CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME
24, ISSUE
2, MAR 2013
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- Title: Professor Andries Jacob Brink :
29 August 1923 - 17 October 2012 : in memoriam
Authors: Opie, Lionel
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 3-4
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Abstract: It has been my privilege to have known the late Prof Andries Brink for almost 50 years. We first met early on in my career, and I had dinner with him only a few months before he died.
- Title: Tribute to the late Professor
Oluwole Ademola Adebo : in memoriam
Authors: Omokhodion, Samuel Ilenre
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 4, 23, 27
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Abstract: Oluwole Ademola Adebo was born in Lagos on 16 August 1944, the first son to Chief Simeon and Regina Adebo. As his father was the former head of the Civil Service of the old western region of Nigeria and later United Nations Under-Secretary General, he had the opportunity of travelling extensively around the world and had access to the best education in Nigeria, Europe and the USA.
- Title: Impact of HIV on the incidence of
pre-eclampsia : editorial
Authors: Moodley, J.
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 5
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Abstract: Pre-eclampsia, a condition unique to human pregnancy, is defined as new-onset hypertension (BP ≥ 140/90 mmHg) in the second half of pregnancy, associated with significant proteinuria (≥ 30 mgms). The aetiology of this condition remains elusive but recent findings suggest that pre-eclampsia is a two-stage disorder. The first stage is thought to be due to failure of the spiral arterioles in the placental bed to undergo vascular remodelling into wide-bore channels. This vascular maladaptation of the placental bed results in a marked reduction in blood flow to the placenta and sets the scene for the second stage.
- Title: Clinical characteristics and
outcomes of atrial fibrillation and flutter at
the Aga Khan University Hospital, Nairobi :
cardiovascular topics
Authors: Shavadia, Jay; Yonga, Gerald; Mwanzi, Sitna; Jinah, Ashna; Moriasi, Abednego; Otieno, Harun
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 6-9
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DOI Number: 10.5830/CVJA-2012-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-064
Abstract: Introduction : Scant data exist on the epidemiology and clinical characteristics of atrial fibrillation in Kenya. Traditionally, atrial fibrillation (AF) in sub-Saharan Africa is as a result of rheumatic valve disease. However, with the economic transition in sub-Saharan Africa, risk factors and associated complications of this arrhythmia are likely to change.
Methods : A retrospective observational survey was carried out between January 2008 and December 2010. Patients with a discharge diagnosis of either atrial fibrillation or flutter were included for analysis. The data-collection tool included clinical presentation, risk factors and management strategy. Follow-up data were obtained from the patients' medical records six months after the index presentation.
Results : One hundred and sixty-two patients were recruited (mean age 67 ± 17 years, males 56%). The distribution was paroxysmal (40%), persistent (20%) and permanent AF (40%). Associated co-morbidities included hypertension (68%), heart failure (38%) diabetes mellitus (33%) and valvular abnormalities (12%). One-third presented with palpitations, dizziness or syncope and 15% with a thromboembolic complication as the index AF presentation. Rate-control strategies were administered to 78% of the patients, with beta-blockers and digoxin more commonly prescribed. Seventy-seven per cent had a CHA2DS2VASC score ≥ 2, but one-quarter did not receive any form of oral anticoagulation. At the six-month follow up, 6% had died and 12% had been re-admitted at least once. Of the high-stroke risk patients on anticoagulation, just over one-half were adequately anticoagulated.
Conclusion : Hypertension and diabetes mellitus, not rheumatic valve disease were the more common co-morbidities. Stroke risk stratification and prevention needs to be emphasised and appropriately managed.
- Title: Cardioprotective and
anti-hypertensive effects of Prosopis glandulosa
in rat models of pre-diabetes : cardiovascular
topics
Authors: Huisamen, B.; George, C.; Dietrich, D.; Genade, S.
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 10-16
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DOI Number: 10.5830/CVJA-2012-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-069
Abstract: Aim : Obesity and type 2 diabetes present with two debilitating complications, namely, hypertension and heart disease. The dried and ground pods of Prosopis glandulosa (commonly known as the Honey mesquite tree) which is part of the Fabaceae (or legume) family are currently marketed in South Africa as a food supplement with blood glucose-stabilising and anti-hypertensive properties. We previously determined its hypoglycaemic effects, and in the current study we determined the efficacy of P glandulosa as anti-hypertensive agent and its myocardial protective ability.
Methods : Male Wistar rats were rendered either pre-diabetic (diet-induced obesity: DIO) or hypertensive (high-fat diet: HFD). DIO animals were treated with P glandulosa (100 mg/kg/day for the last eight weeks of a 16-week period) and compared to age-matched controls. Hearts were perfused ex vivo to determine infarct size. Biometric parameters were determined at the time of sacrifice. Cardiac-specific insulin receptor knock-out (CIRKO) mice were similarly treated with P glandulosa and infarct size was determined. HFD animals were treated with P glandulosa from the onset of the diet or from weeks 12-16, using captopril (50 mg/kg/day) as the positive control. Blood pressure was monitored weekly.
Results : DIO rats and CIRKO mice: P glandulosa ingestion significantly reduced infarct size after ischaemia-reperfusion. Proteins of the PI-3-kinase/PKB/Akt survival pathway were affected in a manner supporting cardioprotection. HFD model: P glandulosa treatment both prevented and corrected the development of hypertension, which was also reflected in alleviation of water retention.
Conclusion : P glandulosa was cardioprotective and infarct sparing as well as anti-hypertensive without affecting the body weight or the intra-peritoneal fat depots of the animals. Changes in the PI-3-kinase/PKB/Akt pathway may be causal to protection. Results indicated water retention, possibly coupled to vasoconstriction in the HFD animals, while ingestion of P glandulosa alleviated both. We concluded that treatment of pre-diabetes, type 2 diabetes or hypertension with P glandulosa poses possible beneficial health effects.
- Title: Low prevalence of abdominal aortic
aneurysm in the Seychelles population aged 50 to
65 years : cardiovascular topics
Authors: Yerly, Patrick; Madeleine, George; Riesen, Walter; Bovet, Pascal
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 17-18
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DOI Number: 10.5830/CVJA-2012-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-070
Abstract: The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western countries but few data are available from low- and middle-income countries. We are not aware of systematically collected population-based data on AAA in the African region. We evaluated the prevalence of AAA in a population-based cardiovascular survey conducted in the Republic of Seychelles in 2004 (Indian Ocean, African region). Among the 353 participants aged 50 to 64 years and screened with ultrasound, the prevalence of AAA was 0.3% (95% CI: 0-0.9) and the prevalence of ectatic dilatations of the abdominal aorta was 1.5% (95% CI: 0.2-2.8). The prevalence of AAA in the general population seemed lower in Seychelles than in Western countries, despite a high prevalence in Seychelles of risk factors of AAA, such as smoking (in men), high blood pressure and hypercholesterolaemia.
- Title: Comparative evaluation of warfarin
utilisation in two primary healthcare clinics in
the Cape Town area : cardiovascular topics
Authors: Njovane, Xolani W.; Fasinu, Pius S.; Rosenkranz, Bernd
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 19-23
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DOI Number: 10.5830/CVJA-2012-072
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-072
Abstract: Background : Although warfarin remains the anticoagulant drug of choice in a wide range of patients, its narrow therapeutic window makes patients susceptible to a high risk of bleeding complications or failure to prevent clotting. This has necessitated therapeutic monitoring in warfarinised patients. Factors that could be responsible for the fluctuating responses to warfarin vary from pharmacogenetic to concomitant morbidity, diet and medication. In order to assess the quality of management of warfarin treatment in a local primary-care setting, the current study evaluated warfarin utilisation and monitoring records in two hospitals with different patient groups.
Methods : A retrospective study was undertaken in the specialised warfarin clinics at Wesfleur and Gugulethu hospitals (Western Cape, South Africa) covering all warfarin-related therapy records over a 12-month period. Data extracted from the patients' folders included age, gender, race, weight, address, concurrent chronic illnesses, treatment and medication, indication for warfarin and INR history.
Results : A total of 119 patients' folders were analysed. Attendance at the clinics reflects the demographics and racial distribution of the host location of the hospitals. While all the patients were maintained above the minimum international normalised ratio (INR) value of 2, about 50% had at least one record of INR above the cut-off value of 3.5. However, over a third of the patients (32.2%) had at least one record of INR greater than 3.5 in Gugulethu Hospital, compared to over half (58.3%) in Wesfleur Hospital.
In total, atrial fibrillation was the most common indication for warfarinisation while hypertension was the most common concurrent chronic condition in warfarinised patients. All patients who received quinolone antibiotics had INR values above the cut-off point of 3.5 within the same month of the initiation of antibiotic therapy, suggesting drug-induced warfarin potentiation. Other co-medications, including beta-lactam antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) and anti-ulcer drugs appeared to alter warfarin responses as measured by recorded INR values.
Conclusion : The study found inter-individual variability in the response to warfarin therapy, which cut across racial classifications. It also confirms the possible influence of concomitant morbidity on patient response to anticoagulant therapy.
- Title: Is the prevalence of pre-eclampsia
affected by HIV/AIDS? A retrospective
case-control study : cardiovascular topics
Authors: Kalumba, V.M.S.; Moodley, J.; Naidoo, T.D.
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 24-27
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DOI Number: 10.5830/CVJA-2012-078
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-078
Abstract: Objective : To evaluate the rate of HIV/AIDS (and CD4 levels) in women with pre-eclampsia compared to that of a control group.
Methods : This was a retrospective case-control study in a tertiary and regional hospital in South Africa. We reviewed the hospital records of women who had delivered in these hospitals between 1 January 2008 and 30 June 2010. The records of women with pre-eclampsia during the study period were analysed. Their HIV infection rate was compared to that of a control group consisting of normotensive healthy pregnant women.
Results : Among 492 cases of pre-eclampsia, 130 (26.4%) were HIV infected. In the control group, 183/500 (36.6%) were HIV infected (p = 0.001, OR = 0.62, 95% CI: 0.47-0.82). After adjustment to match the difference in maternal age and parity, the rate of HIV/AIDS was lower in the pre-eclamptic group than in the control group (p = 0.005, OR = 0.658).
Conclusion : The rate of HIV/AIDS was significantly lower in women with pre-eclampsia than in normotensive healthy pregnant women.
- Title: Presenting features of newly
diagnosed rheumatic heart disease patients in
Mulago Hospital : a pilot study : cardiovascular
topics
Authors: Zhang, Wanzhu; Mondo, Charles; Okello, Emmy; Musoke, Charles; Kakande, Barbara; Nyakoojo, Wilson; Kayima, James; Freers, Jurgen
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 28-33
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DOI Number: 10.5830/CVJA-2012-076
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-076
Abstract: Introduction : Rheumatic heart disease (RHD) continues to cause gross distortions of the heart and the associated complications of heart failure and thromboembolic phenomena in this age of numerous high-efficacy drugs and therapeutic interventions. Due to the lack of contemporary local data, there is no national strategy for the control and eradication of the disease in Uganda. This study aimed to describe the presenting clinical features of newly diagnosed patients with RHD, with particular reference to the frequency of serious complications (atrial fibrillation, systemic embolism, heart failure and pulmonary hypertension) in the study group.
Methods : One hundred and thirty consecutive patients who satisfied the inclusion criteria were recruited over a period of eight months from June 2011 to January 2012 at the Mulago Hospital, Uganda. Data on demographic characteristics, disease severity and presence of complications were collected by means of a standardised questionnaire.
Results : Seventy-one per cent of the patients were female with a median age of 33 years. The peak age of the study group was 20 to 39 years, with the commonest presenting symptoms being palpitations, fatigue, chest pain and dyspnoea. The majority of the patients presented with moderate-to-severe valvular disease. Pure mitral regurgitation was the commonest valvular disease (40.2%), followed by mitral regurgitation plus aortic regurgitation (29%). Mitral regurgitation plus aortic regurgitation plus mitral stenosis was found in 11% of patients. There was only one case involving the tricuspid valve. The pulmonary valves were not affected in all patients; 45.9% of patients presented in severe heart failure in NYHA class III/IV, 53.3% had pulmonary hypertension, 13.9% had atrial fibrillation and 8.2% had infective endocarditis. All patients presented with dilated atria (> 49 mm).
Conclusion : A significant proportion of RHD patients present to hospital with severe disease associated with severe complications of advanced heart failure, pulmonary hypertension, infective endocarditis and atrial fibrillation. There is a need to improve awareness of the disease among the population, and clinical suspicion in primary health workers, so that early referral to specialist management can be done before severe damage to the heart ensues.
- Title: Epidemiology of ischaemic heart
disease in sub-Saharan Africa : review article
Authors: Onen, Churchill Lukwiya
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 34-42
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Full text: Click here to read via Sabinet » (Login Required) - DOI Number: 10.5830/CVJA-2012-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-071
Abstract: Background : The epidemiology of ischaemic heart disease (IHD) in sub-Saharan Africa (SSA) remains largely enigmatic. Major obstacles to our understanding of the condition include lack of reliable health statistics, particularly cause-specific mortality data, inadequate diagnostic capabilities, shortage of physicians and cardiologists, and misguided opinions.
Methods : This review of the epidemiology of ischaemic heart disease in sub-Saharan Africa involved a systematic bibliographic MEDLINE search of published data on IHD in SSA over the past century. Search words included epidemiology, ischaemic (coronary) heart disease, myocardial infarction, cardiovascular risk factors and sub-Saharan Africa. Selected data are presented on the prevalence of cardiovascular risk factors and mortality from ischaemic heart disease from different countries representing the main regions of the continent.
Results : Although IHD in SSA remains relatively uncommon, its prevalence is predicted to rise in the next two decades due to the rising prevalence of risk factors, especially hypertension, diabetes, overweight and obesity, physical inactivity, increased tobacco use and dyslipidaemia. It is estimated that age-standardised mortality rates for IHD will rise by 27% in African men and 25% in women by 2015, and by 70 and 74%, respectively by 2030.
Conclusion : Ischaemic heart disease remains relatively uncommon in SSA, despite an increasing prevalence of risk factors, but its incidence is rising. The pace and direction of economic development, rates of urbanisation, and changes in life expectancy resulting from the impact of pre-transitional diseases and violence will be major determinants of the IHD epidemic in SSA. The best window of opportunity for prevention of the emerging epidemic of ischaemic heart disease in sub-Saharan Africa is now.
- Title: Consequences of underlying
infection complicate CVD management in Africa -
satellite symposium : 6th World Congress
Paediatric Cardiology and Cardiac Surgery, Cape
Town, February 2013
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 44-46
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Abstract: New era in antiplatelet therapy - is clopidogrel adequate in 2013?
Achieving glycaemic control - incretins : cardiovascular safety and rationale for use
- Title: Philips hosts breakfast symposia
to drive experience-sharing on minimally
invasive cardiology procedures : 6th World
Congress Paediatric Cardiology and Cardiac
Surgery, Cape Town, February 2013
Authors: Delport, R.; Hardy, G.
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: 47-48
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Abstract: The burden of acquired heart disease in adults and children presents a very real healthcare challenge across the world. Philips Healthcare's commitment to improving access to healthcare infrastructure in Africa was emphasised through the hosting of and participation in dialogues, discussions and workshops at the sixth World Congress on Paediatric Cardiology and Cardiac Surgery that recently took place in Cape Town, South Africa.
- Title: ST-T-wave alternans in Brugada
electrocardiogram type I pattern during the
resolution of febrile states : case report -
online article
Authors: Zhou, Yifeng; Wang, Jiali; Li, Xianlun; Wang, Yong
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2012-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-065
Abstract: Brugada syndrome is often electrocardiographically characterised by ST-segment elevation in the right precordial leads. The characteristic Brugada electrocardiogram pattern is often dynamic and concealed, and may be revealed during febrile states or under the challenge of drugs that have a sodium channel-blocking effect. In this report, we describe two cases of exposure of the Brugada electrocardiogram pattern during febrile states. When the patients' body temperature decreased and before the ST-elevation disappeared, ST-segment and T-wave alternans in the right precordial leads were observed, especially in lead V2.
- Title: Is a drug-challenge test with
propafenone adequate to exclude Brugada
syndrome? : case report - online article
Authors: Yildiz, Bekir Serhat; Gungor, Hasan; Gul, Ilker; Bilgin, Murat; Zoghi, Mehdi; Akilli, Azem
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: e4-e6
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DOI Number: 10.5830/CVJA-2012-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-068
Abstract: Brugada syndrome is associated with sudden cardiac death in patients with a structurally normal heart. The electrocardiogram (ECG) pattern of Brugada syndrome is characterised by complete or incomplete right bundle branch block and ST-segment elevation in the right precordial leads. These ECG signs may not always be apparent but can be unmasked with certain anti-arrhythmia agents. We report here a case of a 26-year-old woman without detectable structural heart disease but with a history of syncope, cardiac arrest, intubation and defibrillation for ventricular fibrillation. We performed challenge tests with propafenone and ajmaline. After infusion of propafenone, there were minimal ECG changes which were not diagnostic for Brugada syndrome. One week later the provocation test was repeated with ajmaline. During infusion of ajmaline, prominent J waves and ST-segment elevation appeared in the right precordial leads (V1-3). Premature ventricular complexes were seen on a 12-lead ECG. The patient's ECG showed Brugada type 1 pattern. She received an internal cardioverter/defibrillator and was discharged with a beta-blocker.
- Title: Acute arterial thrombosis
following chemotherapy in a patient with a
gastric carcinoma : case report - online article
Authors: Doganci, Suat; Kadan, Murat; Kaya, Erkan; Erol, Gokhan; Gunay, Celalettin; Demirkilic, Ufuk
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: e7-e9
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DOI Number: 10.5830/CVJA-2012-074
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-074
Abstract: The pathogenesis of in situ thrombosis in cancer patients is not well known. Possible factors include endothelial damage, decreasing levels of anticoagulant factors and increasing levels of pro-coagulants. In the literature, the incidence of arterial thrombosis in cancer patients is reported to be 3.8%; 5-fluorouracil is mentioned as a rare causative agent, whereas cisplatin is thought to be the most common agent responsible for in situ thrombosis. In this report we present a 43-year-old male patient with bilateral popliteal artery embolism after 5-fluorouracil/cisplatin/taxotare combination chemotheraphy for gastric carcinoma. He had no additional risk factors such as smoking or any persistent organic arterial disease. He had sinus cardiac rhythm on electrocardiography and there were no abnormalities on echocardiography that could have been source of emboli. Surgical thrombectomy was performed with effective anticoagulation. After the operation, our medical oncologist discontinued 5-fluorouracil. At follow up, there was no evidence of thrombosis, with normal vascular flow rate.
- Title: Kounis syndrome secondary to
simultaneous oral amoxicillin and parenteral
ampicillin use in a young man : case report -
online article
Authors: Bezgin, Tahir; Gecmen, Cetin; Ozkan, Birol; Alici, Gokhan; Kalkan, Mehmet Emin; Kargin, Ramazan; Esen, Ali Metin
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: e10-e12
Multimedia: Video Clip 1 / Video Clip 2
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DOI Number: 10.5830/CVJA-2012-077
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-077
Abstract: The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome', progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission.
- Title: Localised bullous eruptions after
extravasation of normal saline in the forearm
during left ventricular device-assisted surgery
: case report - online article
Authors: Lee, Chih-Hsien; Chang, Cheng-Hsi; Wu, Ching-Wen; Wei, Jeng; Tsai, Yi-Ting
From: Cardiovascular Journal of Africa, Vol 24, Issue 2, Mar
Published: 2013
Pages: e13-e15
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DOI Number: 10.5830/CVJA-2012-073
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-073
Abstract: Peripheral infusion of intravenous agents is a daily routine in hospitals. Extravasation is an unintended complication associated with intravenous infusion where accidental injection or leakage of fluid occurs into the perivascular or subcutaneous space. Extravasation is fairly common but is usually without serious consequences. This has led clinicians to underestimate the potentially serious consequences of extravasation. Extravasation injury results from a combination of factors, including cytotoxicity of the solution, osmolality, vasoconstrictor effects, infusion pressure and other factors. We describe a case of upper extremity localised bullous eruptions resulting from the pressurised infusion of crystalloid solutions through an intravenous catheter, placed in the operating room during left ventricular device-assisted surgery. Peri-operative management of acute localised bullous eruptions requires surveillance for unforeseen consequences. Early recognition, diagnosis and intervention averted potential complications and morbidity.
