CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23,
ISSUE 2, MARCH 2012
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- Title: New antithrombotic drugs : a
revolution in stroke management : editorial
Authors: Bryer, Alan
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 61-62
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Abstract: Embolism of cardiac origin accounts for 20% of ischaemic strokes. Atrial fibrillation is by far the most common cause of cardioembolic stroke, and anticoagulation is the treatment generally indicated for secondary, and in many cases, primary prevention. The decision to prescribe warfarin is usually based on an accurate assessment of the likely absolute annual risk of stroke without warfarin, and whether or not such benefits of warfarin treatment are likely to outweigh the risk of bleeding associated with its use.
- Title: Effect of sequential coronary
artery bypass venous grafting on right
ventricular functions assessed by tissue Doppler
echocardiography : cardiovascular topics
Authors: Ozerdem, G.; Katrancioglu, N.; Candemir, B.; Saricam, E.; Ozturk, O.; Berkan, O.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 63-66
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DOI Number: 10.5830/CVJA-2010-093
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-093
Abstract: Background : Coronary artery bypass graft surgery is a well-known and proven method of treatment for coronary artery disease. A modification of this method is complete revascularisation of the right ventricle by sequential bypass grafting of the right coronary artery, the effects of which on ventricular function need to be clarified. We sought to determine the effect of the sequential bypass graft method on right ventricular (RV) function utilising tissue Doppler echocardiography.
Methods : A total of 35 coronary artery disease patients (group A: 20 sequential grafts; group B: 15 individual grafts) were enrolled. Patients were examined pre-operatively with tissue Doppler echocardiography for RV function, and again postoperatively after the first month.
Results : Pre-operatively, there were no significant differences with regard to demographics or basal echocardiographic findings. On the other hand, postoperative right ventricular diastolic function was found to have improved significantly as the right ventricular E wave and E/A increased (9.5 ± 1.6 vs 7.6 ± 2.7 cm/s, p = 0.009 and 1.4 ± 0.2 vs 0.9 ± 0.2, p ≤ 0.01, respectively), while the A wave and isovolumic relaxation times (6.8 ± 2.1 vs 8.3 ± 3.4 cm/s, p < 0.03 and 55.2 ± 11.9 vs 87.2 ± 16.2 ms, p < 0.001, respectively) decreased. Although the S-wave peak amplitude decreased in group A patients, it did not reach statistical significance.
Conclusions : Sequential, but not single, complete revascularisation of the right coronary artery appeared to improve the diastolic function of the right ventricle.
- Title: Heart rate variability in
physically active individuals : reliability and
gender characteristics : cardiovascular topics
Authors: Sookan, Takshita; McKune, Andrew J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 67-72
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Abstract: Purpose : To evaluate the reliability of short-term recordings (five minutes) of heart rate variability (HRV) and the association between HRV and gender.
Methods : HRV time- and frequency-domain parameters were calculated in 44 physically active students (21 males and 23 females) over four consecutive days. A Suunto t6 heart rate monitor was used to obtain inter-beat intervals (IBIs) that were then transferred to Kubios HRV analysis software. The relative reliability [intra-class correlation (ICC)] and absolute reliability, [typical error of measurement (TEM) and typical error of measurement as a percentage (TEM%)] of the HRV parameters were then calculated for day 2 versus day 3 and day 3 versus day 4, with day 1 being a familiarisation day. The following HRV parameters were calculated: (1) time domain: resting heart rate (RHR), R-R intervals (IBI), standard deviation of normal-to-normal intervals (SDNN), root mean square differences of the standard deviation (RMSSD), percentage of beats that changed more than 50 ms from the previous beat (pNN50); and (2) frequency domain: low-frequency normalised units (LFnu), high-frequency normalised units (HFnu), low-frequency to high-frequency ratio in normalised units (LF/HFnu). An analysis of variance (ANOVA) with Tukey post-hoc testing was performed to compare HRV parameters in males and females. Significance was set at p ≤ 0.05.
Results : The ICCs for both relationship 1 and 2 indicated primarily good to excellent (> 0.8) relative reliability. The lowest value was found in the LF/HFnu ratio (ICC = 0.36) for males. Absolute reliability was low with TEM% greater than 10% for all HRV parameters, except IBIs. Females demonstrated better relative (higher ICCs) and absolute reliability (lower TEM and TEM%) compared to males for the frequency domain. The relative and absolute reliability for the time domains were similar except for SDNN where the absolute reliability was higher in males. ANOVA illustrated significant gender differences for the LF/HFnu ratio (41% higher in males, p = 0.003), HFnu (12% higher in females, p = 0.02) and IBI (21% higher in females, p < 0.0001).
Conclusions : Short-term recordings of HRV over three consecutive days demonstrated a high relative reliability. However, a low absolute reliability indicated large day-to-day random variation in HRV, which would make the detection of intervention effects using HRV difficult in individual participants. Females were shown to have a higher parasympathetic modulation of HRV, which may indicate an underlying cardioprotective mechanism in females compared to males.
- Title: Left ventricular hypertrophy and
geometry in type 2 diabetes patients with
chronic kidney disease. An echocardiographic
study : cardiovascular topics
Authors: Bayauli, M.P.; Lepira, F.B.; Kayembe, P.K.; M'Buyamba-Kabangu, J.R.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 73-77
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DOI Number: 10.5830/CVJA-2011-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-028
Abstract: Objective : We assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes.
Methods : This was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62%) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m2), moderate (CrCl 30-60 ml/min per 1.73 m2) and severe CKD (< 30 ml/min per 1.73 m2). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m2.7 and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI.
Results : Compared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 µmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40-33.73).
Conclusion : In keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.
- Title: The relationship between cortisol,
C-reactive protein and hypertension in African
and Causcasian women : the POWIRS study :
cardiovascular topics
Authors: Tolmay, Claire M.; Malan, Leone; Van Rooyen, Johannes M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 78-84
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DOI Number: 10.5830/CVJA-2011-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-035
Abstract: Research on the roles that C-reactive protein (CRP) and other risk factors such as cortisol and obesity play in the diagnosis of cardiovascular disease (CVD) in African and Caucasian women has become increasingly imperative when one considers the prevalence of hypertension in these groups. CRP and cortisol have been associated with an increased prevalence of hypertension and obesity. Cortisol has also been linked with both hypertension and the hypothalamic-pituitary-adrenal (HPA) response. African women have previously presented with an increased vascular reactivity. Conversely, Caucasian women have displayed an increased central cardiac reactivity. We included African (n = 102) and Caucasian (n = 115) women in the study, matched for age and body mass index. Elevated CRP levels were observed in African women compared to Caucasian women. A trend of hypocortisolism was exhibited in both hypertensive ethnic groups. Systolic blood pressure (SBP) and a vascular marker, arterial compliance (Cw), predicted hypertension in African women. Conversely, in Caucasian women, only SBP predicted hypertension. These results suggest the apparently diverse roles that dysregulation by the HPA axis, in conjunction with the respective cardiac and vascular responses in both Caucasian and African women, can play in future cardiovascular risk for these groups.
- Title: End digit preference in blood
pressure measurement in a hypertension specialty
clinic in southwest Nigeria : cardiovascular
topics
Authors: Ayodele, O.E.; Sanya, E.O.; Okunola, O.O.; Akintunde, A.A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 85-89
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DOI Number: 10.5830/CVJA-2011-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-045
Abstract: Background : One of the observer errors associated with blood pressure (BP) measurement using a mercury sphygmomanometer is end digit preference (EDP) which refers to the occurrence of a particular end digit more frequently than would be expected by chance alone. Published reports, mainly from outside Africa, have shown a high prevalence ranging from 22 to 90% of end digit zero in BP readings taken by healthcare workers (HCWs). This study examined the prevalence of EDP and patients' and physicians' characteristics influencing the occurrence of EDP.
Methods : A retrospective review was undertaken of BP readings of 114 patients seen over a two-month period at our hypertension specialty clinic.
Results : Nurses and physicians displayed a high frequency of preference for end digit zero in systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The preference for end digit zero was, however, higher for nurses than for physicians (SBP: 98.5 vs 51.2%, p < 0.001; DBP: 98.5 vs 64.3%, p < 0.001). Among the physicians, the consultant staff displayed the least preference for end digit zero compared to resident doctors. There was no statistically significant difference in gender, age, weight, height and BMI of those with BP readings with end digit zero compared with those with non-zero end digits.
Conclusion : The high prevalence of EDP for zero argues for the training, retraining and certification of HCWs in BP measurement and the institution of a regular monitoring and feedback system on EDP in order to minimise this observer error.
- Title: Echocardiographic diagnoses in
HIV-infected patients presenting with cardiac
symptoms at Muhimbili National Hospital in Dar
es Salaam, Tanzania : cardiovascular topics
Authors: Chillo, Pilly; Bakari, Muhammad; Lwakatare, Johnson
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 90-97
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DOI Number: 10.5830/CVJA-2011-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-060
Abstract: Objective : To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.
Methods : Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital's care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.
Results : A total of 102 patients were recruited from September 2009 to April 2010. The patients' mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.
Conclusion : Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.
- Title: Sudden cardiac death due to
β2-agonist therapy : is a genetic basis
overlooked? : letter to the editor
Authors: Yalta, K.; Sivri, N.; Geyik, B.; Aksoy, Y.; Yetkin, E.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 97, 102
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Abstract: β2-adrenoceptor agonists have long been widely used for the management of certain conditions, including chronic obstructive pulmonary disease (COPD). However, in recent years, sudden cardiac death (SCD) associated with the use of β2-adrenoceptor agonists has raised significant concerns about the safety profile of these agents. These drugs may have the potential to induce SCD in a proportion of susceptible subjects with structural heart diseases (SHD) including cardiomyopathies, and should not be routinely prescribed before ruling out these pathologies.
- Title: Experimental malaria : the in
vitro and in vivo blood pressure paradox :
cardiovascular topics
Authors: Nwokocha, C.R.; Nwokocha, M.I.; Owu, D.U.; Ajayi, I.O.; Ebeigbe, A.B.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 98-102
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DOI Number: 10.5830/CVJA-2011-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-059
Abstract: Objective : Malaria causes more deaths worldwide than any other parasitic disease. Many aspects of the biology that governs the pathogenesis of this parasite are still unclear. Therefore insight into the complexity of the pathogenesis of malaria is vital to understand the disease, particularly as it relates to blood pressure.
Methods : In vivo and in vitro experimental models were used for this study. In the in vivo study, mean arterial pressure, pulse rates and heart rates were recorded by cannulation of the carotid artery of rats. In the in vitro study, ring preparations of blood vessels from the rat aorta were studied using standard organ bath techniques. Dose-response curves for phenylepherine (PE)- and acetylcholine (Ach)0induced relaxation were constructed for rings pre-contracted with PE.
Results : Our results showed a significant (p < 0.05) reduction in the mean arterial pressure and pulse rates, while the heart rates remained unaltered in rats with malaria parasites, compared with the controls. Incubation of rat aortic rings with parasitised blood resulted in a significant (p < 0.05) increase in maximum contractile response to phenylephrine in the rat aortic rings but there was no effect on the baseline. The dose-response curve showed a significant (p < 0.05) leftward shift following the addition of parasitised blood and the EC70 (M) values increased from 7 x 10-7 to 5 x 10-6 M. Following exposure to parasitised blood, the magnitude of Ach-induced relaxation responses reduced significantly (p < 0.05) from 73 ± 3.6 to 24.75 ± 7.25% in the rat aortic rings.
Conclusions : The results suggest that malaria parasitaemia caused in vivo reduction in blood pressure, and enhanced the responses to contractile agents and reduced relaxation responses to acetylcholine in vitro. This appears to be a paradox but is explainable by the complex cardiovascular control mechanisms in vivo. This may be independent of direct action on vascular smooth muscle.
- Title: A systematic overview of
prospective cohort studies of cardiovascular
disease in sub-Saharan Africa : review article
Authors: Kengne, Andre Pascal; Ntyintyane, Lucas M.; Mayosi, Bongani M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 103-112
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DOI Number: 10.5830/CVJA-2011-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-042
Abstract: Background : Cardiovascular diseases (CVDs) are becoming increasingly significant in sub-Saharan Africa (SSA). Reliable measures of the contribution of major determinants are essential for informing health services and policy solutions.
Objective : To perform a systematic review of all longitudinal studies of CVDs and related risk factors that have been conducted in SSA.
Data source : We searched electronic databases from 1966 to October 2009. Published studies were retrieved from PubMed and Africa EBSCO. Reference lists of identified articles were scanned for additional publications.
Study selection : Any longitudinal study with data collection at baseline on major cardiovascular risk factors or CVD, including 30 or more participants, and with at least six months of follow up were included.
Data extraction : Data were extracted on the country of study, year of inception, baseline evaluation, primary focus of the study, outcomes, and number of participants at baseline and final evaluation.
Results : Eighty-one publications relating to 41 studies from 11 SSA countries with a wide range of participants were included. Twenty-two were historical/prospective hospital-based studies. These studies focused on risk factors, particularly diabetes mellitus and hypertension, or CVD including stroke, heart failure and rheumatic heart disease. The rate of participants followed through the whole duration of studies was 72% (64-80%), with a significant heterogeneity between studies (for heterogeneity, p < 0.001). Outcomes monitored during follow up included trajectories of risk markers and mortality.
Conclusions : Well-designed prospective cohort studies are needed to inform and update our knowledge regarding the epidemiology CVDs and their interactions with known risk factors in the context of common infectious diseases in this region.
- Title: The diabetologist/cardiologist
debate : a meeting of the minds : drug trends in
cardiology
Authors: Mohamed, F.; Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 115-117
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Abstract: In-hospital diabetes management of non-critical care patients
Ageing and type 2 diabetes
Contrast nephropathy
Modern approach to anticoagulant and antithrombotic therapy
The incretins : so much attention at international meetings that a review in South Africa is timeous
Is type 2 diabetes a cardiovascular risk equivalent?
Diabetic dyslipidaemia : new therapies
- Title: New ESC/EASD lipid guidelines
emphasises need to expand cholesterol screening
and treating to target in clinical practice :
drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 118, 120
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Abstract: 'Clinicians are not measuring cholesterol levels often enough in at-risk patients worldwide, and the new ESC/EAS (European Society of Cardiology and European Atherosclerosis Society) task force recommends stronger action in this regard', Prof Richard Hobbs, professor and head of Primary Care, University of Burmingham, UK, noted in his countrywide talks to South African doctors, sponsored by AstraZeneca. Cardiovascular disease is the most important cause of premature death on the planet and lipid levels are one of the major modifiable factors that drive death and disability from vascular disease worldwide.
- Title: Recruitment of pulmonary
hypertension patients for PATENT trial with RIOCIQUAT completed - sub-Saharan pulmonary
hypertension study launched : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: 120
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Abstract: The first-ever clinical trial of an agent to treat both pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) has completed recruitment. This landmark development was announced in Cape Town recently at a Bayer Healthcare media conference, held to coincide with an international meeting of the Pulmonary Vascular Research Institute (PVRI), an expert, non-profit global organisation.
- Title: Multiple coronary cameral
fistulae : a rare anomaly and cause of ischaemia
: case report : online article
Authors: Sengul, C.; Fotbolcu, H.; Ozden, K.; Duman, D.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: e1-e2
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DOI Number: 10.5830/CVJA-2010-097
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-097
Abstract: An 82-year-old hypertensive, diabetic woman was admitted to our department for pre-operative cardiac evaluation. A myocardial perfusion scan revealed apicoseptal and inferior segment hypoperfusion. Coronary angiography exhibited extensive multiple coronary cameral fistulae draining into the left ventricle in a homogeneous and circular way.
- Title: Rare cardiac defect in Holt-Oram
syndrome : case report : online article
Authors: Sinha, R.; Nema, D.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: e3-e4
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DOI Number: 10.5830/CVJA-2011-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-017
Abstract: Holt-Oram syndrome is an autosomal dominant condition associated with skeletal malformations of the upper limbs, and congenital heart disease. Approximately 40% of cases represent new mutations. Defective development of the embryonic radial ray (e.g. aplasia, hypoplasia, fusion, other anomalous development) results in a wide spectrum of phenotypes, including triphalangeal or absent thumbs, foreshortened arms and phocomelia. The syndrome is associated with defective development of cardiac structures that results in atrial septal defect (ASD), most commonly the secundum type, heart block of varying degrees, or both. We report a rare cardiac defect patent ductus arteriosus (PDA) and ventricular septal defect (VSD) in a case of Holt-Oram syndrome.
- Title: Infective endocarditis and spondylodiscitis due to posterior nasal packing
in a patient with a bioprosthetic aortic valve :
case report : online article
Authors: Gungor, H.; Ayik, M.F.; Gul, I.; Yildiz, S.; Vuran, O.; Ertugay, S.; Kanyilmaz, H.; Erturk, U.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: e5-e7
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DOI Number: 10.5830/CVJA-2011-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-002
Abstract: Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.
- Title: Total correction in tetralogy of Fallot with anomalous major coronary artery : an
alternative method to conduit use : case report
: online article
Authors: Saritas, B.; Ozker, E.; Vuran, C.; Yoruker, U.; Ayabakan, C.; Turkoz, R.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: e8-e10
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DOI Number: 10.5830/CVJA-2011-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-004
Abstract: Introduction : A coronary artery anomaly precludes the use of a trans-annular patch in right ventricular outflow tract (RVOT) reconstruction. Herein we present three patients with coronary artery anomalies who underwent total corrective operations without using a conduit.
Methods : Between 2007 and 2010, 84 patients with tetralogy of Fallot (TOF) were operated on. Nine (9.4%) of them had a coronary artery anomaly. Three (3.1%) of the patients were operated on using the double-outflow technique and two had a Blalock-Taussig shunt before the total corrective operation. In two patients, the left anterior descending artery (LAD) and in one, the right coronary artery (RCA) crossed the RVOT.
Results : Postoperatively, the right-to-left ventricular pressure ratios were 0.45, 0.59 and 0.60 after cardiopulmonary bypass. No gradient was detected in the RVOT in postoperative echocardiographical measurements (< 15 mmHg gradient). In all three patients, there were moderate pulmonary insufficiencies. All were discharged home on the sixth day postoperatively. Mean follow-up duration was 9.8 ± 8 months. In the follow up of all three patients, there were moderate pulmonary insufficiencies but no right ventricular dysfunction.
Conclusion : The 'double-outflow' technique is appropriate for TOF patients with a major coronary artery anomaly since it can easily be performed without the need of a conduit.
- Title: The perils of pharmacological
treatment for obesity : a case of sibutramine-associated
cardiomyopathy and malignant arrhythmias : case
report : online article
Authors: Schamroth, Colin L.
From: Cardiovascular Journal of Africa, Vol 23, Issue 2, Mar
Published: 2012
Pages: e11-e12
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DOI Number: 10.5830/CVJA-2011-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-003
Abstract: A 58-year-old woman presented with severe left ventricular dysfunction and malignant arrhythmias after taking combination drug treatment for weight loss. The combination treatment included sibutramine, liothyronine, hydrochlorothiazide diuretic, metformin and fucus. The effect of these drugs individually and in combination is discussed, with particular reference to it being a malignant combination. The patient showed reversability of the left ventricular dysfunction and negative ventricular stimulation studies after cessation of the drug concoction.
