CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 22, ISSUE 4, AUGUST 2011
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- Title: Dismal management of
hypertension at primary level : does it reflect
a failure of patients, a failure of the system
or a failure of doctors? : editorial
Authors: Ntusi, N.B.A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 172-174
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Abstract: Hypertension is a major but modifiable risk factor for cardiovascular disease (CVD). About 25% of adults in the world have hypertension and this is expected to increase in the coming years. In sub-Saharan Africa (SSA), the number of hypertensive adults is projected to rise from 80 million in 2000 to 150 million by 2025.
- Title: Proteomic analysis of
mitochondrial proteins in a mouse model of type
2 diabetes : cardiovascular topics
Authors: Essop, M.F.; Chan, W.A.; Hattingh, S.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 175-178
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DOI Number: 10.5830/CVJA-2010-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-058
Abstract: Objective: Impaired mitochondrial function may contribute to the onset of contractile dysfunction with insulin resistance / type 2 diabetes. Our aim was therefore to determine alterations in the mitochondrial proteome of a mouse model of obesity / type 2 diabetes.
Methods: Mitochondrial proteins were isolated from hearts collected from 18- to 20-week-old female db/db mice and compared to matched controls. We performed two-dimensional polyacrylamide gel electrophoresis to determine differentially expressed proteins. Peptides of interest were further analysed by mass spectrometry and Mascot software was employed to identify protein matches.
Results: Our data showed that ATP synthase D chain, ubiquinol cytochrome-C reductase core protein 1 and electron transfer flavoprotein subunit alpha peptide levels were altered with obesity. Moreover, we found coordinate down-regulation of contractile proteins in the obese heart, i.e. α-smooth muscle actin, α-cardiac actin, myosin heavy-chain α and myosin-binding protein C.
Conclusion: We propose that decreased contractile protein levels may contribute to contractile dysfunction of hearts from diabetic mice.
- Title: Late surgical treatment of
tetralogy of Fallot : cardiovascular topics
Authors: Tchoumi, J.C.T.; Ambassa, J.C.; Giamberti, A.; Cirri, S.; Frigiola, A.; Butera, G.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 179-181
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DOI Number: 10.5830/CVJA-2010-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-057
Abstract: Aim: To study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF).
Methods: This retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients' records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery.
Results: Classical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%.
Conclusion: Even if treated later in life, our study showed very good surgical results of patients with ToF.
- Title: Colour M-mode superiority in
evaluation of improvement in myocardial
performance indices following successful
percutaneous coronary intervention (PCI)
Authors: Sattarzadeh, R.; Maleki, M.; Jamalian, A.; Amirpour, A.; Firuzi, A.; Samiei, N.; Esmaeilzadeh, M.; Ghorbani, A.; Tavoosi, A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 182-185
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DOI Number: 10.5830/CVJA-2010-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-061
Abstract: Aim: This study aimed at evaluating the early effects of successful elective percutaneous coronary intervention (PCI) on systolic and diastolic function.
Methods: We consecutively studied the systolic and diastolic function in 21 patients with stable coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) > 40% before and 48 hours after successful elective PCI.
Results: Tei index and systolic indices (LVEF, regional wall motion abnormality score, tricuspid annular plane systolic excursion and peak systolic velocity of mitral and tricuspid annulus) did not change significantly. Among the diastolic indices, only velocity propagation (Vp) improved significantly (from 42.9 ± 10.8 to 51.8 ± 10.7, p-value = 0.008) following PCI. Diastolic velocities, E/A ratio, deceleration time (DT), early and late diastolic velocities of mitral annulus in TDI, pulmonary vein systolic (PVs) and diastolic flow velocity (PVd) did not show significant improvement.
Conclusion: Propagation velocity of mitral inflow was the earliest index to recover following successful PCI in patients with stable CAD.
- Title: Health practitioners' state
of knowledge and challenges to effective
management of hypertension at primary level :
cardiovascular topics
Authors: Parker, A.; Nagar, B.; Thomas, G.; Badri, M.; Ntusi, N.B.A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 186-190
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DOI Number: 10.5830/CVJA-2010-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-066
Abstract: Background : Patient- and physician-related factors impact on the management and control of hypertension.
Objectives : To systematically examine: (1) South African primary care doctors' state of knowledge on the management of hypertension; (2) primary health practitioners' knowledge on the South African hypertension guidelines; (3) current approaches to management of hypertensive patients; and (4) challenges to effective management of hypertension at primary level.
Methods : A cross-sectional, observational study using a semi-structured questionnaire was carried out in two large community health centres (CHCs) in the Cape Town metropole. All 16 doctors employed at both CHCs were voluntarily enrolled, seven (43.7%) of whom were female, with 14 (87.5%) younger than 40 years of age. The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.
Results : Ten (62.5%) of the doctors surveyed aimed to treat hypertension to target, and recommendations on lifestyle modifications were reportedly poorly done. While 11 (68.8%) of the doctors were aware of the South African hypertension guidelines, were (81.8%) of them were not conversant with the contents thereof. Doctors estimated that only 35% of their patients are treated to target. Poor patient adherence to prescribed treatment, language difficulty, heavy patient load, medical staff shortages, and patient loss to follow up were identified by the doctors as significant impediments to the effective management of hypertension at the primary level of care.
Conclusion : Primary healthcare practitioners' knowledge regarding hypertension and the South African hypertension guidelines is poor. Management of hypertension by these doctors is sub-optimal. There are significant challenges to effective management of hypertension at this level of care.
- Title: William Nelson ECG Quiz
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 190, 196
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Abstract: William Nelson ECG Quiz
- Title: The state of heart disease in
Sudan : review article
Authors: Suliman, A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 191-196
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DOI Number: 10.5830/CVJA-2010-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-054
Abstract: Cardiovascular disease (CVD) is the leading cause of mortality worldwide and an important cause of disability. In Africa, the burden of CVD is increasing rapidly and it is now a public health concern. Epidemiological data on diseases is scarce and fragmented on the continent.
Aim: To review available data on the epidemiology and pattern of heart disease in Sudan.
Methods: Data were obtained from the Sudan Household Survey (SHHS) 2006, annual health statistical reports of the Sudan Federal Ministry of Health, the STEPS survey of chronic disease risk factors in Sudan / Khartoum, and journal publications.
Results: The SHHS reported a prevalence of 2.5% for heart disease. Hypertensive heart disease (HHD), rheumatic heart disease (RHD), ischaemic heart disease (IHD) and cardiomyopathy constitute more than 80% of CVD in Sudan. Hypertension (HTN) had a prevalence of 20.1 and 20.4% in the SHHS and STEPS survey, respectively. There were poor control rates and a high prevalence of target-organ damage in the local studies. RHD prevalence data were available only for Khartoum state and the incidence has dropped from 3/1 000 people in the 1980s to 0.3% in 2003. There were no data on any other states. The coronary event rates in 1989 were 112/100 000 people, with a total mortality of 36/100 000. Prevalence rates of low physical activity, obesity, HTN, hypercholesterolaemia, diabetes and smoking were 86.8, 53.9, 23.6, 19.8, 19.2 and 12%, respectively, in the STEPS survey. Peripartum cardiomyopathy occurs at a rate of 1.5% of all deliveries. Congenital heart disease is prevalent in 0.2% of children.
Conclusion: Heart diseases are an important cause of morbidity and mortality in Sudan. The tetrad of hypertension, RHD, IHD and cardiomyopathy constitute the bulk of CVD. Hypertension is prevalent, with poor control rates. A decline in rheumatic heart disease was seen in the capital state and no data were available on other parts of the country. No recent data on IHD were available. Peripartum cardiomyopathy and congenital heart disease occur at similar rates to those in other African countries.
- Title: Progressive human
immunodeficiency virus-associated vasculopathy :
time to revise antiretroviral therapy
guidelines? : case reports
Authors: Ntusi, N.B.A.; Taylor, D.; Naidoo, N.G.; Mendelson, M.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 197-200
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DOI Number: 10.5830/CVJA-2010-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-048
Abstract: Cardiovascular abnormalities were appreciated early in the epidemic of the acquired immunodeficiency syndrome (AIDS), even before the aetiological agent, human immunodeficiency virus (HIV) was isolated and characterised. The aetiology and pathogenesis of cardiovascular disease in HIV infection is still the subject of intense speculation, and is likely multi-factorial. HIV affects every aspect of the cardiac axis, causing pericarditis, myocarditis, cardiomyopathy, coronary artery disease and microvascular dysfunction, valvular heart disease, pulmonary vascular disease and pulmonary hypertension, stroke and peripheral vascular disease. HIV-associated vasculopathy is an increasingly recognised clinical entity, causing high morbidity and increasing mortality in southern Africa, particularly from stroke and cardiovascular disease. HIV causes disease of the vascular tree, either by a direct effect on vascular or perivascular tissue, or indirectly via immune complex-mediated mechanisms, associated opportunistic infections and malignancies. As a result, highly active antiretroviral therapy (HAART) may have an important role in controlling disease progression. We report a case of histologically defined primary HIV vasculopathy in which the chance to start HAART was initially missed and in which the patient progressed to require bilateral amputations, but obtained disease quiescence upon commencement of HAART.
- Title: Subclavian crush syndrome : a
cause of pacemaker lead fracture : case reports
Authors: Femenia, F.; Diez, J.C.L.; Arce, M.; Baranchuk, A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 201-202
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DOI Number: 10.5830/CVJA-2010-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-052
Abstract: A 48-year-old male with a symptomatic 2:1 atrio-ventricular block and a dual-chamber pacemaker, implanted one year previously, was admitted due to a syncopal episode. Pacemaker malfunction was identified as the cause of syncope. Subclavian crush syndrome was the cause of the pacemaker malfunction. Its incidence, consequences and management are discussed in this report.
- Title: Diagnosis of a congenitally
corrected transposition of the great arteries in
a 50-year-old multiparous woman : case reports
Authors: Jalalian, R.; Masoumi, S.; Ghaemian, A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 203-204
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DOI Number: 10.5830/CVJA-2010-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-053
Abstract: Congenitally corrected transposition of the great arteries (cc-TGA) is a rare congenital heart disease. In the literature, few patients with this anomaly have been reported to be asymptomatic until after the fifth decade. We describe a 50-year-old female with five pregnancies and successful deliveries, who was unrecognised until late in her fifth decade.
- Title: Cardiogenic shock due to
dynamic left ventricular outflow tract
obstruction of acute myocardial infarction : an
under-diagnosed complication : case reports
Authors: Karabay, K.Y.; Kocabay, G.; Kalayci, A.; Tanboga, H.; Mert, M.; Kirma, C.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 205-206
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DOI Number: 10.5830/CVJA-2010-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-051
Abstract: We report on a patient who developed cardiogenic shock caused by dynamic left ventricular outflow tract (LVOT) obstruction following percutaneous coronary intervention for anteroseptal acute myocardial infarction.
- Title: Snake-like thrombus in the
right atrium causing pulmonary embolism : case
reports
Authors: Karabay, C.Y.; Kocabay, G.; Kalayci, A.; Zehir, R.; Mert, M.; Kirma, C.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 206-207
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DOI Number: 10.5830/CVJA-2010-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-060
Abstract: In this report, we present a case of an 84-year-old woman treated with a low-dose prolonged infusion of tissue plasminogen activator (tPA) for a free-floating thrombus in the right atrium.
- Title: The sensitivity of
waist-to-height ratio in identifying children
with high blood pressure : short communication
Authors: Motswagole, B.S.; Kruger, H.S.; Faber, M.; Van Rooyen, J.M.; De Ridder, J.H.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 208-211
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DOI Number: 10.5830/CVJA-2010-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-062
Abstract: We determined the sensitivity of waist-to-height ratio (WHtR) as a marker for high blood pressure in children aged nine to 15 years (n = 1 131), from schools in the North West province, South Africa. Anthropometric and blood pressure measurements were taken. The sensitivity and specificity of the WHtR to identify children with high blood pressure were evaluated. At a cut-off value of 0.5, 7.9% of the girls and 3.4% of the boys had central adiposity. Thirteen per cent of the children were hypertensive. The optimal WHtR cut-off value to identify children with hypertension was 0.41 in both boys and girls. Positive correlations were observed between anthropometric indices. Using linear regression analyses, age and body mass index were significant predictors of high blood pressure in boys, while for girls it was height and weight. Results suggest that adopting a WHtR cut-off value < 0.5 could enhance the use of WHtR as a marker for high blood pressure in children.
- Title: Malignant convulsive
vasovagal syncope : images in cardiology
Authors: Amasyali, B.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 212
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DOI Number: 10.5830/CVJA-2010-089
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-089
Abstract: A patient was referred for evaluation of repeated episodes of syncope with loss of consciousness and convulsions. A dualchamber pacemaker with rate-drop feature was implanted.
- Title: PASCAR meeting in Kampala,
Uganda : cardio news
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 213
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Abstract: PASCAR meeting in Kampala, Uganda : cardio news
- Title: The evolution of heart rate :
past, present and future : drug trends in
cardiology
Authors: Wagenaar, Peter
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 214, 216
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Abstract: 'Heart rate is simple - and simple is not "sexy". This has led to the mistaken impression that heart rate is not important. But, in fact, nothing is more important than heart rate'. This is the viewpoint of Prof Prakash Deedwania, who was in South Africa recently as a guest of Servier.
- Title: New data support ivabradine
use in chronic heart failure : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 216-217
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Abstract: Improvements in quality of life
Safety of ivabradine shown in the pre-specified ECG Holter study of patients participating in the SHIfT study
Use with β-blockers
- Title: Torsades de pointes : letter
to the editor
Authors: Solomons, H.D.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 217
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Abstract: Torsades de pointes : letter to the editor
- Title: FDA approves rivaroxaban for
prevention of deep-vein thrombosis in surgery :
drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 218
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Abstract: Rivaroxaban has just become the first factor Xa inhibitor and so far the only oral anticoagulant to be approved in the United States for orthopaedic surgery.
- Title: South Africa's poor warfarin
control raises questions of benefit above other
anticoagulant therapies in atrial fibrillation :
drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 220
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Abstract: South African patients entered into the ACTIVE-W trial were outside the ideal INR targets of 2-3 for 60% of the time while on warfarin therapy.
- Title: Obesity and platelet
reactivity : the relationship remains uncertain
: drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 223
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Abstract: Two recent studies on obesity have sought to provide clarity to the hypothesis that increasing BMI could be associated with high on-treatment platelet reactivity. These studies were undertaken in different populations.
- Title: ARBs for cardiovascular and
renal protection in high-risk patients : drug
trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 224
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Abstract: The contribution of recent trials such as the extensive ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) 'a thorough, double-blind, prospective, randomised trial, which documents the equal-outcome efficacy of an ARB (telmisartan) and an ACE inhibitor in a high-risk population' is noted in a recent meta-analysis of ARBs.
- Title: Safe use of ezetimibe plus
simvastatin in high-risk vascular patients (with
chronic kidney disease and PAD) : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 227-228
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Abstract: The use of ezetimibe together with a statin to reduce LDL cholesterol in high-risk patients in whom raising the statin dose is not desirable has been shown to be safe in the SHARP trial and in a trial on a small group of peripheral arterial disease (PAD) patients.
- Title: Torulopsis glabrata
endocarditis in a retro-positive individual :
letter to the editor
Authors: Solomons, H.D.
From: Cardiovascular Journal of Africa, Vol 22, Issue 4
Published: 2011
Pages: 228 Full text: Click here to order »
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Abstract: Torulopsis glabrata endocarditis in a retro-positive individual : letter to the editor
