclusions : These data confirm important blood lipid differentials according to ethnicity in patients diagnosed with heart disease in Soweto, South Africa. Such disparities in CVD risk factors may justify the use of specialised prevention and management protocols.
- Title: Effect of perindopril on
pulse-wave velocity and endothelin-1 in black
hypertensive patients : cardiovascular topics
Authors: Osuch, Elzbieta; Du Plooy, Willem J.; Du Plooy, Sandra H.; Bohmer, Linde H.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 396-399
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-043
Abstract: Introduction : We investigated the effect of perindopril on pulse-wave velocity (as indicator of arterial elasticity) and endothelin-1 (ET-1) levels in black hypertensive patients.
Methods : Forty-four newly diagnosed hypertensive patients who received 4 mg perindopril daily were monitored for nine months. Pulse-wave velocity (PWV) was measured noninvasively along the carotid-femoral arterial segment (high elastic content) and the brachial-ulnar segment (low elastic content).
Results : There was a significant increase in arterial elasticity, as indicated by a slower PWV in the carotid-femoral segment of the treatment group, from 11.6 to 7.5 m/s after nine months. The PWV of the treatment group (7.5 m/s) after nine months was lower than that of the healthy volunteer group (8.2 m/s) but it was not statistically significant. No correlation between ET-1 and PWV could be found.
Conclusion : In addition to its blood pressure-lowering effect, our study confirmed the improvement in arterial elasticity in patients on perindopril therapy, without involvement of ET-1.
- Title: The effect of the metabolic
syndrome on the risk and outcome of coronary
artery bypass graft surgery : cardiovascular
topics
Authors: Swart, Marius J.; De Jager, Wihan H.; Kemp, Johann T.; Nel, Paul J.; Van Staden, Sarel L.; Joubert, Gina
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 400-404
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-055
Abstract: Background : The individual components of the metabolic syndrome are risk factors for coronary artery disease. The underlying pathophysiology of a low-grade inflammatory process postulates that the metabolic syndrome could compromise a procedure such as coronary artery bypass graft surgery (CABG) done on cardiopulmonary bypass (CPB).
Methods : From a single institution, 370 patients with the metabolic syndrome (IDF and ATP III criteria) and 503 patients without the metabolic syndrome were identified. The influence of the metabolic syndrome on the pre-operative core risk factors for CABG mortality as well as its effect on the mortality and major morbidity post surgery were investigated.
Results : Patients with the metabolic syndrome were operated on less urgently than those without the metabolic syndrome. The EuroSCORE was also lower in those with the metabolic syndrome. Patients with the metabolic syndrome required fewer units of homologous red blood cells, but stayed statistically longer in hospital.
Conclusions : In this surgical population the metabolic syndrome had no detrimental clinical effect on either the pre-operative risk factors or the outcome after CABG.
- Title: The promise of
computer-assisted auscultation in screening for
structural heart disease and clinical teaching :
review article
Authors: Zuhlke, L.; Myer, L.; Mayosi, B.M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 405-408
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-007
Abstract: Cardiac auscultation has been the central clinical tool for the diagnosis of valvular and other structural heart diseases for over a century. Physicians acquire competence in this technique through considerable training and experience. In Africa, however, we face a shortage of physicians and have the lowest health personnel-to-population ratio in the world. One of the proposed solutions for tackling this crisis is the adoption of health technologies and product innovations to support different cadres of health workers as part of task shifting.
Computer-assisted auscultation (CAA) uses a digital stethoscope combined with acoustic neural networking to provide a visual display of heart sounds and murmurs, and analyses the recordings to distinguish between innocent and pathological murmurs. In so doing, CAA may serve as an objective tool for the screening of structural heart disease and facilitate the teaching of cardiac auscultation. This article reviews potential clinical applications of CAA.
- Title: South African Heart
Association Congress
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 410-411
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
Abstract: The Cardiovascular Journal of Africa recently attended the 13th annual SA Heart congress, which was held at Sun City from 19-22 July.
- Title: Treating angina pectoris with
If channel blockade : evaluating treatment with
a newer agent : conference reports
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 412, 415
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
Abstract: The medical treatment of angina has become the poor relative in coronary artery disease (CAD) management, having been largely overshadowed by percutaneous coronary intervention and bypass surgery. Nonetheless, in angina patients with minor coronary involvement, in the very elderly, in patients with substantial comorbidity, and in those not wishing to have an intervention, so-called 'conservative' medical therapy is appropriate.
- Title: Catheter ablation of atrial
fibrillation : evidence shows significant
benefit and reduced progression of disease :
conference report
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: 415-416
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
Abstract: Catheter ablation for patients with paroxysmal atrial fibrillation (PAF) and long-standing atrial fibrillation (LS-AF) delays progression of the disease, with improved results if patients are treated early and aggressively. Presenting the evidence for this approach, Dr R Tilz, representing Prof K Kuck of St Georg Hospital, Hamburg, Germany, noted that clinicians should consider AF ablation earlier and not wait too long.
- Title: Severe cardiac failure due to
rapidly progressive rheumatoid
arthritis-associated valvulopathy : case report
- online article
Authors: Tarkin, Jason M.; Hadjiloizou, Nearchos; Savage, Henry Oluwasefunmi; Prasad, Sanjay K.; Sheppard, Mary N.; Moat, Neil E.; Kaddoura, Sam
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: e1-e3
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-012
Abstract: Cardiac failure due to rapidly progressive valve disease is a rare complication of rheumatoid arthritis (RA) that can be challenging to manage. A patient with severe heart failure secondary to RA who, after failing to respond to medical therapy, underwent high-risk valve surgery and did remarkably well, with dramatic symptomatic improvement and essentially normalised left ventricular size and function as seen on follow-up echocardiography.
- Title: HIV infection, pulmonary
arterial hypertension and pregnancy : a fatal
triad : case report - online article
Authors: Nyo, Myat Tun Lin; Schoeman, Leann; Sookhayi, Raveendra; Mayosi, Bongani M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: e4-e6
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-020
Abstract: A 30-year-old pregnant HIV-seropositive woman presented with symptoms and signs suggestive of severe pulmonary arterial hypertension, with a fatal outcome. Histological features of pulmonary arterial hypertension were present at post mortem. This is the first report of histologically confirmed HIV-associated pulmonary arterial hypertension associated with pregnancy in Africa.
- Title: Triple papillary
fibroelastomas in an asymptomatic patient : case
report - online article
Authors: Kireyev, D.; Ashraf, M.H.; Wilson, M.F.
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: e7-e9
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-024
Abstract: Papillary fibroelastoma is the third most common type of primary cardiac tumour. Even though the majority of patients with these tumours are asymptomatic, they may present with embolic phenomena, syncope and death. This report describes a patient with papillary fibroelastomas affecting all three cusps of the aortic valve, with accompanying transoesophageal echocardiography and images of surgical specimens of the tumours.
- Title: Cardiac mass in a patient
with sigmoid adenocarcinoma : a metastasis? :
case report - online article
Authors: Ngow, Harris A.; Khairina, W.M.N. Wan
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: e10-e12
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-027
Abstract: Cardiac metastasis from a bowel malignancy seldom occurs and there is a limited number of case reports published on this subject. Although colorectal cancer is the third commonest malignancy in Malaysia, the incidence of cardiac metastasis has never been reported. We report a case of an elderly man with recently diagnosed adenocarcinoma of the sigmoid colon, who presented with congestive cardiac failure secondary to mechanical obstruction by a right atrial mass. The intractable shock led to his sudden death before any intervention could be planned. If an intra-cavity cardiac mass is detected in a patient with an underlying metastatic malignancy, cardiac metastasis should be suspected. However, primary cardiac tumour or thrombus could also be the differential diagnosis. In our case, the definitive cardiac pathology remained unsolved as an autopsy was refused.
- Title: Isolated lower limb ischaemia
as an unusual presenting symptom of aortic
dissection : case report - online article
Authors: Lee, Chih-Hsien; Chang, Cheng-Hsi; Tsai, Yi-Ting; Wu, Ching-Wen
From: Cardiovascular Journal of Africa, Vol 23, Issue 7, Aug
Published: 2012
Pages: e13-e14
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2012-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-029
Abstract: Acute aortic dissection is not common but usually presents with a severe, sharp chest pain and high blood pressure. Widening of the mediastinum is usually also evident on chest X-ray. Although acute onset of severe chest or back pain is the most common presenting symptom, some patients may present with atypical symptoms and signs.
Establishing a diagnosis of aortic dissection can be difficult in the presence of atypical symptoms, especially in the absence of pain. Such presentation of aortic dissection is easily ignored. We report a case of painless aortic dissection with normal blood pressure, which resulted in acute isolated lower limb ischaemia at presentation.
Atypical presentation of isolated limb arterial occlusions in an older patient without the classic symptoms are seldom reported as aortic dissection. However, aortic dissection should be included in the differential diagnosis of patients with arterial occlusive disease without chest pain and with normal blood pressure.
