Cardiovascular Journal of Africa: Vol 26, Issue 6, November / December 2015

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CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 26, ISSUE 6, NOV/DEC 2015

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Title: From the Editor’s Desk
Authors: Commerford, P
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 151
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Abstract:This issue provides an array of articles on a variety of
cardiovascular topics ranging from clinical registries to basic
laboratory science.
Title: Comparison of a qualitative measurement of heart-type fatty acid-binding protein with other cardiac markers as an early diagnostic marker in the diagnosis of non-ST - segment elevation myocardial infarction
Authors:Gerede, DM; Güleç, S; Kılıçkap, M; Kaya, CT; Vurgun, VK; Özcan, ÖU; Göksülük, H; Erol, Ç
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 204-209
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DOI Number:10.5830/CVJA-2015-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-028
Objective: Heart-type fatty acid-binding protein (H-FABP) is a novel cardiac marker used in the early diagnosis of acute myocardial infarction (AMI), which shows myocyte injury. Our study aimed to compare bedside H-FABP measurements with routine creatine kinase-MB (CK-MB) and troponin I (TnI) tests for the early diagnosis of non-ST-elevation MI (NSTEMI), as well as for determining its exclusion capacity.
Methods: A total of 48 patients admitted to the emergency room within the first 12 hours of onset of ischaemic-type chest pain lasting more than 30 minutes and who did not have ST-segment elevation on electrocardiography (ECG) were included in the study. Definite diagnoses of NSTEMI were made in 24 patients as a result of 24-hour follow up, and the remaining 24 patients did not develop MI.
Results: When various subgroups were analysed according to admission times, H-FABP was found to be a better diagnostic marker compared to CK-MB and TnI (accuracy index 85%), with a high sensitivity (79%) and specificity (93%) for early diagnosis (≤ six hours). The respective sensitivities of bedside H-FABP and TnI tests were 89 vs 33% (p < 0.05) for patients presenting within three hours of onset of symptoms.
Conclusion: Bedside H-FABP measurements may contribute to correct early diagnoses, as its levels are elevated soon following MI, and measurement is easy, with a rapid result.
Title: Management and outcome of topical beta-blocker-induced atrioventricular block
Authors: Ozcan, KS; Gungor, B; Tekkesin, AI; Altay, S; Ekmekci, A; Toprak, E; Yildirim, E; Calik, N; Alper, AT; Gurkan, K; Erdinler, I; Osmonov, D
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 210-213
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DOI Number:10.5830/CVJA-2015-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-030
Background: Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers.
Methods: All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period.
Results: A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation.
Conclusion: Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.
Title: Autonomic imbalance assessed by time-domain heart rate variability indices in primary Raynaud's phenomenon
Authors: Karabacak, K; Celik, M; Kaya, E; Kadan, M; Arslan, G; Demirkilic, U
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 214-216
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DOI Number: 10.5830/CVJA-2015-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-032
Objectives: The pathogenesis of primary Raynaud's phenomenon (RP) seems to be multifactorial and autonomic nervous dysfunction is one factor. Heart rate variability (HRV) is one of the most reliable parameters to demonstrate autonomic dysfunction. Our aim was to evaluate the time-domain HRV in patients with primary RP.
Methods: A time analysis of HRV was performed in patients with primary RP and age- and gender-matched healthy controls. The results of the study and control group were compared.
Results: Thirty patients with primary RP [all men, median (IQR) age: 21 (2) years) and 31 age- and gender-matched healthy controls (median (IQR): 21(3) years) were enrolled in the study. We found a statistically significant difference between the primary RP patients and control subjects in terms of time-domain HRV parameters (p < 0.05 for all).
Conclusion: Our study showed the presence of autonomic nervous dysfunction of heart function in patients with primary RP.
Title: Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome : interatrial conduction delay
Authors: Gazi, E; Gencer, M; Hanci, V; Temiz, A; Altun, B; Barutcu, A; Gungor, AN; Hacivelioglu, S; Uysal, A; Colkesen, Y
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 217-221
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DOI Number: 10.5830/CVJA-2015-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-046
Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women during the reproductive period. Cardiovascular risk factors are more frequent in patients with PCOS. We aimed to investigate the P-wave dispersion (Pd), inter- and intra-atrial conduction time and mechanical functions of the left atrium (LA) in patients with PCOS.
Methods: Forty-eight patients with PCOS and 38 normal healthy women were enrolled in this study. A 12-lead surface electrocardiogram was used to evaluate Pd. Left ventricular (LV) functions were measured using conventional and tissue Doppler imaging (TDI) methods. Inter- and intra-atrial conduction times were measured by TDI. LA volumes were measured echocardiographically with the biplane area-length method from the apical four-chamber view.
Results: Heart rate (82.02 ± 13.15 vs 74.24 ± 11.02 bpm, p = 0.014) and Pd were significantly increased in the PCOS patients [27 ± 5 vs 24 ± 6 ms, p = 0.035]. Transmitral E/A ratio was significantly lower in the PCOS patients than in the controls (1.5 ± 0.3 vs 1.7 ± 0.4 m/s, p = 0.023). Passive emptying volume (12.54 ± 4.39 vs 15.28 ± 3.85 ml/m², p = 0.004) and passive emptying fraction [54.4 (21-69) vs 59.1% (28-74), p = 0.008] were significantly decreased in PCOS patients. Total emptying volume was significantly decreased (17.9 ± 5.49 vs 20.67 ± 4.29 ml/m², p = 0.018) in PCOS patients. Interatrial (19 ± 7.4 vs 15 ± 6.4 ms, p = 0.035) and intra-atrial [8.5 (1-19) vs 5 ms (1-20), p = 0.026] electromechanical delays were found to be significantly higher in PCOS patients.
Conclusion: This study showed that patients with PCOS had increased inter- and intra-atrial conduction delays, and decreased LA passive emptying volumes and fractions.
Title: Protective effects of ginseng extracts and common anti-aggregant drugs on ischaemia-reperfusion injury
Authors: Caliskan, A; Karahan, O; Yazici, S; Demirtas, S; Guclu, O; Tezcan, O; Yavuz, C
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 222-226
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DOI Number: 10.5830/CVJA-2015-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-047
Objective: Ginseng is a traditional herbal medicinal product widely used for various types of diseases because of its cellular protective effects. Possible protective effects of ginseng were investigated in blood, cardiac and renal tissue samples and compared with common anti-aggregant agents in an animal ischaemia-reperfusion (I/R) model.
Methods: Twenty rats were equally divided into four different groups as follows: control group (I/R-induced group without drug use), group I (acetylsalicylic acid-administered group), group II (clopidogrel bisulfate-administered group), group III (ginsenoside Rb1-administered group). For the groups assigned to a medication, peripheral I/R was induced by clamping the femoral artery one week after initiation of the specified medication. After reperfusion was initiated, cardiac and renal tissues and blood samples were obtained from each rat with subsequent analysis of nitrogen oxide (NOx), malondialdehyde (MDA), paraoxonase 1 (PON1) and prolidase.
Results: NOx levels were similar in each group. Significant decrements were observed in serum PON1 levels in each group when compared with the control (p < 0.05). Serum MDA levels were significantly lower in groups II and III (p < 0.05). Ameliorated renal prolidase levels were detected in study groups (p < 0.05) and recovered cardiac prolidase levels were obtained in groups II and III (p < 0.05).
Conclusion: These findings indicate that ginseng extracts may have a potential beneficial effect in I/R injury. However, more comprehensive studies are required to clarify the hypothetical cardiac, renal and systemic protective effects in reperfusion-induced oxidative damage.
Title: An open-access mobile compatible electronic patient register for rheumatic heart disease ('eRegister') based on the World Heart Federation's framework for patient registers
Authors: Van Dam, J; Tadmor, B; Spector, J; Musuku, J; Zuhlke, L; Engel, ME; Mayosi, BM; Nestle, N
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 227-233
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DOI Number: 10.5830/CVJA-2015-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-058
Background : Rheumatic heart disease (RHD) remains a major disease burden in low-resource settings globally. Patient registers have long been recognised to be an essential instrument in RHD control and elimination programmes, yet to date rely heavily on paper-based data collection and non-networked data-management systems, which limit their functionality.
Objectives : To assess the feasibility and potential benefits of producing an electronic RHD patient register.
Methods : We developed an eRegister based on the World Heart Federation's framework for RHD patient registers using CommCare, an open-source, cloud-based software for health programmes that supports the development of customised data capture using mobile devices.
Results : The resulting eRegistry application allows for simultaneous data collection and entry by field workers using mobile devices, and by providers using computer terminals in clinics and hospitals. Data are extracted from CommCare and are securely uploaded into a cloud-based database that matches the criteria established by the WHF framework. The application can easily be tailored to local needs by modifying existing variables or adding new ones. Compared with traditional paper-based data-collection systems, the eRegister reduces the risk of data error, synchronises in real-time, improves clinical operations and supports management of field team operations.
Conclusions : The user-friendly eRegister is a low-cost, mobile, compatible platform for RHD treatment and prevention programmes based on materials sanctioned by the World Heart Federation. Readily adaptable to local needs, this paperless RHD patient register program presents many practical benefits.
Title: High-sensitivity cardiac troponin T is more helpful in detecting peri-operative myocardial injury and apoptosis during coronary artery bypass graft surgery
Authors: Kocak, EF; Kocak, C; Aksoy, A; Isiklar, OO; Akcilar, R; Ozdomanic, IF; Unsal, C; Celenk, M; Altuntas, I
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 234-241
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DOI Number: 10.5830/CVJA-2015-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-052
Aim : To determine whether there is a correlation between cardiac markers and peri-operative myocardial injury (PMI) and apoptosis in coronary artery bypass graft (CABG) surgery and to compare the efficacy of cardiac markers to detect PMI.
Methods : The study population consisted of 37 patients (24 male, 13 female, mean age 63.4 ± 8.9 years) undergoing elective CABG. Arterial and coronary sinus blood samples were collected just before aortic cross-clamping (pre-ACC) and after aortic declamping (post-ACC). Creatine kinase-MB isoenzyme (CK-MB) activity, and high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB isoenzyme mass (CK-MB mass) and cardiac troponin I (cTnI) concentrations were measured in blood samples. Myocardial injury and apoptosis were examined in atrial biopsies.
Results : CABG caused PMI and apoptosis in all cases. Concentrations and net releases of cardiac markers significantly increased after aortic declamping (p < 0.001 for CK-MB and CK-MB mass, p < 0.01 for cTnI, p < 0.05 for hs-cTnT). A positive correlation was found between apoptotic index (r = 0.611, p < 0.001 for cTnI; r = 0.806, p < 0.001 for hs-cTnT), myocardial injury score (r = 0.544, p < 0.001 for cTnI; r = 0.719, p < 0.001 for hs-cTnT) and cTnI and hs-cTnT values in the post-ACC period. A positive correlation was found between apoptotic index (r = 0.507, p < 0.001), myocardial injury score (r = 0.416, p = 0.010) and net release of hs-cTnT. Furthermore, a positive correlation was found between aortic cross-clamp (ACC) time (r = 0.448, p = 0.007), cardiopulmonary bypass (CPB) time (r = 0.342, p = 0.047) and net release of hs-cTnT.
Conclusion : Although both cTnI and hs-cTnT may be specific and efficacious markers of myocardial apoptosis and injury occurring during CABG with CPB, hs-cTnT may be a more useful marker than cTnI to detect peri-operative myocardial apoptosis and injury.
Title: Lack of cardioprotection by single-dose magnesium prophylaxis on isoprenaline-induced myocardial infarction in adult Wistar rats
Authors: Garson, C; Kelly-Laubscher, R; Blackhurst, D; Gwanyanya, A
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 242-249
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DOI Number: 10.5830/CVJA-2015-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-055
Aim: Magnesium (Mg²⁺) is effective in treating cardiovascular disorders such as arrhythmias and pre-eclampsia, but its role during myocardial infarction (MI) remains uncertain. In this study, we investigated the effects of Mg²⁺ pre-treatment on isoprenaline (ISO)-induced MI in vivo.
Method : Rats divided into four groups were each pre-treated with either MgSO₄ (270 mg/kg intraperitoneally) or an equivalent volume of physiological saline, prior to the ISO (67 mg/kg subcutaneously) or saline treatments. One day post-treatment, the electrocardiogram and left ventricular blood pressures were recorded. Infarcts were determined using 2,3,5-triphenyltetrazolium chloride staining, and serum markers of lipid peroxidation were measured with spectrophotometric assays.
Result : Mg²⁺ pre-treatment neither altered the ISO-induced infarct size compared with ISO treatment alone (p > 0.05), nor reversed the low-voltage electrocardiogram or the prominent Q waves induced by ISO, despite a trend to decreased Q waves. Similarly, Mg²⁺ did not prevent the ISO-induced decrease in peak left ventricular blood pressure or the decrease in minimal rate of pressure change. Mg²⁺ did not reverse the ISO-induced gain in heart weight or loss of body weight. Neither ISO nor Mg²⁺ altered the concentrations of lipid peroxidation markers 24 hours post MI induction.
Conclusion: Although Mg²⁺ had no detrimental effects on electrical or haemodynamic activity in ISO-induced MI, the lack of infarct prevention may detract from its utility in MI therapy.
Title: Drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 250
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Title: Cardio News
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: 251
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Title: Dyspnoea and chest pain as the presenting symptoms of pneumomediastinum : two cases and a review of the literature
Authors:Kara, H; Uyar, HG; Degirmenci, S; Bayir, A; Oncel, M; Ak, A
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: e1-e4
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DOI Number: 10.5830/CVJA-2015-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-035
Abstract: Pneumomediastinum is the presence of air in the mediastinum. It may occur as spontaneous, traumatic, or iatrogenic pneumomediastinum. Although spontaneous pneumomediastinum is usually observed in healthy young men, traumatic pneumomediastinum may be caused by blunt or penetrating trauma to the chest and neck. Pneumomediastinum is a clinical condition with potential complications that cause high morbidity and mortality rates. Pneumomediastinum also may develop without tracheal or oesophageal injury after spontaneous or blunt chest, neck and facial injuries, and it may be accompanied by pneumothorax.
We treated two patients who had pneumomediastinum. Case 1 was a 20-year-old man who had pain and dyspnoea around the sternum for one hour, as a result of a blow from an elbow during a football match. Case 2 was a 23-year-old man who had a two-day history of dyspnoea and chest pain with no history of trauma. In both patients, diagnosis of pneumomediastinum was confirmed with thoracic computed tomography scans, and the condition resolved within five days of in-patient observation. In conclusion, the diagnosis of pneumomediastinum should be considered for all patients who present to the emergency department with chest pain and dyspnoea.
Title: Iatrogenic left main-stem dissection extending to the circumflex artery and retrogradely involving the left and non-coronary sinuses of Valsalva : iatrogenic aortocoronary dissection
Authors: Zwolinski, R; Marcinkiewicz, A; Szymczyk, K; Jaszewski, R; Pietruszynski, R
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: e5-e7
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DOI Number: 10.5830/CVJA-2015-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-060
Abstract: We present the case of a 57-year-old female who experienced iatrogenic left main-stem (LMS) dissection during elective coronary angiography. The dissection immediately affected the circumflex artery (Cx), causing its total distal occlusion, and the left anterior descending artery (LAD), in which a metal stent, implanted six months earlier, provided blood flow. The dissection spread retrogradely to the left and non-coronary sinuses of Valsalva (SV). Ventricular fibrillation (VF) occurred but the patient was successfully defibrillated. The subsequent introduction of a catheter resulted in recurrent VF, again successfully defibrillated. Total arterial myocardial revascularisation with double skeletonised internal thoracic arteries was performed without complications and SV repair was avoided. At the one-year follow up, a control multi-slice CT (MSCT) angiography was conducted, revealing complete healing of the SV and LMS dissections. It also showed native blood flow, the left internal thoracic artery (LITA) graft to the Cx occlusion, and a patent right internal thoracic artery (RITA) graft implanted to the LAD.
Title: A rare case of aortic dissection presenting as pure transient global amnesia
Authors: Kaveeshvar, H; Loomba, V; Kashouty, R; Yono, N
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: e8-e9
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DOI Number: 10.5830/CVJA-2015-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-061
Abstract: Transient global amnesia (TGA) is a well-described neurological phenomenon. Clinically, it manifests with the sudden onset of a paroxysmal, transient loss of anterograde memory and disorientation but with intact consciousness. Typically, symptoms last for only a few hours. We present an unusual case of aortic dissection presenting with pure TGA in a patient, who had a positive outcome. This is the second case report of a patient with aortic dissection presenting with pure TGA syndrome, but it is the first case in which the patient survived.
Title: Application of thoracic endovascular dissecting aneurysm repair for secondary type B aortic dissection
Authors: Karahan, O; Tezcan, O; Demirtas, S; Caliskan, A; Yavuz, C
From: Cardiovascular Journal of Africa, Vol 26, Issue 6, Nov/Dec
Published: 2015
Pages: e10-e12
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DOI Number: 10.5830/CVJA-2015-067
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-067
Abstract: Type A aortic dissection is an emergency condition that requires immediate surgery. Graft replacement of the ascending aorta is the main treatment for this disorder. However, after ascending aortic replacement, the dissection flap may progress to the distal side (to the descending aorta) and a new intimal tear may develop. In this study, we report on a 66-year-old woman who had a history of ascending aortic replacement six months earlier. She was admitted to hospital with a new onset of back pain. Computed tomography revealed a new dissection tear originating from the distal side of the subclavian artery orifice. Thoracic endovascular dissecting aneurysm repair (TEVDAR) was carried out on the patient. Additional complications were not observed in the postoperative period. Complete cure was provided and the patient was discharged on the fourth day after the operation. TEVDAR may be safe and effective in preventing progression of the aortic flap and the formation of a new intimal tear in type A aortic dissections. Optional hybrid interventions could ameliorate the outcomes in aortic dissection cases.