CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE
9, OCT 2012
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- Title: Professor Andries Jacob Brink, FRCP
(London), FACC (USA), Dr Sc Med, Stellenbosch.
29 August 1923 - 17 October 2012
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 476
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Abstract: It is with great regret that we announce the death of our editor-in-chief, Prof Andries Brink, former dean of the Medical Faculty and head of Cardiology at Tygerberg Hospital, University of Stellenbosch, and previously the president of the South African Medical Research Council.
- Title: Cardiotoxicity of plants in South
Africa : editorial
Authors: Van Der Bijl (Jun), Pieter; Van Der Bijl (Sen), Pieter
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 476-477
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Abstract: The floral kingdom of southern Africa comprises well over 30 000 species of higher plants, many of which have the potential to be toxic to animals and humans. Livestock losses due to poisoning by plants have been significant over the years and have prompted extensive research efforts. Although there is a considerable body of information in the veterinary field, there is a paucity of published data on human poisoning in South Africa. While poisoning in livestock and humans is mainly accidental (e.g. confusing toxic with edible species, contamination of foodstuffs, for example by mycotoxins and other toxin-elaborating organisms, or perhaps overwhelmingly by medicinal use of plants in traditional medical practice), it may be deliberate.
- Title: Right ventricular dysfunction in a
hypertensive population stratified by patterns
of left ventricular geometry : cardiovascular
topic
Authors: Karaye, Kamilu M.; Sai'du, Hadiza; Shehu, Mohammed N.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 478-482
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DOI Number: 10.5830/CVJA-2012-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-014
Abstract: Introduction : The aim of this study was to assess the prevalence, determinants and correlates of right ventricular (RV) systolic and diastolic dysfunction (RVSD and RVDD, respectively) in hypertensives, stratified by left ventricular (LV) geometric patterns.
Methods : The study was carried out in Aminu Kano Teaching Hospital in Kano, Nigeria, and was cross-sectional in design. Hypertensive subjects referred for echocardiography were consecutively recruited after satisfying the inclusion criteria. RVSD was defined as either tricuspid annular plane systolic excursion (TAPSE) of < 16 mm, or peak velocity of the systolic wave (Sm) in tissue Doppler imaging (TDI) of the RV lateral tricuspid annulus of < 10 cm/s, or both. RVDD was defined as the ratio of < 1.0 of the peak velocities of the early (Em) to late (Am) diastolic waves in the TDI of the RV lateral tricuspid annulus. Subjects with normal LV geometry (NG) served as controls, and were compared with those who had eccentric (EH) or concentric (CH) LV hypertrophy or concentric LV remodelling.
Results : A total of 128 subjects were recruited. Overall, the prevalence of RVDD almost doubled that of RVSD in the studied subjects (61.72 vs 32.03%, respectively). Subjects with EH had the highest prevalence of RVSD (52.63%), while those with CH had the lowest prevalence (20.69%) (p < 0.01). By contrast, the prevalence of RVDD was high across the four groups without significant statistical difference; as high as 68.52% in subjects with NG and as low as 42.86% in those with CR. LVEF was the only independent determinant of RVSD after controlling for confounding variables, while age was the only determinant of RVDD. Likewise, age was the only correlate for Em:Am ratio, while the best correlate for both TAPSE and Sm was LVEF.
Conclusion : The study has revealed that about two-thirds of the hypertensives had RVDD while about one-third had RVSD. Subjects with EH had the highest prevalence of RVSD, while RVDD was common across all the groups. LVEF and age were the only independent determinants of RVSD and RVDD, respectively.
- Title: Doppler echocardiographic indices in
aortic coarctation : a comparison of profiles
before and after stenting : cardiovascular topic
Authors: Hajsadeghi, Shokoufeh; Fereshtehnejad, Seyed-Mohammad; Ojaghi, Mahshid; Bassiri, Hossein Ali; Keramati, Mohammad Reza; Chitsazan, Mitra; Gholami, Saeid
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 483-490
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DOI Number: 10.5830/CVJA-2012-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-044
Abstract: Background : Diagnosis of aortic coarctation is important as it is a difficult condition to evaluate, especially in adults. A Doppler echocardiographic index could provide a simple tool to evaluate coarctation. This study was performed to compare Doppler echocardiographic profiles before and after stenting and to assess the diagnostic value of a complete list of echocardiographic indices for detecting aortic coarctation.
Methods : This prospective study was conducted on 23 patients with a diagnosis of aortic coarctation based on angiography. Echocardiographic assessment was done twice for all patients before and after stenting. Each time, two-dimensional and Doppler echocardiographic imaging modalities were performed and complete lists of indices were recorded for each case. After comparing the values of indices before and after stenting, diagnostic values of each index were calculated in order to diagnose significant coarctation.
Results : Twenty-three patients, including 16 males and seven females with a mean age of 26.14 ± 10.17 years, were enrolled in this study. Except for the mean velocity and mean pressure gradient of the abdominal aorta, the values of the other indices of the abdominal / descending aorta showed enough change after stenting to indicate significant diagnostic accuracy for detecting aortic coarctation. The velocity-time integral and the pressure half-time were among the indices with the highest accuracy rates for this purpose (all p < 0.001).
Conclusion : Post-stenting echocardiographic profiles could provide a reliable reference value of the normal aortic haemodynamics as a unique identification of each patient and it is presumed that these indices could be used as reliable indicators of response to treatment.
- Title: William Nelson ECG Quiz
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 490, 494
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Abstract: William Nelson ECG Quiz
- Title: A comparative study of amoxicillin,
clindamycin and chlorhexidine in the prevention
of post-extraction bacteraemia : cardiovascular
topic
Authors: Maharaj, Breminand; Coovadia, Yacoob; Vayej, Ahmed C.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 491-494
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DOI Number: 10.5830/CVJA-2012-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-049
Abstract: We evaluated some of the regimens recommended for the antimicrobial prophylaxis of infective endocarditis prior to dental extraction in 160 patients. Group A patients served as the control group, group B subjects rinsed their mouths with chlorhexidene, group C subjects took 3 g amoxicillin orally and group D patients took 600 mg clindamycin orally. The proportion of patients who had post-extraction bacteraemia in groups A, B, C and D was 35, 40, 7.5 and 20%, respectively. The differences between the control and amoxicillin groups (p = 0.003) and between the chlorhexidine and amoxicillin groups (p = 0.0006) were statistically significant. Streptococci were not isolated in any patients in the amoxicillin and clindamycin groups. In our study, none of the regimens were effective in preventing post-extraction bacteraemia.
- Title: Comparison of outcomes in ST-segment
depression and ST-segment elevation myocardial
infarction patients treated with emergency PCI :
data from a multicentre registry :
cardiovascular topic
Authors: Knot, Jiri; Kala, Petr; Rokyta, Richard; Stasek, Josef; Kuzmanov, Boyko; Hlinomaz, Ota; Belohlavek, Jan; Rohac, Fili P.; Petr, Robert; Bilkova, Dana; Djambazov, Slavejko; Grigorov, Mladen; Widimsky, Petr
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 495-500
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DOI Number: 10.5830/CVJA-2012-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-053
Abstract: Background : Traditionally, acute myocardial infarction (AMI) has been described as either STEMI (ST-elevation myocardial infarction) or non-STEMI myocardial infarction. This classification is historically related to the use of thrombolytic therapy, which is effective in STEMI. The current era of widespread use of coronary angiography (CAG), usually followed by primary percutaneous coronary intervention (PCI) puts this classification system into question.
Objectives : To compare the outcomes of patients with STEMI and ST-depression myocardial infarction (STDMI) who were treated with emergency PCI.
Methods : This multicentre registry enrolled a total of 6 602 consecutive patients with AMI. Patients were divided into the following subgroups: STEMI (n = 3446), STDMI (n = 907), left bundle branch block (LBBB) AMI (n = 241), right bundle branch block (RBBB) AMI (n = 338) and other electrocardiographic (ECG) AMI (n = 1670). Baseline and angiographic characteristics were studied, and revascularisation therapies and in-hospital mortality were analysed.
Results : Acute heart failure was present in 29.5% of the STDMI vs 27.4% of the STEMI patients (p < 0.001). STDMI patients had more extensive coronary atherosclerosis than patients with STEMI (three-vessel disease: 53.1 vs 30%, p < 0.001). The left main coronary artery was an infract-related artery (IRA) in 6.0% of STDMI vs 1.1% of STEMI patients (p < 0.001). TIMI flow 0-1 was found in 35.0% of STDMI vs 66.0% of STEMI patients (p < 0.001). Primary PCI was performed in 88.1% of STEMI (with a success rate of 90.8%) vs 61.8% of STDMI patients (with a success rate of 94.5%) (p = 0.012 for PCI success rates). In-hospital mortality was not significantly different (STDMI 6.3 vs STEMI 5.4%, p = 0.330).
Conclusion : These data suggest that similar strategies (emergency CAG with PCI whenever feasible) should be applied to both these types of AMI.
- Title: Think before you say 'pass the salt
please'
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 500, 521
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Abstract: South Africans are eating twice as much salt as they should. Even more alarming, a fifth of South Africans are so entrenched in the salt habit, they add salt to their food without tasting it first. Men are the worst offenders.
- Title: Elevated salivary C-reactive protein
predicted by low cardio-respiratory fitness and
being overweight in African children :
cardiovascular topic
Authors: Naidoo, T.; Konkol, K.; Biccard, B.; Dubose, K.; McKune, A.J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 501-506
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DOI Number: 10.5830/CVJA-2012-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-058
Abstract: Introduction : C-reactive protein (CRP) is a sensitive marker of systemic inflammation and is an independent risk factor for cardiovascular disease. The aim of the study was to examine the relationship between salivary CRP, cardio-respiratory fitness and body composition in a paediatric population.
Methods : This was a cross-sectional study of 170 black South African children (age 9.41 ± 1.55 years, 100 females, 70 males) in grades 3 to 7. Unstimulated whole saliva samples were obtained for the analysis of CRP. Height, mass, skin-fold thickness, resting blood pressure, and waist and hip circumference measurements were obtained. Cardio-respiratory fitness was assessed using a 20-m multi-stage shuttle run. Children were classified as overweight/obese according to the Center for Disease Control and Prevention (CDC) body mass index (BMI) percentile ranking, and meeting percentage body fat recommendations, if percentage body fat was ≤ 25% in boys and ≤ 32% in girls. The cut-off point for low cardio-respiratory fitness was a predicted aerobic capacity value ≤ the 50th percentile for the group. Contributions of low cardio-respiratory fitness, overweight/obesity, and not meeting percentage body fat recommendations, to elevated salivary CRP (≥ 75th percentile) concentration and secretion rate were examined using binary logistic regression analysis with a backward stepwise selection technique based on likelihood ratios.
Results : Poor cardio-respiratory fitness was independently associated with elevated salivary CRP concentration (OR 3.9, 95% CI: 1.7-8.9, p = 0.001). Poor cardio-respiratory fitness (OR 2.7, 95% CI: 1.2-6.1, p = 0.02) and overweight/obesity (BMI ≥ 85th percentile) (OR 2.5, 95% CI: 1.1-5.9, p = 0.03) were independent predictors of elevated salivary CRP secretion rate.
Conclusion : The results suggest a strong association between poor cardio-respiratory fitness and/or overweight/obesity and inflammatory status in children, based on elevated salivary CRP levels.
- Title: Neo-intimal hyperplasia, diabetes and
endovascular injury : review article
Authors: Kruger, Deirdre
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 507-511
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DOI Number: 10.5830/CVJA-2012-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-019
Abstract: Diabetes is a significant major risk factor for peripheral arterial disease (PAD) and critical limb ischaemia (CLI), the latter which is also the most common cause of amputation in these patients. Revascularisation of the lower extremities of such patients is imperative for limb salvage and has become first-line therapy. However, the incidence of restenosis following endovascular stenting is very high and is largely due to neo-intimal hyperplasia (NIH), the regulation of which is for the greater part not understood.
This article therefore reviews our understanding on the regulation of NIH following stent-induced vascular injury, and highlights the importance of future studies to investigate whether the profile of vascular progenitor cell differentiation, neo-intimal growth factors and lumen diameters predict the severity of post-stent NIH in the peripheral arteries. Results from future studies will (1) better our understanding of the regulation of NIH in general, (2) determine whether combinations of any of the vascular factors discussed are predictive of the extent of NIH postoperatively, and (3) potentially facilitate future therapeutic targets and/or change preventive strategies.
- Title: Obesity and its health impact in
Africa : a systematic review : review article
Authors: Adeboye, Bridget; Bermano, Giovanna; Rolland, Catherine
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 512-521
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DOI Number: 10.5830/CVJA-2012-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-040
Abstract: Obesity and its association with co-morbidities in Africa are on the rise. This systematic review examines evidence of obesity and its association with co-morbidities within the African continent. Comparative studies conducted in Africa on adults 17 years and older with mean body mass index (BMI) ≥ 28 kg/m2 were included. Five electronic databases were searched. Surveys, case-control and cohort studies from January 2000 to July 2010 were evaluated. Of 720 potentially relevant articles, 10 met the inclusion criteria. Prevalence of obesity was higher in urban than rural subjects with significant increases in obesity rates among women. Inflammatory marker levels were significantly elevated among Africans compared with Caucasians. The co-relationship between obesity and chronic diseases was also highlighted. This systematic review demonstrates that while obesity remains an area of significant public health importance to Africans, particularly in urban areas, there is little evidence of proper diagnosis, treatment and/or prevention.
- Title: New ESC guidelines on atrial
fibrillation accept reality of next generation
of anti-coagulants : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 522
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Abstract: 'The development of dabigatran and the first results from the use of the novel anticoagulant in the RE-LY trial mark an extremely important time in medical history; the first time in 75 years that physicians have agents that are better than the extremely effective warfarin in secondary stroke prevention.'
- Title: Renal denervation in Symplicity
trials and real-life setting continue to show
significant blood pressure reduction in all
treatment groups : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 524
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Abstract: Medtronic announced at the 2012 European Society of Cardiology (ESC) congress in Munich, Germany, new results from the Symplicity HTN-2 trial, the only randomised clinical trial investigating safety and efficacy of renal denervation. The 18-month follow-up data presented at the ESC congress showed the Symplicity system continues to provide superior and sustained blood pressure reduction in patients with treatment-resistant hypertension.
- Title: Rivaroxaban in acute coronary
syndromes and atrial fibrillation : rivaroxaban
shown to reduce cardiovascular deaths in STEMI
patients : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 525-526
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Abstract: The addition of rivaroxiban to dual therapy for ST-elevation myocardial infarction (STEMI) patients has been shown to reduce recurrent cardiovascular events and cardiovascular death without increasing fatal bleeding, although TIMI non-coronary artery bypass graft (CABG) major bleeding was increased.
- Title: Ivabradine reduces total hospital
burden in heart failure : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 528
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Abstract: Heart rate reduction using ivabradine in patients with chronic heart failure who were in sinus rhythm and with heart rates of at least 70 beats/min resulted in substantially reduced clinical deterioration in total hospitalisations for worsening heart failure and in an increase in time to first and subsequent hospitalisations.
- Title: GARFIELD : a window on the real-life
treatment of atrial fibrillation - South Africa
joins the GARFIELD registry : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: 528
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Abstract: The results of the evaluation of the first cohort of 10 000 newly diagnosed atrial fibrillation (AF) patients in the GARFIELD registry, which reflects contemporary global real-life treatment of AF, has shown that fewer than half of the eligible patients received anticoagulant therapy with vitamin K antagonists. In addition, those patients at significantly increased risk of experiencing stroke or systemic emboli with a CHADS2 risk score greater than 2 were poorly treated.
- Title: Acute anterior myocardial infarction
in an 85-year-old male patient, complicated by
the deadly duo : ventricular septal rupture and
pseudoaneurysm : case report - online article
Authors: Aykan, Ahmet C.; Zehir, Regayip; Karabay, Can Y.; Cakal, Sinem; Poci, Nertil A.; Sonmez, Kenan
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2012-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-039
Abstract: Ventricular septal rupture and ventricular pseudoaneurysm formation are rare complications of acute myocardial infarction. Immediate intervention is mandatory in these circumstances. Our case is a unique presentation of an anterior myocardial infarction in an 85-year-old male, complicated by ventricular septal rupture and ventricular pseudoaneurysm formation.
- Title: Giant pseudoaneurysm of the left
axillary artery following a stab wound : case
report - online article
Authors: Fokou, M.; Eyenga, V.C.; Mefire, A. Chichom; Guifo, M.L.; Pagbe, J.J.; Sandmann, W.
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: e4-e6
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DOI Number: 10.5830/CVJA-2012-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-045
Abstract: Axillary artery pseudoaneurysms are rare. We report on a 30-year-old patient with a 6.5-cm post-traumatic pseudoaneurysm of the left axillary artery two months after a knife stab wound of the shoulder. The patient showed axillary fullness and signs of severe brachial plexus compression. A surgical repair was undertaken. The aneurysm was excluded and a saphenous vein interposition was performed. The early and late postoperative periods were uneventful. This is probably not only the largest axillary artery pseudoaneurysm ever reported, but also the first secondary to a stab wound.
- Title: Acute ST-elevation inferior
myocardial infarction in a patient with a
non-obstructive mechanical mitral valve
thrombosis : case report - online article
Authors: Aykan, Ahmet Cagri; Ozkan, Mehmet; Duran, Nilufer Eksi; Yildiz, Mustafa
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: e7-e8
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DOI Number: 10.5830/CVJA-2012-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-047
Abstract: The risk of systemic embolisation in patients with prosthetic heart valves who are receiving anticoagulation therapy is 0.5 to 1.7% per patient year and most cases present with cerebrovascular events. Here we report the case of a 42-year-old woman who was uneventfully treated with a low dose, prolonged infusion of tissue plasminogen activator because of non-obstructive prosthetic mitral valve thrombosis. It presented as coronary embolism and resulted in acute ST-elevation inferior myocardial infarction.
- Title: Prolonged coagulopathy related to coumarin rodenticide in a young patient :
superwarfarin poisoning : case report - online
article
Authors: Altay, Servet; Cakmak, Huseyin Altug; Boz, Gulsah Cemiloglu; Koca, Sinan; Velibey, Yalcin
From: Cardiovascular Journal of Africa, Vol 23, Issue 9, Oct
Published: 2012
Pages: e9-e11
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DOI Number: 10.5830/CVJA-2012-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-051
Abstract: Superwarfarins (brodifacoum, difenacoum, bromodialone and chlorphacinone) are anticoagulant rodenticides that were developed in 1970s to overcome resistance to warfarin in rats. A 26-year-old previously healthy man was admitted to the emergency department with epigastric pain, severe upper and lower gastrointestinal haemorrhage, gingival bleeding and melena. The patient stated that he had been healthy with no prior hospital admissions and no personal or family history of bleeding diathesis. The patient, who later admitted attempted suicide, stated that he had taken 400 g rodenticide including brodifacoum orally for five days prior to admission to hospital. He had oral mucosal bleeding, numerous bruises over the arms, legs and abdomen, and an abdominal tenderness, together with melena. Laboratory tests revealed a haemoglobin level of 12.3 g/dl, leucocyte count of 9.1 x 109 /l, haematocrit of 28% and platelet count of 280 x 109 /l. The prothrombin time (PT) was > 200 s (normal range 10.5-15.2 s) and the activated partial thromboplastin time (aPTT) was 91 s (normal range 20-45 s). The INR (International normalised ratio) was reported to be > 17 (normal range 0.8-1.2). The thrombin time and plasma fibrinogen levels were in the normal range. The results showed the presence of brodifacoum at a concentration of 61 ng/ml, detected by reversed-phase liquid chromatography.
