CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 17, ISSUE 4, JULY 2006
- Title: Controlling rheumatic heart
disease in developing countries : editorial
Authors: Carapetis, Jonathan R.; Mayosi, Bongani M.; Kaplan, Edward L.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.164-165
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- Title: Some in vitro and in vivo
cardiovascular effects of Hypoxis hemerocallidea
Fisch & CA Mey Hypoxidaceae) corm (African
potato) aqueous extract in experimental animal
models : cardiovascular topics
Authors: Ojewole, J.A.O.; Kamadyaapa, D.R.; Musabayane, C.T.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.166-171
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Abstract: This study was undertaken to investigate some cardiovascular effects of Hypoxis hemerocallidea Fisch & CA Mey (Hypoxidaceae) corm (African potato) aqueous extract in experimental animal paradigms. The effect of the corm aqueous extract (APE) on myocardial contractile performance was evaluated on guinea-pig isolated atrial muscle strips in vitro; whereas the antihypertensive (hypotensive) effect of the plant extract was examined in hypertensive Dahl salt-sensitive rats in vivo. APE (25-400 mg/ml) produced concentration-dependent, significant (p < 0.05-0.001) negative inotropic and negative chronotropic effects on guinea-pig isolated electrically driven left, and spontaneously beating right atrial muscle preparations, respectively. Moreover, APE reduced or abolished, in a concentrationdependent manner, the positive inotropic and chronotropic responses of guinea-pig isolated atrial muscle strips induced by noradrenaline (NA, 1-100 µM) and calcium (Ca2+, 5-40 mM). The negative inotropic and chronotropic effects of APE on guinea-pig atrial muscle strips were not modified by exogenous administration of atropine (ATR, 7.5 x 10-7-2.5 x 10-6 M) to the bath fluid. APE also significantly reduced (p < 0.05-0.001) or abolished in a concentration-dependent manner, the rhythmic, spontaneous, myogenic contractions of portal veins isolated from rats. Furthermore, APE caused dose-related transient but significant (p < 0.05-0.001) reductions in the systemic arterial blood pressure and heart rates of the hypertensive rats used.
Although the exact mechanisms of the cardiodepressant and the transient hypotensive (antihypertensive) actions of APE could not be established in the present study, we exclude the involvement of the cholinergic system; since the extract's cardiovascular effects were resistant to atropine pretreatment. However, the results of this laboratory animal study indicated that APE caused bradycardia and brief hypotension in the mammalian experimental models used. These observations tend to suggest that the herb may be used as a natural supplementary remedy in some cases of cardiac dysfunctions and in essential hypertension. The findings of this experimental animal study lend pharmacological support to the folkloric, anecdotal uses of the African potato in the management and / or control of certain cardiac dysfunctions and essential hypertension in some rural communities of southern Africa.
- Title: The William Nelson ECG Quiz
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.171, 185
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- Title: A model for determining
baseline morphometrics of the capillary bed in
skeletal muscle : cardiovascular topics
Authors: Gregory, Michael A.; Mars, Maurice
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.172-177
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Abstract: Changes in capillary diameter (CD) have been used to detect the effect of pharmacological interventions, physical treatments and ischaemic reperfusion injury in skin and muscle. For comparison, CDs within similar structures in the untreated limb of the same subject have been used as the control, with the assumption that CDs are the same in both limbs. This study employs light microscopic morphometry (LMM) to explore this premise, investigates the repeatability of LMM and determines the number of CDs that should be measured to produce a reliable result.
Muscle biopsies were obtained from the left (L) and right (R) vastus lateralis of four rabbits and the left and right tibialis anterior of three vervet monkeys. Thin (1-µm) resin sections were prepared for LMM examination and CDs were measured using computerised image analysis. To determine the repeatability of measurement, two specimens were re-measured on five occasions at monthly intervals. The mean CD of each biopsy from L and R limbs were compared and the number of measurements necessary to produce a result with less than a 3% difference was determined.
A minimum of 58 and a maximum of 175 CDs were measured from each specimen. Repeated measurement of the same biopsies showed a non-significant mean difference of less than 2% in CD means between the first measurement and each of the four subsequent measurements. There was a non-significant difference of 3.7% in CD means between R and L limbs in one animal, in which less than 70 CDs were measured on each side. When 100 CDs or more were measured, the difference was always less than 2.3%. When grouped, the difference in CD means between L and R limbs was 0.5% in rabbits and 2.0% in vervet monkeys.
The results confirm that firstly, CD data derived from a muscle in an untreated limb can be used as a control for experiment-mediated changes of CD in the other; secondly, LMM appears to be a reliable means of measuring CD; and thirdly, while fewer measurements may suffice, ideally 75-100 CDs are needed to provide a dependable result.
- Title: An experience with
cardiopulmonary bypass in HIV-infected patients
: cardiovascular topics
Authors: Blyth, D.F.; Buckels, N.J.; Sewsunker, R.R.; Khan, S.; Mathivha, T.M.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.178-185
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Abstract: Having noted the good clinical status of some HIV patients who were referred for but refused surgery, we undertook surgery with the aim of determining outcome, risk-to-benefit ratio and, if possible, the effect of surgery with cardiopulmonary bypass (CPB) on the progression of their HIV disease. Antiretroviral drugs (ARVD) were not available to these patients.
The records of 49 patients, 17 males and 32 females, aged between 17 and 67 years, undergoing surgery with cardiopulmonary bypass over a nine-year period, were reviewed. Forty-eight of these underwent cardiac surgery and one aortic dissection repair. Four HIV-infected patients underwent surgery with good early outcome. Thereafter an absolute CD4 cell count greater than 400/µl (normal 550-1 955/µl) and the absence of the stigmata of AIDS in patients fulfilling the normal criteria for surgery allowed cardiac surgery using CPB. Fifty operations were performed.
Three patients with CD4 counts of 37, 868 and 1 245/µl died early, giving a 30-day mortality of 6% for 50 procedures. Six patients with active infective endocarditis (IE) underwent emergency surgery. Three of these, one with a pre- and two with only post-operative counts all below 250/µl, died within three months. Sixteen complications occurred in the remaining 46 patients (34.7%). Pre-operative CD4 cell counts taken in 42 patients averaged 685/µl. Pre- and post-operative counts known in eight showed variations, as did repeated counts in those awaiting surgery. Forty-one patients left hospital in the New York Heart Association (NYHA) class I, five in class II and one in class III. Prior to surgery, the majority (38) were in class III and seven were in class IV. Follow up ranging from two to 70 months averaged 23.1 months. Eight late deaths occurred, three related to AIDS.
We found surgery to be worthwhile in selected HIV-infected patients. Early outcome paralleled that in the uninfected, giving a low risk-to-benefit ratio. Emergency surgery in those with active infective endocarditis and marked immunocompromise met with high mortality. It is essential in our population to test and stage all patients for HIV. We could not show that CPB accelerated progression to AIDS. This experience and the present availability of ARVDs would enable us to review our selection criteria for surgery.
- Title: Salt intake in an urban,
developing South African community :
cardiovascular topics
Authors: Maseko, Muzi J.; Majane, Harold O.; Milne, John; Norton, Gavin R.; Woodiwiss, Angela J.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.186-191
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Abstract: Introduction: Present guidelines for the diagnosis and management of hypertension indicate that a reduction in sodium (Na+) intake levels and an increase in potassium (K+) intake levels are critical components of blood pressure (BP) control. Whether this is being successfully implemented in urban, developing communities in South Africa is uncertain.
Aims: The first was to assess how mean 24-hour urinary Na+ and K+ excretion rates, used as an index of salt intake, compared against recommended daily allowances (RDA) for Na+ and K+ intake in an urban, developing South African community. The second was to determine the relationship between hypertension awareness and treatment, and 24- hour urinary Na+ and K+ excretion rates in this community.
Methods: Four hundred and thirty-eight subjects living in metropolitan areas of Johannesburg, of whom 291 had complete 24-hour urine collections and BP measurements, obtained on three separate occasions, were randomly recruited. Thirty-one per cent of the sample of 291 subjects were hypertensive (either receiving therapy or with an average BP measured on three separate occasions > 140/90 mmHg). Sixty-seven per cent of hypertensives were aware of their hypertension and were being treated for it. On average, 82% of subjects had 24-hour Na+ excretion values above the RDA for Na+ intake of 65 mmol/day. All subjects had 24- hour K+ excretion rates below the RDA for K+ intake (120 mmol/day). The mean value for 24-hour urinary Na+ and K+ excretion rates (mmol/24 hours) in patients who were aware of their hypertension and receiving treatment for it (n = 61; Na+ = 112 + 54, K+ = 32 + 16) was similar to that of patients who were unaware of their hypertension (n = 30; Na+ = 102 + 49, K+ = 28 + 13), or to normotensives (n = 200; Na+ = 117 + 56, K+ = 33 + 17).
Hypertension awareness and treatment were not associated with electrolyte excretion rates either when considered alone or after adjusting for age, gender, body mass index, alcohol and tobacco intake, the presence of diabetes mellitus and the type of antihypertensive therapy (multivariate regression analysis). Moreover, the proportion of patients who were aware of their hypertension, were receiving treatment for it, and who had 24-hour Na+ excretion values above the RDA for Na+ intake (80%) was similar to the proportion noted in those who were unaware of their hypertension (73%), and to normotensives (84%).
Conclusions: The lack of relationship between either hypertension awareness and treatment, and Na+ and K+ intake levels suggests that current recommendations for a reduced Na+ and increased K+ intake in hypertensives do not translate into clinical practice in urban, developing communities of South Africa.
- Title: Blood pressure-measuring
devices in rural South Africa : an audit
conducted by the SASPI team in the Agincourt
field site : cardiovascular topics
Authors: Connor, M.D.; Hopkins, T.; Tollman, S.M.; Thorogood, M.; Modi, G.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.192-196
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Abstract: Background: Cardiovascular disease is an important cause of morbidity and mortality in South Africa. The Southern Africa Stroke Prevention Initiative (SASPI) found a high prevalence of stroke in the rural Agincourt subdistrict, Limpopo province. Hypertension is the commonest vascular risk factor in our population and it is essential that primary care services be adequately equipped to detect and treat hypertension. The aim of this study was to assess the number, accuracy and working condition of blood pressuremeasuring devices (BMD) in the clinics that serve the field site, and to assess the clinic sisters' perceptions of the availability of antihypertensive medication and aspirin.
Methods: In each of the clinics serving the site we assessed the BMDs and cuffs using the following criteria: general condition, bladder size, state of rubber components, operation of the inlet valve and control of valve operation. The legibility of the gauge, level and condition of the mercury, and the condition of the glass tube were checked when relevant. The performance of the BMD was then assessed both with the cuff used in the clinic and with a new functioning cuff, against an accurate mercury sphygomomanometer. By interviewing the clinic sister we could assess the availability of antihypertensive medication and aspirin, as well as the state of the drug delivery system.
Results: All BMDs were mercury sphygmomanometers. Four clinics had one BMD each, one clinic had two, and one clinic had four. In one clinic the device was not functional at all until the study cuff was used. None of the clinics had spare cuffs and only one clinic had access to a large cuff. Nine out of 10 (90%) cuffs tested had unsatisfactory valve function, and none was of the size recommended by the guidelines. Although the condition of the mercury was only considered satisfactory in 40% of BMDs, once a new cuff had been fitted to the BMDs all of them were accurate to within 4 mmHg between 50 and 250 mmHg. Fifty per cent of clinic sisters felt they always had sufficient stock of hydrochlorothiazide and ?-methyldopa, but the supply of more expensive medication was less reliable. Only one clinic always had sufficient aspirin.
Conclusion: Although none of the primary care clinics had fully functioning BMDs, almost all the defects related to malfunctioning and inappropriately sized cuffs, which would be inexpensive to repair or replace. A procedure for routine servicing or replacement of both BMDs and cuffs is needed, as well as optimisation of medication delivery to remote areas.
- Title: New simulation-technology
training for interventionalists in South Africa
: Baroque Medical and Abbott Vascular satellite
institute : cardiovascular topics
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.198-199
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- Title: Late complication after
closure of a ventricular septal rupture : images
in cardiology
Authors: Smedema, J.P.; Bekkers, Scam; Snoep, G.
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.200-201
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- Title: SYNAGIS(R) proven to reduce
hospitalization due to RSV in children with CHD
: advertorial
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.202
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- Title: Improving endothelial
function and reducing remodeling post-MI are key
to perindopril benefits in coronary artery
disease : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.203-204
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- Title: High-dose atorvastatin
therapy achieves 25% reduction in CV events in
TNT substudy of diabetic patients : drug trends
in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.206, 207
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- Title: Moxonidine well tolerated and
effective in the treatment of viscerally obese,
non-controlled hypertensive patients : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.209
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- Title: 19th World Diabetes Congress
: Cape Town International Convention Centre 3 -
7 December 2006
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.209
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- Title: Advertorial : telmisartan
provides superior BP reduction from morning to
morning compared to other leading ARBs : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.210
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- Title: Acute coronary syndromes :
clearing up controversies in clopidogrel use :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.213-214
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- Title: Abdominal obesity and
cardiovascular risk : does waist circumference
tell the story? : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.215
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- Title: Simvastatin effectively
reduced all triglyceride-rich liporoteins (VLDL
and LDL) in type 2 diabetes using VAP analysis :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.216
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- Title: Tight glycaemic control using
soluble insulin benefits critically ill patients
during hospitalization : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.218
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- Title: SA Hypertension Guidelines
set minimum standards for medical aid schemes :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.218-219
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- Title: Joint World Congress on
Stroke : International Stroke Society,
Mediterranean Stroke Society and Southern
African Stroke Foundation Cape Town, South
Africa, October 26-29, 2006
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.219
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 17, Issue 4, Jul / Aug
Published: 2006
Pages: p.220
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