Title: From the Editor’s Desk:
Out-of-hospital cardiac arrest
Authors: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 275
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Abstract: Terminology may drive our perceptions
of activities and our actions in response to the
events we see occurring around us. Is it time to
take the P (pulmonary) out of CPR
(cardiopulmonary resuscitation) when referring
to witnessed out-of-hospital cardiac arrests
(OHCA)? I was prompted to consider this when I
was personally involved in resuscitation of an
individual who suffered an out-of-hospital
cardiac arrest when walking his dog, as I was
walking mine, in a park near our home. He
collapsed a few metres in front of me,
immediately after tossing a ball for his dog to
chase, and when I examined him he was wheezing,
cyanosed and pulseless.
Title: Pre-anesthetic
echocardiographic findings in children
undergoing non-cardiac surgery at the University
of Benin Teaching Hospital, Nigeria
Authors:WE Sadoh, P Ikhurionan, C Imarengiaye
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 276-280
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DOI Number:10.5830/CVJA-2016-006
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-006
Background: A pre-anaesthestic echocardiogram
(echo) is requested for most non-cardiac
surgeries to identify possible cardiac
structural anomalies.
Objective: To describe the prevalence and
spectrum of structural cardiac abnormalities
seen in various non-cardiac conditions.
Methods: We carried out a retrospective review
of pre-anaesthetic echos performed over five
years on children scheduled for non-cardiac
surgery. The requests were categorised according
to referring specialities, and the biodata and
echo findings were noted.
Results: A total of 181 children and 181
echocardiograms were studied, and 100 (55.2%) of
the patients were male. Most of the children
(87, 48.1%) with oro-facial clefts were referred
from dentistry. Of the 181 children, 39 (21.5%)
had cardiac abnormalities, most (34, 87.2%) of
whom had congenital heart disease (CHD).
Ophthalmic requests with suspected congenital
rubella syndrome (CRS) had the highest
prevalence of 8/12 (66.7%) while the lowest was
oro-facial clefts at 15/87 (17.2%). Atrial
septal defect was the commonest abnormality,
found in 14 patients (35.9%).
Conclusion: Pre-anaesthetic echo should be
performed, especially for children with
suspected CRS and other congenital anomalies,
requiring non-cardiac surgery.
Title: Gender-based differences in the relationship between fatty
liver disease and atherosclerosis
Authors: H-J Kim, C-W Lim, JH Lee, H-B Park, Y
Suh, Y-H Cho, T-Y Choi, E-S Hwang, D-K Cho
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 281-286
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DOI Number:10.5830/CVJA-2016-014
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-014
Background: Carotid intima–media thickness
(CIMT) is a surrogate of subclinical atherosclerosis. Fatty liver disease is
also linked to increased risk of cardiovascular events. The aim of this study
was to evaluate the association between fatty liver disease and CIMT according
to gender.
Methods: Patients who had undergone carotid and abdominal ultrasound between
June 2011 and December 2013 were retrospectively evaluated. The differences
between the CIMT values measured in the common carotid artery and the prevalence
of carotid plaque in patients with fatty liver disease and those with normal
livers were investigated.
Results: Out of a total of 1 121 patients, the men had more fatty liver disease
than the women. The mean CIMT of the men was significantly higher than that of
the women, and the men had more plaque than the women. The women with fatty
liver disease had a significantly higher mean CIMT value and more plaque than
the women with normal livers. The differences between the men with fatty liver
and those with normal livers in mean CIMT values and in the prevalence of plaque
were not significant. In the women, multivariate analysis showed that fatty
liver disease was independently associated with subclinical atherosclerosis
[adjusted hazards ratio (HR) 1.65, 95% confidence interval (CI) 1.007–2.697, p =
0.047].
Conclusions: The men had more fatty liver disease, carotid plaque and higher
CIMT values than the women. Fatty liver disease was a useful predictor of
atherosclerosis, especially for the female study patients.
Title: Congenital heart disease and
Down syndrome: various aspects of a confirmed
association
Authors: S Benhaourech, A Drighil, AE Hammiri
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 287-290
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DOI Number: 10.5830/CVJA-2016-019
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-019
Background: Congenital heart disease (CHD) is
frequently described in patients with Down
syndrome (DS) and is the main cause of death in
this population during the first two years of
life. The spectrum of CHD patterns in DS varies
widely worldwide; this variation could be due to
sociodemographic, genetic and geographic
factors.
Methods: A six-year retrospective, descriptive
study was carried out from December 2008 to
October 2014, based on the Paediatric Unit CHD
registry of Ibn Rochd University Hospital.
Clinical, echocardiographic and outcomes data
were collected and sorted according to
confirmation of the syndrome.
Results: Among 2 156 patients with CHD, 128 were
identified with Down syndrome. The genders were
equally represented (gender ratio 1) and the
median age at diagnosis was 9.5 months (2 days
to 16 years). The median age of mothers at
delivery was 39 years (16–47). Of the 186 CHD
lesions reported, the most common was
atrioventricular septal defect (AVSD, 29%),
followed by ventricular septal defect (VSD,
21.5%) and atrial septal defect (ASD, 19.9). The
most common associations of CHD were AVSD + ASD
(10%) and VSD + ASD (7.8%). Surgery was the most
common modality of treatment (54.3%). The
overall mortality rate was 14.1%.
Conclusion: Our study confirmed that the profile
and type of CHD in DS in the Moroccan setting
exhibited slight differences in the distribution
of these CHDs compared with European neighbours
and other Western countries. Further studies are
needed to determine which variables have an
impact on these differences.
Title: Could the novel ‘double-hole’ technique be an alternative for
the inflow occlusion method?
Authors: S Bozok, G Ilhan, H Kazdal, B Ozpak, I
Yurekli, S Bayrak, M Kestelli
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 291-293
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DOI Number: 10.5830/CVJA-2016-020
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-020
Background: Inflow occlusion on beating heart
and cardiopulmonary bypass techniques have been proposed for the removal of
foreign material, such as stents, catheters and mass lesions, from cardiac
chambers. However, both techniques are not devoid of disadvantages and
complications. In this article, we define an alternative, novel ‘double-hole’
technique, which is based on opening the right atrium without cardiopulmonary
bypass.
Methods: Bovine hearts were obtained from a local supermarket. Two purse-string
sutures were placed in the right atrium using 2-0 braided, non-absorbable
polyester suture material, one close to the auricle, and the other close to the
interatrial septum. The guidewire of a haemodialysis catheter was inserted
through the superior vena cava into the right atrium and passed all the way
through the right ventricle.
Results: We suggest that the double-hole technique may be useful, especially in
revision cases with adhesions. Further research should be performed to document
the efficacy and safety of this method.
Conclusion: We are aware that further extensive research is necessary to
investigate the utility of this novel technique in contemporary cardiovascular
surgery. We believe the doublehole technique has the potential to become a safe,
practical and effective measure in the future.
Title: The relationship between
elevated magnesium levels and coronary artery
ectasia
Authors: M Yolcu, E Ipek, S Turkmen, Y Ozen, E
Yıldırım, A Sertcelik, FR Ulusoy
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 294-298
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DOI Number: 10.5830/CVJA-2016-023
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-023
Background: Coronary artery ectasia (CAE)
without specific symptoms is the localised or
diffuse swelling of the epicardial coronary
arteries. Magnessium (Mg) plays an important
role in cardiac excitability, vascular tonus,
contractibility, reactivity and vasodilatation.
In our research, we aimed to study the
vasodilatory effect of Mg in the
aetiopathogenesis of ectasia.
Methods: Patients identified during routine
coronary angiograms in our clinic between
January 2010 and 2013 were included in the
study. Sixty-two patients with isolated CAE, 57
with normal coronary angiograms (NCA), 73 with
severe coronary artery disease (CAD), and 95
with stenosis of at least one coronary artery
and CAE (CAD + CAE) were included in the study.
Serum Mg levels were measured in mg/dl after 12
hours of fasting.
Results: There were no statistically significant
differences between the groups in terms of age,
hypertension, smoking, hyperlipidaemia, diabetes
mellitus, family history of coronary artery
disease and medications used. Serum glucose,
thyroid stimulating hormone (TSH), urea, total
cholesterol, triglyceride, low-density
lipoprotein (LDL) cholesterol, sodium and
potassium levels were similar in all groups.
Serum Mg levels were 1.90 ± 0.19 mg/dl in
patients with isolated CAE, 1.75 ± 0.19 mg/dl in
those with CAD, 1.83 ± 0.20 mg/dl in those with
CAD + CAE, and 1.80 ± 0.16 mg/dl in the NCA
group. These results show that Mg levels were
higher in ectasia patients with or without CAD.
Conclusions: The histopathological
characteristics of patients with CAE were
similar to those with CAD. The specific
mechanism of abnormal luminal dilatation seen in
CAE however remains to be elucidated. Mg is a
divalent cation with powerful vasodilatory
effects. In our study, serum Mg levels were
found to be statistically higher in ectasia
patients with or without CAD.
Title: Relationship between site of myocardial infarction, left
ventricular function and cytokine levels in patients undergoing coronary artery
surgery
Authors: I Kiris, S Kapan, C Narin, M Ozaydın,
MC Cure, R Sutcu, H Okutan
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 299-306
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DOI Number: 10.5830/CVJA-2016-027
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-027
Background: The purpose of this study was to
examine the relationship between left ventricular (LV) function, cytokine levels
and site of myocardial infarction (MI) in patients undergoing coronary artery
bypass grafting (CABG).
Methods: Sixty patients undergoing CABG were divided into three groups (n = 20)
according to their history of site of myocardial infarction (MI): no previous
MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed
analysis of LV function was done by transthoracic echocardiography. The levels
of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis
factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and
pericardial fluid were also measured.
Results: Echocardiographic analyses showed that the anterior MI group had
significantly worse LV function than both the group with no previous MI and the
posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional
shortening, LV end-systolic volume, LV end-systolic volume index and ejection
fraction). In the anterior MI group, both plasma and pericardial fluid levels of
adrenomedullin and and pericardial fluid levels of interleukin-6 and
interleukin- 1-beta were significantly higher than those in the group with no
previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin,
interleukin-6 and interleukin-1-beta were significantly higher than those in the
posterior/inferior MI group (p < 0.05).
Conclusions: The results of this study indicate that (1) patients with an
anterior MI had worse LV function than patients with no previous MI and those
with a posterior/inferior MI, and (2) cytokine levels in the plasma and
pericardial fluid in patients with anterior MI were increased compared to
patients with no previous MI.
Title: Strain and strain rate echocardiography in children with
Wilson’s disease
Authors: C Karakurt, S Çelik, A Selimoğlu, İ
Varol, H Karabiber, S Yoloğlu
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 307-314
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DOI Number: 10.5830/CVJA-2016-028
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2015-028
Objective: This study aimed to evaluate strain
and strain rate echocardiography in children with Wilson’s disease to detect
early cardiac dysfunction.
Methods: In this study, 21 patients with Wilson’s disease and a control group of
20 age- and gender-matched healthy children were included. All the patients and
the control group were evaluated with two-dimensional (2D) and colour-coded
conventional transthoracic echocardiography by the same paediatric cardiologist
using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in
standard precordial positions, according to the American Society of
Echocardiography recommendations. 2D strain and strain rate echocardiography
were performed after the ECG probes of the echocardiography machine were
adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and
strain rate were assessed from six basal and six mid-ventricular segments of the
left ventricle, as recommended by the American Society of Echocardiography.
Results: Left ventricular wall thickness, systolic and diastolic diameters, left
ventricular diameters normalised to body surface area, end-systolic and
end-diastolic volumes, cardiac output and cardiac index values were within
normal limits and statistically similar in the patient and control groups (p >
0.05).
Global strain and strain rate: the patient group had a statistically significant
lower peak A longitudinal velocity of the left basal point and peak E
longitudinal velocity of the left basal (VAbasR) point, and higher global peak A
longitudinal/ circumferential strain rate (GSRa) compared to the corresponding
values of the control group (p < 0.05).
Radial strain and strain rate: end-systolic rotation [ROT (ES)] was
statistically significantly lower in the patient group (p < 0.05). Longitudinal
strain and strain rate: end-systolic longitudinal strain [SLSC (ES)] and
positive peak transverse strain (STSR peak P) were statistically significantly
lower in the patient group (p < 0.05).
Segmental analysis showed that rotational strain measurement of the anterior and
lateral segments of the patient group were statistically significantly lower
than the corresponding values of the control group (p < 0.05). Segmental
analysis showed statistically significantly lower values of end-systolic
longitudinal strain [STSR (ES)] of the basal lateral (p < 0.05) and end-systolic
longitudinal strain [SLSC (ES)] of the basal septal segment (p < 0.05) in the
patient group.
End-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain
(STSR peak P) were statistically significantly lower in the patient group (p <
0.05). Segmental analysis showed statistically significantly lower values of
endsystolic longitudinal strain [SLSC (ES)] of the mid-anterior and basal
anterior segments (p < 0.05), end-systolic longitudinal strain [STSR (ES)]
measurements of the posterior and mid-posterior segments, end-systolic
longitudinal displacement [DLDC (ES)] of the basal posterior, mid-posterior and
mid-antero-septal segments in the patient group.
Conclusion: Cardiac arrhythmias, cardiomyopathy and sudden cardiac death are
rare complications but may be seen in children with Wilson’s disease due to
copper accumulation in the heart tissue. Strain and strain rate echocardiography
is a relatively new and useful echocardiographic technique to evaluate cardiac
function and cardiac deformation abnormalities. Our study showed that despite
normal systolic function, patients with Wilson’s disease showed diastolic
dysfunction and regional deformation abnormalities, especially rotational strain
and strain rate abnormalities.
Title: Cardiovascular risk factors in pre-pubertal schoolchildren in
Angola Authors: ABT Silva, DP Capingana, P
Magalhães, MAA Gonçalves, M del CB Molina, SL Rodrigues, MP Baldo, MSB Mateus,
JG Mill
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 215-321
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DOI Number: 10.5830/CVJA-2016-029
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-029
Methods: The incidence of obesity is increasing
worldwide, especially in countries with accelerated economic growth. We
determined the prevalence of and associations between overweight/obesity and
cardiovascular risk factors in pre-pubertal (seven- to 11-year-old)
schoolchildren (both genders, n = 198) in Luanda, Angola. Biochemical (fasting
blood) and clinical examinations were obtained in a single visit. Data are
reported as prevalence (95% confidence intervals) and association (r, Pearson).
Results: Prevalence of overweight/obesity was 17.7% (12.4–23.0%), high blood
pressure (BP > 90% percentile) was 14.6% (9.7–19.5%), elevated glucose level was
16.7% (11.5–21.9%) and total cholesterol level > 170 mg/dl (4.4 mmol/l) was
69.2% (62.8–75.6%). Significant associations between body mass index (BMI) and
systolic and diastolic BP (r = 0.46 and 0.40, respectively; p < 0.05) were
found. No association between BMI and elevated glucose or cholesterol levels was
found.
Conclusion: The prevalence of cardiovascular risk factors was high in
pre-pubertal schoolchildren in Angola and fat accumulation was directly
associated with blood pressure increase but not with other cardiovascular risk
factors.
Title: Clustering of cardiovascular
risk factors in semi-urban communities in
south-western Nigeria Authors: R Oluyombo, PO Akinwusi, MA
Olamoyegun, OE Ayodele, MB Fawale, OO Okunola,
TO Olanrewaju, A Akinsola
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 322-327
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DOI Number: 10.5830/CVJA-2016-024
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-024
Background: In addition to poor socio-economic
indices and a high prevalence of infectious
diseases, there have been various reports of a
rising prevalence of cardiovascular diseases,
with associated morbidity and mortality in
developing countries. These factors co-exist,
resulting in a synergy, with serious
complications, difficult-to-treat conditions and
fatal outcomes. Hence this study was conducted
to determine the clustering of cardiovascular
disease risk factors and its pattern in
semi-urban communities in south-western Nigeria.
Methods: This was a cross sectional study over
seven months in 11 semi-urban communities in
south-western Nigeria.
Results: The total number of participants was 1
285 but only 1 083, with 785 (65%) females,
completed the data. Participants were 18 years
and older, and 51.2% were over 60 years. The
mean age was 55.12 ± 19.85 years. There were
2.6% current cigarette smokers, 22% drank
alcohol and 12.2% added salt at the table, while
2% had been told by their doctors they had
diabetes, and 23.6% had hypertension. The
atherogenic index of plasma was at a high-risk
level of 11.1%. Elevated total cholesterol and
low-density lipoprotein cholesterol, and low
high-density lipoprotein cholesterol levels were
seen in 5.7, 3.7 and 65.1%, respectively.
Prevalence of hypertension was 44.9%, diabetes
was 5.2%, obesity with body mass index (BMI) >
30 kg/m2 was 5.7%, and abdominal circumference
was 25.7%. Prevalence of clusters of two, three,
and four or more risk factors was 23.1, 15.5 and
8.4%, respectively. Increasing age 2.94 (95% CI:
1.30–6.67), BMI 1.18 (95% CI: 1.02–1.37),
fasting plasma glucose level 1.03 (95% CI: 1.00–
1.05), albuminuria 1.03 (95% CI: 1.00–1.05),
systolic blood pressure 1.07 (95% CI:
1.04–1.10), diastolic blood pressure 1.06 (95%
CI: 1.00–1.11) and female gender 2.94 (95% CI:
1.30–6.67) showed increased odds of clustering
of two or more cardiovascular risk factors.
Conclusion: Clustering of cardiovascular risk
factors is prevalent in these communities.
Patterns of clustering vary. This calls for
aggressive and targeted public health
interventions to prevent or reduce the burden of
cardiovascular disease, as the consequences
could be detrimental to the country.
Title: Patient outcomes following after-hours and weekend admissions
for cardiovascular disease in a tertiary hospital in Calabar, Nigeria Authors: A Ucak, V Temizkan, M Ugur, AE Yedekci, O Uz, A Selcuk, AT
Yilmaz
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: 328-332
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DOI Number: 10.5830/CVJA-2016-025
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-025
Background: There are various reports of higher
mortality rates occurring after admissions over the weekend and during
after-hours. This study aimed to determine if there was a difference in
mortality rates occurring during the weekend and after-hours among
cardiovascular admissions in a tertiary hospital in Nigeria.
Methods: A review of cardiovascular admissions (including stroke) was carried
out at the University of Calabar Teaching Hospital in Nigeria from January 2010
to December 2013. All admissions to the medical wards from the emergency
department and medical out-patient department clinics during the study period
were included.
Results: A total of 339 patients were studied and stroke was the commonest type
of cardiovascular disease (CVD) admitted (187; 55.2%). Hypertension was the
commonest cause of heart failure (70; 48.6%). Presentation to hospital during
after-hours and length of stay of more than 14 days were significant predictors
of death (OR: 3.37; 0.22).
Conclusion: An increase in CVD mortality rates occurred during after-hours, most
likely a consequence of uneven staffing patterns and poor access to equipment.
Healthcare providers in Nigeria need to consider remedies to this with a view to
reducing excess mortality rates.
Title: Takotsubo cardiomyopathy post liver transplantation
Authors: A Vachiat, K McCutcheon, A Mahomed, G
Schleicher, L Brand, J Botha, M Sussman, P Manga
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2016-032
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-032
Abstract: A patient with end-stage liver disease
developed stressinduced Takotsubo cardiomyopathy post liver transplantation,
with haemodynamic instability requiring a left ventricular assist device. We
discuss the diagnosis and management of this condition.
Title: Active schistosomiasis, severe hypereosinophilia and rapid
progression of chronic endomyocardial fibrosis
Authors: AO Mocumbi, C Goncalves, A Damasceno, C
Carrilho
From: Cardiovascular Journal of Africa, Vol 27,
Issue 5, September/October
Published: 2016
Pages:e4-e6
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DOI Number: 10.5830/CVJA-2016-030
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2016-030
Abstract: Endomyocardial fibrosis (EMF) is a
neglected restrictive cardiomyopathy of unknown aetiology and unclear natural
history, which causes premature deaths in endemic areas. We present the case of
a 13-year-old boy from a highly endemic area, presenting with concurrent signs
of chronic EMF and severe hypereosinophilia associated with active schistosomal
cystitis. We discuss the possible role of this parasitic infection in
determining the progression of EMF in endemic areas for both conditions.