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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017



Call me old fashioned if you wish, but I remain saddened by

the apparent erosion of clinical skills in cardiology and the

determined rush to involve ever more-sophisticated imaging

modalities prior to simple clinical evaluation, examination of

a chest radiograph and an ECG. The ECG remains one of the

oldest ways of evaluating the heart; it is cheap and non-invasive

and when interpreted correctly, can contribute an enormous

amount of information. In this issue of the journal, Viljoen and

colleagues (page 257) provide an example of the utility of the

simple resting 12-lead ECG in explaining the patient’s symptoms

and prompting appropriate treatment. If this ECG abnormality

had been recognised at primary or secondary level, the patient

could have been referred promptly. Instead, he joined the queue

for unnecessary echocardiography. This will, I hope, be the first

in an ECG series, of which each will consist of a brief clinical

vignette, an ECG and an explanation linking the clinical features

to the ECG.

It is a particular pleasure to write this piece to introduce the

articles in this issue. All of them emanate from Africa and all

address common and important diseases of Africa. On page 262,

Dzudie and his colleagues from PASCAR outline a roadmap

for hypertension in Africa. The intention is to develop practical

guidelines on how to implement strategies that translate existing

knowledge into effective action and improve detection, treatment

and control of hypertension in sub-Saharan Africa by the year

2025. Given the importance of hypertension to cardiovascular

disease in Africa, successful adoption of such a roadmap should

make a major contribution to health on the continent.

Rheumatic heart disease remains a problem in Africa. Given

the scarcity of surgical facilities, prevention and secondary

prophylaxis remain at the heart of attempts to control the

condition, and Long and colleagues (page 242) describe an

initiative in Zambia, consisting of an educational and access-

to-medicine programme aimed at increasing appropriate use

of benzathine penicillin for the prevention and management of

rheumatic heart disease. They describe well-established barriers

to correct care, including the concerns of healthcare workers.

Gratifyingly, they are able to show a measure of success, as

indicated by increased use of benzathine penicillin.

A programme such as that described by Long will only

succeed on a large scale if it is incorporated into an effective

primary care network such as that envisaged for Africa by Ojji

and co-authors (page 251). Such a programme requires effective

political will and has substantial financial implications but

remains essential.

Continuing the theme of rheumatic heart disease, in a

retrospective record review, Makrexeni and colleagues describe

the spectrumof rheumatic heart disease at a paediatric cardiology

tertiary care service in Port Elizabeth, South Africa (page 248).

Sadly, the majority presented with established structural heart

disease and a minority with acute rheumatic fever, which would

allow institution of effective prophylaxis. Such retrospective

series are often criticised but they do serve the important role of

reminding us of the reality of our day-to-day practice.

Meel and co-authors (page 215), using echocardiographic

evaluation of a contemporary cohort of patients with rheumatic

mitral regurgitation, describe similar changes to the presentation

at another institution, with few patients having acute rheumatic

fever, most being older and characterised by more co-morbidities

and thickened and calcified valves.

Endomyocardial fibrosis remains a rare and poorly

understood condition with striking geographic variability in

its distribution. Khalil and co-authors present an analysis of

their echocardiographic experience (page 208) and provide

echocardiographic images, which should be helpful to all

performing imaging in this condition.

It is a great privilege to be able to publish in this journal

the work of African authors reporting their experiences with

important diseases of Africa.

Pat Commerford


From the Editor’s Desk

Professor PJ Commerford