CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
196
AFRICA
Quick facts: Rheumatic heart disease in Africa
Liesl Zulkhe (South Africa), Mark Engel (South Africa), Andre Samadoulougou (Burkina Faso), Serigne Ba (Senegal)
•
Infection with
β
-haemolytic strain of Group A
Streptococcus
(GAS) leading to acute rheumatic fever. Recurrent rheumatic
fever episodes lead to RHD.
–– Developing countries show a nine-fold burden of GAS disease compared to the developed world.
•
Most frequent cause of heart failure in children and adults, with a 17.8% 180-day mortality.
•
Females may be more likely to have RHD.
•
Echo-based screening studies in South Africa indicate a higher prevalence than previously estimated.
•
Earlier diagnosis requires:
–– Standardisation of echocardiographic screening, with simple criteria for non-expert staff
–– Evidence-based diagnostic criteria for RHD
–– Determining the significance of sub-clinical carditis
–– Determining the cost-effectiveness of echo screening, and making it practical and affordable.
•
Pregnancy is contra-indicated in the presence of severe cyanosis, advanced heart failure and severe, irreversible pulmonary
arterial hypertension.
•
Favourable maternal outcomes are associated with prior cardiac events, prior surgical valve replacement and cardiac prosthetic
valve.
events in African SCD patients. PWV is
significantly lower in SCD patients than
in controls, but may correlate positively
with the vascular severity in each SCD
Quick facts: WHO–AFRO priorities for NCDs
Boureima Sambo, Congo
•
Primary prevention: to promote interventions to reduce the
main shared modifiable risk factors for NCDs
–– Tobacco and alcohol legislation
–– Improvement of unhealthy diets low in fruit and vegeta-
ble consumption
–– ‘Active living adds years to life’
•
NCD prevention and management at primary healthcare
level:
–– Implement and monitor cost-effective early detection
of NCDs
–– Establish standards of healthcare for common condi-
tions
•
Strategic plan for Africa to be adopted during the course of
2013 in line with the 2011 Brazzaville Declaration of NCD
prevention and control
Quick facts: HIV-associated heart disease in
Africans
Patrice Zabsonre, Burkina Faso
•
Multifactorial pathogenesis of HIV-associated heart disease:
–– HIV infection of cardiomyocytes
–– Myocarditis
–– Other opportunistic infections
–– Mitochondrial toxicity
–– Cytokines
•
Cardiac manifestations are predominantly HIV-related
cardiomyopathy, pericardial disease and valve disease.
•
Myocarditis virtually disappears after the introduction of
highly active antiretroviral therapy (HAART).
•
Incidence of chronic vascular disease increases with
HAART-related improved survival.
•
Despite a high prevalence of rheumatic heart disease,
prevalence of endocarditis in HIV infection is unknown.
population. The prognostic value of PWD
and haemolysis markers will be further
established during on-going follow-up
studies.
B Ranque. The CADRE study (Coeur Arteres et
Drepanocytose)
G Hardy
