CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 20, ISSUE 3, JUNE 2009
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- Title: Discovery of the function of
the heart and circulation of blood : editorial
Authors: Friedland, Gerald
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 160
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Abstract: In Medicine's 10 Greatest Discoveries, which I co-authored with cardiologist Meyer Friedman, we stated that William Harvey's discovery of the function of the heart and the circulation of blood was the greatest medical discovery of all time. Not only did it initiate the field of physiology, but it also introduced the principle of experimentation in medicine.
- Title: Cardiovascular effects of
Ekebergia capensis Sparrm (Meliaceae)
ethanolic leaf extract in experimental animal
paradigms : cardiovascular topic
Authors: Kamadyaapa, D.R.; Gondwe, M.M.; Moodley, K.; Ojewole, J.A.O.; Musabayane, C.T.
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 162-167
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Abstract: The purpose of this study was to examine the in vivo effects of Ekebergia capensis leaf ethanolic extract (EKE) on the blood pressure of anaesthetised normotensive male Wistar rats and conscious weanling Dahl salt-sensitive (DSS) rats, which develop hypertension as they age. To investigate possible mechanism(s) of the extract's hypotensive effects, the contractile or relaxant responses to EKE in the absence or presence of reference drugs were evaluated in Wistar rat isolated aortic rings precontracted with methoxamine hydrochloride (ME, 10 µM).
Acute intravenous administration of EKE elicited hypotensive responses in anaesthetised animals, while sub-chronic treatment with the extract averted the development of high blood pressure in weanling DSS rats. Isometric recordings of methoxamine hydrochloride (ME) pre-contracted, isolated, endothelium-intact and -denuded aortic rings revealed concentration-dependent relaxation responses to EKE (1 - 160 mg/ml). The potency was significantly less in the endothelium-denuded rings. Inhibitors of endothelium-derived relaxing factor (EDRF), L-NAME, methylene blue and indomethacin significantly reduced EKE-evoked vasorelaxations in endothelium-intact aortic rings.
These results indicate that the vasorelaxant effect of EKE was in part mediated via EDRF-dependent or -independent pathways. These observations suggest that the hypotensive effect of EKE was in part mediated via modulation of total peripheral resistance of the vascular smooth muscles.
- Title: Influence of albumin
concentration in priming solution on blood
viscosity under hypothermic conditions :
cardiovascular topic
Authors: Sapmaz, Ismail; Manduz, Sinasi; Sanri, Umut S.; Karahan, Oguz; Dogan, Kasim
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 168-169
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Abstract: Objective: Albumin is used routinely as a plasma volume expander in cardiopulmonary bypass operations. The effect of two different concentrations of albumin in Ringer's lactate on blood viscosity was explored in this study.
Methods: Ten healthy volunteers (all male) were included in the study, based on their haematocrit levels (42.6 ± 0.96). Using a heparinised 50-ml syringe, 40 cm3 of blood were drawn from the antecubital veins of fasting volunteers. Six ml of blood were haemodiluted with 2 ml of albumin (20%), 2 ml of Ringer's lactate containing albumin (1.3%), and 2 ml of Ringer's lactate, in order to simulate cardiopulmonary bypass conditions. Test tubes with the solutions were placed in a 15°C water bath for 25 minutes. Viscosity was measured in the haemodiluted blood samples using an Ostwald viscometer. Relative viscosities of samples were assessed with SPSS software and the ANOVA test.
Results: The mean relative viscosity of Ringer's lactate was 4.19 (± 0.49), that of Ringer's lactate with 1.3% albumin was 4.30 (± 0.31), and of 20% albumin was 7.32 (± 0.71). The relative viscosity of Ringer's lactate and Ringer's lactate with 1.3% albumin were statistically similar, but that of 20% albumin was higher than the Ringer's lactate and Ringer's lactate with 1.3% albumin.
Conclusion: Albumin is used as a plasma volume expander in priming solutions for cardiopulmonary bypass operations, but its effect on blood viscosity depends on the concentration of albumin used.
- Title: The influence of diabetes on
short-term outcome following a prosthetic
above-the-knee femoro-popliteal bypass :
cardiovascular topic
Authors: Mulaudzi, T.V.; Robbs, J.V.; Paruk, N.; Pillay, B.; Madiba, T.E.; Govindsamy, V.
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 170-172
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Abstract: Objectives: To assess the influence of diabetes mellitus on early morbidity and mortality following a femoro-popliteal bypass.
Methods: Clinical data on patients subjected to a prosthetic above-the-knee femoro-popliteal bypass for atherothrombotic disease over a four-year period in the Durban Metropolitan Vascular Service were culled from a prospectively maintained computerised database. The patients were divided into two groups, diabetic and non-diabetic.
Results: Two hundred and seventeen patient records were analysed; 102 (47%) patients were diabetic and 115 (53%) non-diabetic. The mean age in the two groups was almost similar. Differences noted between the two groups were that there was a higher prevalence of males and cigarette smokers in the non-diabetic group and hypertension among the diabetics. The prevalence of ischaemic heart disease in the two groups was not statistically significant. The majority of patients in both groups presented with critical limb ischaemia.
Overall, 208 (96%) of the patients had their procedures performed using loco regional anaesthesia. The incidence of superficial wound infection between the two groups was not statistically significant. Deep infection, which necessitated removal of the graft, and cardiovascular complications were significantly higher in the diabetics. Four patients (3.9%) in the diabetic group and only one (0.9%) in the non-diabetic group died.
Conclusion: Diabetes mellitus significantly increases the incidence of graft sepsis and cardiovascular morbidity in patients undergoing above-the-knee femoro-popliteal bypass.
- Title: Relationship between left
ventricular diastolic function and geometric
patterns in Nigerians with newly diagnosed
systemic hypertension : cardiovascular topic
Authors: Adamu, Umar G.; Kolo, Philip M.; Kitibi, Ibrahim A.; Opadijo, George O.; Omotosho, Ayodele B.O.; Araoye, Matthew A.
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 173-177
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Abstract: Background: It is not known whether abnormalities of left ventricular diastolic function are influenced by the various cardiac geometric patterns in Nigerians with newly diagnosed systemic hypertension.
Objective: To evaluate the relationship between the parameters of left ventricular diastolic function and the geometric patterns in this group of patients.
Methods: Two-dimensional, guided M-mode echocardiography including Doppler was performed in 150 consecutive, newly diagnosed hypertensive individuals and normotensive controls aged between 35 and 74 years. Left ventricular mass index and relative wall thickness were used to classify the hypertensive individuals into four geometric patterns, and the pulsed-wave Doppler parameters obtained were used to categorise the abnormalities of diastolic function.
Results: Four left ventricular geometric patterns were identified : 23 (15.3%) had normal left ventricle geometry, 33 (22%) had concentric remodelling, 37 (24.7%) were found to have eccentric hypertrophy, and concentric hypertrophy occurred in 57 (38%) of the hypertensive individuals. Left ventricular diastolic dysfunction occurred more in hypertensives with concentric left ventricular geometric pattern.Increased left ventricular mass index and relative wall thickness were found to be associated with the mitral E-wave, E/A ratio and pulmonary venous flow S-wave in the hypertensives (p < 0.001).
Conclusion: In newly diagnosed Nigerian hypertensives, the abnormalities in left ventricular diastolic function varied between the different left ventricular geometric patterns, being worst in those with concentric geometry.
- Title: Gender differences in
metabolic risk factor prevalence in a South
African student population : cardiovascular
topic
Authors: Smith, Carine; Essop, M. Faadiel
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 178-182
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Abstract: We determined selected risk factors for the metabolic syndrome and assessed the metabolic risk status (using IDF criteria) of third-year physiology students at Stellenbosch University (88 males and 178 females). Outcome measures included anthropometry [body mass index (BMI), waist circumference, waist-to-hip ratio], blood pressure (BP), resting pulse rate, and fasting blood glucose, total cholesterol and triglyceride levels. In addition, students completed a lifestyle questionnaire.
A number of gender-based differences were found, with male students displaying a greater incidence of risk factors for the metabolic syndrome : 6% of males versus 3% of females displayed a cluster of three risk factors. Twenty-five per cent of female students (but only 14% of males) exhibited waist circumferences above the accepted range, which was positively correlated, for males and females, with both systolic and diastolic BP, and in females only, also with total cholesterol levels. Male students on average exercised more than their female counterparts, but also exhibited poorer eating habits. Average blood triglyceride levels for both male and female students exceeded the accepted threshold (1.85 ± 1.62 mmol/l and 2.15 ± 1.79 mmol/l, respectively).
We concluded that metabolic risk factors were evident in a much younger population than commonly expected. Moreover, the gender-specific differences observed may impact on future risk assessment and preventative measures adopted.
- Title: Echocardiographic assessment
of left atrial size in patients with end-stage
renal disease : cardiovascular topic
Authors: Kocinaj, Dardan; Gashi, Masar; Berisha, Merita; Kocinaj, Allma; Ramadani, Naser; Korca, Hajrije
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 183-186
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Abstract: Background: Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels.
In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease.
Methods: We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05.
Results: The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium.
Conclusion: Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.
- Title: Investigation of predictors
of increased creatine kinase levels following
vascular surgery and the association with peri-operative
statin therapy : cardiovascular topic
Authors: Biccard, B.M.
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 187-191
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Abstract: Although peri-operative statin administration is likely to be cardioprotective, there remains a concern about the risk of rhabdomyolysis and associated renal failure following statin administration in the peri-operative period. The aim of this study was to determine independent predictors of creatine kinase (CK) elevation following vascular surgery.
Design: A retrospective cohort study was conducted. A multivariate analysis using binary logistic regression was conducted of clinical, surgical and laboratory factors which may be associated with a CK exceeding five times the upper limit of normal (ULN).
Results: Four independent predictors associated with a CK > 5 ULN were identified. Statin therapy was protective [odds ratio (OR) 0.096, 95% confidence interval (CI) 0.014-0.68, p = 0.019], and a serum creatinine > 180 µmol.l-1, positive serum troponins and embolectomy and/or fasciotomy were associated with CK elevation (OR 3.32, 95% CI: 1.03-10.7, p = 0.04; OR 5.84, 95% CI: 1.52-22.4, p = 0.01; OR 5.62, 95% CI: 1.14-27.8, p = 0.03 respectively). Statin therapy was associated with decreased mortality (OR 0.26, 95% CI: 0.08-0.86, p = 0.028).
Conclusion: It may be preferable to continue statin therapy in vascular surgical patients even when CK is elevated, as this may decrease mortality if the CK elevation is in the presence of pre-existing renal dysfunction, peri-operative cardiac events or following embolectomy or fasciotomy. Further investigation is required to confirm this observation.
- Title: CT angiography outperforms
stress testing in diagnosing coronary artery
disease
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 191
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Abstract: A study published in the American Journal of Cardiology comparing stress testing and 64-multislice coronary computed tomography angiography (CTA) shows that the latter has superior sensitivity and specificity in diagnosing obstructive coronary artery disease (CAD).
- Title: Unruptured congenital
aneurysm of the sinus of Valsalva in an African
population : a six-year experience at an
echocardiography laboratory : case report
Authors: Morais, Humberto; Caceres-Loriga, Fidel M.; Martins, Telmo; Vandunem, Georgina; Cunha, Rosa
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 192-195
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Abstract: Sinus of Valsalva aneurysms (SVA) are considered rare congenital anomalies. Apart from a few reported cases of SVA in African patients, there is little information on the clinical presentation of this entity in Africans. We describe the clinical and echocardiographic features of four consecutive African patients in whom the diagnosis of SVA was established over the last six years at the echocardiography laboratory of our institution. In this report we compare the clinical and echocardiographic features in our patients with those of others published in the literature.
- Title: Successful surgical treatment
of a rupture to an arteriovenous fistula
aneurysm : case report
Authors: Yang, Tai-Hou; Lee, Chin-Hsien; Tsai, Chien-Sung; Tsai, Yi-Ting
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 196-197
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Abstract: We describe here the successful surgical treatment of a rupture of an arteriovenous fistula (AVF) aneurysm that compromised access for dialysis. A 59-year-old woman had a history of uraemia s/p with an AVF involving the brachial artery and basilic vein that had been superficialised for eight years. A sudden-onset rupture of the aneurysm was diagnosed just after haemodialysis at a local specialist clinic. The patient volunteered to receive emergency surgery. Partial resection of the aneurysm and anastomosis with 4-0 prolene was performed. She was well with regular haemodialysis at the six-month follow-up.
- Title: Cardiac magnetic resonance
predicts reversibility of cocaine-induced
ventricular dysfunction : case report
Authors: Smedema, J.P.
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 198-199
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Abstract: A 30-year-old Caucasian female was admitted with severe biventricular congestive heart failure secondary to cocaine-induced cardiomyopathy. Contrast-enhanced cardiac magnetic resonance did not reveal myocardial oedema or focal fibrosis. The systolic ventricular function recovered fully after 10 weeks of abstinence from cocaine and supportive medical treatment. This case report is the first to describe findings with magnetic resonance for this condition, and briefly discusses its potential value in the evaluation of patients with cocaine-induced heart failure.
- Title: Rheumatic valvular heart
disease in thalassaemic patients : a summary of
reported Thai cases : short communication
Authors: Wiwanitkit, Viroj
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 200
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Abstract: Thalassaemia is a serious inherited disorder with a high prevalence in south-east Asian countries, including Thailand. Several complications of thalassaemia have been documented. Infection is a major problem and the leading cause of death, particularly in E-beta thalassaemia.
- Title: The hyperparathyroid heart
mimicking acute myocardial infarction : short
communication
Authors: Ker, James
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 201-202
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Abstract: Left ventricular hypertrophy is a common complication of primary hyperparathyroidism.
Numerous disturbances of myocardial physiology have been described as a result of excess parathyroid hormone action. In this brief communication, another phenotype of the hyperparathyroid heart is proposed, the 'pseudo-myocardial infarction hyperparathyroid heart'.
- Title: Transoesophageal
echocardiography prior to atrial flutter
ablation averts a dramatic complication : images
in cardiology
Authors: Michael, Kevin A.; Johri, Amer; Baranchuk, Adrian
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 203-204
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Abstract: Catheter ablation is now the primary strategy for typical atrial flutter, given success rates in the order of 95 to 98%, with a low risk of recurrence. It also has a low complication rate but is not entirely risk free, and should still be approached judiciously as is illustrated by the index case.
- Title: Lower aspirin doses in dual
antiplatelet therapy optimise efficacy and
safety : CHARISMA follow-up study : drug trends
in cardiology
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 205
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Abstract: Evaluation of the aspirin dosage required to prevent cardiovascular disease has shown that daily doses of 75 to 81 mg may optimise efficacy and safety for patients requiring aspirin for long-term prevention, especially those receiving dual antiplatelet therapy.
- Title: Consistency of treatment
effect of perindopril and indapamide across
broad spectrum of vascular disease : drug trends
in cardiology
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 206
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Abstract: Evaluation of the 30 000-patient data captured in the ADVANCE, EUROPA and PROGRESS trials has provided strong evidence for a consistent cardiovascular protection effect when perindopril / indapamide is used as the ACE inhibitor treatment regimen. This view was expressed by the main investigators who participated in these trials in a recent advance publication.
- Title: Statins reduce stroke risk by
one-fifth : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 208-209
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Abstract: A meta-analysis of 24 studies comprising more than 165 000 patients has shown that use of statins was associated with a reduction in stroke risk of around one fifth compared with placebo. The findings and their implications for cholesterol control were reported in a review in the May edition of the Lancet Neurology, written by Dr Pierre Amarenco and Julien Labreuche, INSERM and Bichat University Hospital, Paris-Diderot University, Paris, France.
- Title: Clopidogrel / aspirin
combination therapy in high-risk atrial
fibrillation patients : drug trends in
cardiology
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 210
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Abstract: A combination of clopidogrel and aspirin reduced the incidence of major vascular events by 11%, including a 28% reduction in stroke and a 23% reduction in myocardial infarction in high-risk patients with atrial fibrillation (AF), according to research presented at the 2009 American College of Cardiology's annual scientific session.
- Title: JUPITER study highlights
value of anti-inflammatory action of
rosuvastatin : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 211
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Abstract: Cardiologists in South Africa and internationally are increasingly using highsensitivity C-reactive protein (hsCRP) to improve risk assessment following the positive results of the JUPITER study with rosuvastatin.
- Title: Mother of the nation honoured
: cardio news
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 212
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Abstract: One of the nation's best-loved mothers, Mama Albertina Sisulu, was honoured for her legacy of care of underprivileged children, by the Walter Sisulu Paediatric Cardiac Centre for Africa (WSPCCA) and the Vodacom Foundation at a Mother's Day function in Johannesburg recently.
- Title: Save these dates
From: Cardiovascular Journal of Africa, Vol 20, Issue 3, Jun
Published: 2009
Pages: 212
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Abstract: Generic Medicines Congress : The Science of our Times
The 16th Biennial South African Hypertension Society (SAHS) Congress 2010
