CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME
24, ISSUE
3, APR 2013
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- Title: Acute ischaemic stroke :
highlighting the need for early intervention :
editorial
Authors: Modi, Girish
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 51
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Abstract: If only the brain was like the heart where losing a 'bit' from ischaemia and infarction would have little effect on its function, the treatment of stroke in the acute setting would not be such a public health issue. The effects of stroke on an individual and the burden its leaves on families and society are enormous and costly.
- Title: The prevalence and
distribution of non-communicable diseases and
their risk factors in Kasese district, Uganda :
cardiovascular topics
Authors: Mondo, Charles Kiiza; Otim, Marcel Andrew; Akol, George; Musoke, Robert; Orem, Jackson
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 52-57
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DOI Number: 10.5830/CVJA-2012-081
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-081
Abstract: Background : To date there has been no population-based survey of the major risk factors for non-communicable diseases (NCD) in Uganda. Hospital-based data from urban centres report an increasing burden of NCDs in Uganda. This population-based survey aimed to describe the prevalence of risk factors for NCDs in a rural Ugandan district.
Methods : The survey was conducted using the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) methodology. Participants (n = 611) were residents of the Kasese district selected in a one-step, complete survey of a rural district. Standardised international protocols were used to record history of disease, and measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity), physical characteristics [weight, height, waist and hip circumferences, blood pressure (BP)], fasting blood glucose (BG) and total cholesterol (TC) levels. Data were analysed using simple descriptive analysis.
Results : In this sample, the prevalence of hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg) was 22.1% for men and 20.5% for women. Fifteen per cent of men and 16.8% of women were overweight [body mass index (BMI) ≥ 25 kg/m2] and 4.9% of men and 9.0% of women were obese (BMI ≥ 30 kg/m2). Nine per cent of participants were diabetic, 7.2% ate five or more combined servings of fruit per day while only 1.2% ate five or more combined servings of vegetables per day. Fifty-one per cent of the population were physically inactive and 9.6% were daily smokers. Thirty-one per cent of females had fasting blood sugar levels (FBS) ≥ 6.1 mmol/l while 10% of males had FBS > 6.1 mmol/l.
Conclusion : This study presents evidence on the magnitude of NCDs, their risk factors and gender distribution in a rural population in Uganda, a poor country in east-central Africa. These data, when combined with urban population data, could be useful in the formulation and advocacy of NCD policy and plans of action in Uganda.
- Title: Modulation of
haemodynamics, endogeneous antioxidant enzymes,
and pathophysiological changes by selective
inhibition of angiotensin II type 1 receptors in
pressure-overload rats : cardiovascular topics
Authors: Moinuddin, Ghulam; Inamdar, Mohammed Naseeruddin; Kulkarni, Kala S.; Kulkarni, Chanda
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 58-65
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DOI Number: 10.5830/CVJA-2012-080
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-080
Abstract: Background : Constriction of the thoracic or abdominal aorta provides an experimental model of pressure-overload cardiac hypertrophy. Blockade of AT1 receptors is beneficial in preventing target-organ damage in hypertension.
Objective : To examine the effect of angiotensin II receptor antagonists on blood pressure, endogenous antioxidant enzyme and histopathological changes in pressure-overload rats.
Methods : Pressure overload was produced by abdominal aortic banding (AAB) using a blunt 22-guage needle in male rats as a model of cardiac hypertrophy. After surgery, the AAB-induced hypertension (AABIH) rats were treated with losartan 40 mg/kg/day, candesartan 10 mg/kg/day, irbesartan 10 mg/kg/day per os for 16 weeks. At 16 weeks of surgery, the rats were observed for general characteristics and mortality, and we determined non-invasive blood pressure (NIBP), endogenous antioxidant enzyme catalase and superoxide dismutase (SOD) activities, and histology of the target organs.
Results : In the AABIH group, significant increase in systolic blood pressure was observed from weeks 3 to 16 compared with the control group, along with reduced serum catalase and SOD activities. The treated groups showed significant reduction in systolic BP and increase in serum SOD and catalase activities. The histological changes induced in the target organs, namely heart, liver, kidneys and thoracic aorta in the AABIH rats were attenuated in the treated rats.
Conclusion : Blockade of the AT1 receptor caused an improvement in the myocardial antioxidant reserve and decreased oxidative stress in the hypertensive rats, which was evidenced by the protection observed in the treatment groups.
- Title: Cardiomyopathies and
myocardial disorders in Africa : present status
and the way forward : letter to the editor
Authors: Mayosi, Bongani M.
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 65, 71
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Abstract: I read with great interest the review by Falase and Ogah on cardiomyopathies and myocardial disorders in Africa. It is a timely contribution to the ongoing discourse on the contemporary status of heart muscle disease in Africa. There are however several issues that need to be addressed by the authors of the review. The first relates to the statement by the authors that 'there are no reports of left ventricular non-compaction from Africa, possibly because African cardiologists are not yet familiar with its echocardiographic changes'. This statement is contrary to the published literature. Over the past six years, there have been several reports from different countries of African patients with left ventricular non-compaction, including Djibouti, South Africa and Sudan.
- Title: Hypertension and
associated factors in older adults in South
Africa : cardiovascular topics
Authors: Peltzer, Karl; Phaswana-Mafuya, Nancy
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 66-71
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DOI Number: 10.5830/CVJA-2013-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-002
Abstract: Background : Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Little attention has been focused on hypertension and associated factors among older adults in Africa. Therefore, this study aimed to investigate the prevalence and associated factors of hypertension in a national sample of older South Africans who participated in the Study of Global Ageing and Adults' Health (SAGE) in 2008.
Methods : In 2008 we conducted a national, population-based, cross-sectional study of a sample of 3 840 subjects aged 50 years or older in South Africa. The questionnaire included socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements.
Results : The prevalence of hypertension in the sample population was 77.3% (male 74.4%, female 79.6%). The rates of awareness, treatment and control among the hypertensive participants were 38.1, 32.7 and 17.1%, respectively. The results of multivariate logistic regression analysis revealed that the prevalence of hypertension was associated with being in the Coloured population group, having had a stroke, being overweight or obese and having had five or more out-patients care visits in the past 12 months. Hypertension was inversely associated with current alcohol use.
Conclusion : This study revealed high rates of hypertension among older adults (50 years and more) in South Africa, which puts them at risk for cardiovascular disease. The percentages of hypertensive subjects who were aware, treated and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure-monitoring systems to better manage hypertension among older adults in South Africa.
- Title: Neonatal circulatory failure
due to acute hypertensive crisis : clinical and
echocardiographic clues : cardiovascular topics
Authors: Louw, Jacoba; Brown, Stephen; Thewissen, Liesbeth; Smits, Anne; Eyskens, Benedicte; Heying, Ruth; Cools, Bjorn; Levtchenko, Elena; Allegaert, Karel; Gewillig, Marc
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 72-75
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DOI Number: 10.5830/CVJA-2013-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-003
Abstract: Objective : Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis.
Methods : Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified.
Results : Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30) and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors.
Conclusion : Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.
- Title: Decreased vascular
contractility induced by hemin is associated
with a reduced rho-kinase activity :
cardiovascular topics
Authors: Awede, Bonaventure; Lemaire, Marie-Christine; Bonnet, Pierre; Eder, Veronique
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 76-79
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DOI Number: 10.5830/CVJA-2013-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-005
Abstract: Objectives : In this study, the role of rho-kinase activity in the modulation of vascular contractility induced by hemin, a heme oxygenase inducer, was investigated.
Methods : Aortic rings from Wistar rats were incubated in physiological saline solution (PSS) containing hemin at 10-4 M for six hours then contracted with phenylephrine, and a dose-response curve was established. The effect of Y-27632, a rho-kinase inhibitor, on the relaxation of the pre-contracted aortic rings was then studied.
Results : Incubation of the aortic rings in hemin induced an increased expression of heme oxygenase 1 (HO-1). A reduction in the contractile force of aortic rings incubated in hemin was observed in response to phenylephrine. Y-27632 at a concentration of 10-6 M induced a 36% relaxation of the control aortic rings but only a 20% relaxation in aortic rings treated with hemin.
Conclusion : These data suggest that the decreased vascular contractility induced by hemin could, in part, result from an inhibition of rho-kinase activity.
- Title: Cardiovascular
complications in newly diagnosed rheumatic heart
disease patients at Mulago Hospital, Uganda :
cardiovascular topics
Authors: Okello, Emmy; Wanzhu, Zhang; Musoke, Charles; Twalib, Aliku; Kakande, Barbara; Lwabi, Peter; Wilson, Nyakoojo B.; Mondo, Charles K.; Odoi-Adome, R.; Freers, Juergen
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 80-85
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DOI Number: 10.5830/CVJA-2013-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-004
Abstract: Background : Complications of rheumatic heart disease are associated with severe morbidity and mortality in developing countries where the disease prevalence remains high. Due to lack of screening services, many patients present late, with severe valve disease. In Uganda, the disease and its complications are still not well studied.
Objective : To profile and describe cardiovascular complications in newly diagnosed rheumatic heart disease patients attending the Mulago National Referral Hospital in Uganda.
Methods : This was a cross-sectional study where consecutive, newly diagnosed rheumatic heart disease patients were assessed and followed up for complications, such as heart failure, pulmonary hypertension, atrial fibrillation, recurrence of acute rheumatic fever, and stroke.
Results : A total of 309 (115 males and 196 females) definite rheumatic heart disease patients aged 15-60 years were enrolled in the study and analysed. Complications occurred in 49% (152/309) of the newly diagnosed rheumatic heart disease cases, with heart failure (46.9%) the most common complication, followed by pulmonary arterial hypertension (32.7), atrial fibrillation (13.9%), recurrence of acute rheumatic fever (11.4%), infective endocarditis (4.5%) and stroke (1.3%). Atrial fibrillation and acute rheumatic fever were the most common complications associated with heart failure.
Conclusion : In this study we found that about 50% of newly diagnosed rheumatic heart disease patients in Uganda presented with complications. Heart failure and pulmonary arterial hypertension were the most commonly observed complications.
- Title: Management of ischaemic
stroke in the acute setting : review of the
current status : review article
Authors: Jivan, Kalpesh; Ranchod, Kaushik; Modi, Girish
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 86-92
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DOI Number: 10.5830/CVJA-2013-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-001
Abstract: Acute ischaemic stroke can be treated by clot busting and clot removal. Thrombolysis using intravenous recombinant-tissue plasminogen activator (IV r-TPA) is the current gold standard for the treatment of acute ischaemic stroke (AIS). The main failure of this type of treatment is the short time interval from stroke onset within which it has to be used for any benefit. The evidence is that IV r-TPA has to be used within 4.5 hours.
Other modalities of treatment are not as effective and need more scrutiny and examination. The available modalities are intra-arterial thrombolysis and clot-retrieval devices. Not unexpectedly, recanalisation treatments have flourished at a rapid rate. Although vessel recanalisation is vital to increasing the possibility of significant tissue reperfusion, clinical trials need to emphasise functional outcomes rather than reperfusion/recanalisation rates to adequately assess success of these devices/techniques.
Our view is that until these treatments become proven in large-scale studies, a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5-hour period following onset of stroke. The resources required are small with the main costs being a CT scan of the brain and the cost of r-tPA. This can easily be done in any emergency facility in any part of the world. What is needed is public awareness, and campaigns of 'stroke attack' should be revisited, especially in the resource-limited context. This approach at present will halt to some extent the stroke pandemic that we are facing.
- Title: Successes, failures,
challenges and ground-breaking research :
messages from the 6th World Congress of
Paediatric Cardiology and Cardiac Surgery :
cardio news
Authors: Zuhlke, Liesl
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 93-95
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Abstract: A remarkable cardiac event, the largest and most prestigious yet on African soil, took place in February this year. The 6th World Congress of Paediatric Cardiology and Cardiac Surgery was held in Cape Town, with over 3 000 registered delegates and over 2 500 scientific attendees. It was hosted by the South African Heart Association and organised by the Paediatric Cardiac Society of South Africa, a special-interest group of the South African Heart Association, whose major objective is to improve the quality of care of children with congenital and acquired heart disease.
- Title: South African studies in
the international literature : drug trends in
cardiology
Authors: Hardy, G.
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 95-96
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Abstract: Considerations of ethnicity and gender in chronic diseases of lifestyle
Urban black women at greater risk of chronic heart failure with a younger age of onset
Ethnic variations in the role of adipose tissue on insulin resistance in women
Population-specific cut-off points proposed for diagnosis of the metabolic syndrome in South Africa
Geographic variation of hypertension in South Africa
NCD risk factors in a high-HIV-prevalence rural setting
- Title: Higher statin doses
linked to acute kidney injury : South African
experts comment on clinical implications : drug
trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 97
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Abstract: A meta-analysis published recently in the British Medical Journal has linked higher doses of statins (resulting in at least a 45% reduction in low-density lipoprotein cholesterol) to a higher risk of acute kidney injury (AKI) in the first four months of therapy compared to lower-dose statins.
- Title: Treating hypertension in
the elderly, even white-coat hypertension, is
essential : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 98
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Abstract: Hypertension treatment in the very elderly over the age of 80 years is beneficial and is associated with reduced risk of death from stroke, death from any cause and heart failure. The results from the extensive Hypertension in the Very Elderly Trial (HYVET) using indapamide sustained release 1.5 mg and either 2 or 4 mg perindopril daily provides tangible evidence for this approach.
- Title: Use new antiplatelet
therapies consistently in clinical practice :
drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: 100
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Abstract: Optimising the benefits of new anti-platelet therapies in daily clinical practice should be based on selecting the particular agents that the responsible clinician would like to use in managing acute coronary syndrome (ACS) patients and then sticking to this selection. Speaking in Accra, Ghana to African cardiologists and physicians attending a special AstraZeneca-sponsored CME symposium, Prof Jean-Pierre Bassand, past president of the European Society of Cardiology and head of Cardiology at the University of Besancon, Franche-Comte, noted that 'In my 35 years of experience in cardiology, physicians and nurses respond best when they have a simpler regimen of anti-coagulation and anti-platelet agents to use in the ACS setting.'
- Title: Left ventricular
non-compaction in pregnancy : case report -
online article
Authors: Kilic, Ismail Dogu; Tanriverdi, Halil; Evrengul, Harun; Uslu, Sukriye; Sungur, Mustafa Azmi
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: e1-e2
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DOI Number: 10.5830/CVJA-2012-075
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-075
Abstract: Left-ventricular non-compaction (LVNC) represents an arrest in the normal process of myocardial compaction, resulting in multiple, prominent, persistant trabeculations and deep inter-trabecular recesses communicating with the ventricular cavity. LVNC is a rarely encountered cardiomyopathy and few cases have been reported in pregnancy. In this case report we present a patient who referred to our clinic with symptoms of heart failure during pregnancy and whose echocardiographic examination revealed prominent trabeculations in the left ventricle.
- Title: Unusual variant of
scimitar syndrome associated with an absent
right pulmonary artery, stenosis of the inferior
vena cava, hemi-azygous continuation and the
VACTERL association : case report - online
article
Authors: Takawira, Farirai F.; Omar, Fareed
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: e3-e6
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DOI Number: 10.5830/CVJA-2012-079
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-079
Abstract: We report on a two-month-old infant with an unusual form of scimitar syndrome, associated with an absent right pulmonary artery, obstructed inferior vena cava, hemi-azygous continuation and the VACTERL association. The infant posed a major management problem and eventually died from a lower respiratory tract infection.
- Title: Candida parapsilosis
endocarditis on a prosthetic aortic valve with
unclear echocardiographic features : case report
- online article
Authors: Mvondo, Charles Mve; D'Auria, Francesca; Sordillo, Pasquale; Pellegrino, Antonio; Adreoni, Massimo; Chiariello, Luigi
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: e7-e8
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DOI Number: 10.5830/CVJA-2013-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-006
Abstract: Fungal endocarditis is rare in comparison with bacterial endocarditis and is associated with a poor prognosis. Despite the proven reliability of echocardiography, false negatives are not uncommon and may influence the therapeutic strategy, as some reports have supported the efficacy of antifungal treatment alone. We report on a case of bioprosthetic aortic valve Candida parapsilosis endocarditis without typical echocardiograhy findings, which we treated with both antifungal and surgical therapy.
- Title: Robotically assisted
ventricular tachycardia substrate modification
ablation with the novel Lynx™ integrated sheath
and RF ablation catheter : case report - online
article
Authors: Lorgat, Faizel; Pudney, Evan; Van Deventer, Helena
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: e9-e11
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DOI Number: 10.5830/CVJA-2013-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-008
Abstract: Catheter ablation of ventricular tachycardia (VT) is demanding and time consuming. Robotically controlled catheter ablation reduces operator fatigue and exposure to X-rays, and provides greater precision and stability of the catheter. A new flexible, integrated robotic sheath and ablation catheter has recently been introduced (Lynx™) and used in atrial ablation procedures. We describe the first VT substrate modification ablation in the world with the Lynx™ robotic radio frequency ablation catheter.
- Title: Unexpected preserved
brain perfusion imaging despite severe and
diffuse atherosclerosis of supra-aortic trunks :
case report - online article
Authors: Gargiulo, Guiseppe; Tortora, Fabio; Cirillo, Mario; Perrino, Cinzia; Schiattarella, Gabriele Giacomo; Trimarco, Bruno; Esposito, Giovanni
From: Cardiovascular Journal of Africa, Vol 24, Issue 3, Apr
Published: 2013
Pages: e12-e14
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DOI Number: 10.5830/CVJA-2013-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2013-009
Abstract: We report an unusual case of a patient whose whole cerebral circulation was supported by poor vicariate collaterals and a severely atherosclerotic right vertebral artery, with no brain perfusion abnormalities. Our belief is that despite the brain imaging and the absence of symptoms, because of his critical vascular disease and the paucity of data from large randomised clinical trials on vertebro-basilar revascularisation, the case required an extremely cautious approach regarding any kind of revascularisation. An accurate imaging analysis together with clinical features allowed us to decide on a strategy based on optimal medical therapy and careful clinical monitoring.
