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
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.
From the Editor’s Desk
Professor PJ Commerford