CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 28, ISSUE
4, JULY/AUG 2017
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- Title: From the Editor's Desk
Authors: SC Brown
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 207
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- Title: Endomyocardial fibrosis in
Sudan: clinical and echocardiographic features
Authors: Siddiq Ibrahim Khalil, Suha Khalil, Salma El Tigani, Hanan A Saad
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 208-214
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DOI Number:10.5830/CVJA-2016-079
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-079
Objective: Endomyocardial fibrosis (EMF) is a rare disease and is often an underdiagnosed and forgotten cardiomyopathy. The objective of this study was to document the current frequency of EMF in Sudan by defining and selecting cases from patients attending the echocardiography laboratory. Additionally we aimed to create an EMF registry for Sudan.
Methods: The study started in January 2007 and is on-going. All the patients attending our echocardiography clinics in four different hospitals in Khartoum, Sudan, were included. Transthoracic echocardiography was used as the main diagnostic and selection tool. The diagnosis of EMF was based on predefined criteria and definitions, and was further supported by additional clinical, ECG, laboratory and chest X-ray findings.
Results: Out of 4 332 cases studied, 23 (0.5%) were found to have features of EMF. Females constituted 52% and the age range was 24 to 67 years. All patients presented with dyspnoea grades III–IV. Advanced heart failure with gross fluid overload was seen in 54% of cases and ascites was seen in 30%. EMF was biventricular in 53%, left ventricular in 29% and right ventricular in 18% of cases. Apical and ventricular wall fibrosis was found in all cases, followed by atrial enlargement, atrioventricular valve incompetence, ventricular cavity obliteration, restrictive flow pattern and pericardial effusion. Additional echocardiographic features are defined and discussed.
Conclusion: Although a rare disease, cases of EMF can be identified in Sudan if a high index of suspicion is observed. New echocardiographic features of ventricular wall layering, endocardial fibrous shelf and endomyocardiopericarial fibrosis were identified and are discussed.
- Title: The changing spectrum of rheumatic mitral regurgitation in
Soweto, South Africa
Authors:Ruchika Meel, Ferande Peters, Elena Libhaber, Mohammed Rafique Essop
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 215-220
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DOI Number:10.5830/CVJA-2016-086
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-086
Objectives: To determine the clinical and echocardiographic characteristics of contemporary patients with rheumatic mitral regurgitation (MR) at Chris Hani Baragwanath Academic Hospital.
Methods: This prospective, cross-sectional study included 84 patients with isolated moderate or severe rheumatic MR who underwent clinical and echocardiographic assessment.
Results: Mean age of the patients was 44 ± 15.3 years (84% females). Acute rheumatic fever was rare. Hypertension and HIV were present in 52 and 26%, respectively. Echocardiography showed leaflet thickening and calcification, restricted motion and subvalvular disease in 41, 25 and 34%, respectively. Carpentier IIIa leaflet dysfunction occurred in 80% of patients and leaflet prolapse was seen in only 20%. These findings contrast with the previous literature, where patients were younger, they had rheumatic carditis and there were no co-morbidities. Leaflets were pliable, isolated leaflet prolapse was common and commissural fusion was absent.
Conclusion: Contemporary patients with rheumatic MR were older, fewer had rheumatic fever and there were more co-morbidities. Echocardiographic features had evolved to greater leaflet thickening, calcification and reduced motion with minimal prolapse. These findings may have important implications for surgical management of this disease.
- Title: The prevalence and
radiological findings of pulmonary embolism in
HIV-positive patients referred for computed
tomography pulmonary angiography in the Western
Cape of South Africa
Authors: Raksha Ramlakhan, Savvas Andronikou, Ashmitha Rajkumar
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 221–228
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DOI Number: 10.5830/CVJA-2016-083
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-083
Aim: To provide imaging data and report associations between human immunodeficiency virus (HIV), tuberculosis (TB) and pulmonary embolism (PE) in a South African population that underwent computed tomography pulmonary angiography (CTPA) for suspected PE.
Methods: A validated Qanadli severity scoring system for PE was used for 164 CTPA scans, and parenchymal, pleural and cardiovascular complications were reported. Serological confirmation of HIV testing and microbiological confirmation of TB were recorded.
Results: Prevalence of PE in the CTPA population was 26% (95% CI: 19.67–33.65%). HIV-positive prevalence in patients with PE was 67% (95% CI: 48.17–82.04%), however it was not statistically significantly different when compared with the patients without PE (p = 1). HIV-positive patients had more extensive partial thrombus in the right middle lobe (p = 0.045), but no other differences when compared with HIV-negative patients. TB prevalence in patients with PE was 57% (95% CI: 34.49–76.81%). This was statistically significantly different when compared with the patients without PE (p = 0.073 at the 10% level). Prevalence of TB co-morbidity in the HIV-positive group with proven PE was 71% (95% CI: 41.90– 91.61%), however there was no statistically significant difference in comparison with the HIV-negative patients with TB and PE (p= 0.305).
Conclusion: The high number of patients presenting for CTPA who were HIV infected (and also infected with TB) highlights that PE evaluation should include severity/extent of the disease, as these patients may have more severe disease in specific lung lobes. The use of a validated scoring system, such as the Qanadli score, when reporting PE may have a profound effect on patient risk stratification, management and prognosis and would also provide a system for collecting larger volumes of data for analysis.
- Title: Nuclear cardiology practices and radiation exposure in
Africa: results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)
Authors: Salah E Bouyoucef, Mathew Mercuri, Thomas NB Pascual, Adel H Allam, Mboyo Vangu, João V Vitola, Nathan Better, Ganesan Karthikeyan, John J Mahmarian, Madan M Rehani, Ravi Kashyap, Maurizio Dondi, Diana Paez, Andrew J Einstein, for the INCAPS investigators group
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 129-234
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DOI Number: 10.5830/CVJA-2016-091
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-091
Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide.
Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa.
Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1–15.6) vs 10.3 mSv (6.8–12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0–16.3 mSv; p < 0.0001) and QI range was 4–8.
Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.
- Title: Pilot study of risk factors
associated with cardiovascular disease in
northern and southern Cameroonians
Authors: Jeanne Durendale Chiadak, Jason Perret, Hilaire Macaire Womeni, Jules Roger Kuiaté, Pierre Cullus, Christelle Senterre, Christine Delporte
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 235-341
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DOI Number: 10.5830/CVJA-2016-094
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-094
Aim: The aim of the study was to evaluate whether the risk factors for cardiovascular disease (CVD) are similar in the northern and southern regions of Cameroon.
Methods: The participants answered a questionnaire concerning their lifestyle. Anthropometric and blood pressure measurements were evaluated in 192 individuals and biochemical parameters in 50 randomly selected volunteers.
Results: Northerners displayed low alcohol and tobacco consumption, little practice of sport but physically demanding professions, and consumption of soybean, refined palm and other polyunsaturated oils. Southerners consumed alcohol, practiced sport, had intellectually based professions, and consumed crude and refined palm oils. Waist circumference and body mass index were higher in the southerners compared to the northerners. Blood glucose levels, and systolic and diastolic blood pressures were higher among the northerners than the southerners. Among the southerners, there were positive correlations between total cholesterol levels and systolic or diastolic blood pressure, low-density lipoprotein cholesterol and blood glucose levels or diastolic blood pressure, triglyceride levels and systolic blood pressure.
Conclusion: Providing region-adapted, health-related advice for northern and southern Cameroonians would contribute to reducing risk factors for CVD.
- Title: A programme to increase appropriate usage of benzathine
penicillin for management of streptococcal pharyngitis and rheumatic heart
disease in Zambia
Authors: Aidan Long, Joyce Chipili Lungu, Elizabeth Machila, Sherri Schwaninger, Jonathan Spector, Brigitta Tadmor, Mark Fishman, Bongani M Mayosi, John Musuku
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 242–247
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DOI Number: 10.5830/CVJA-2017-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-002
Abstract: Rheumatic heart disease is highly prevalent and associated with substantial morbidity and mortality in many resourcepoor areas of the world, including sub-Saharan Africa. Primary and secondary prophylaxis with penicillin has been shown to significantly improve outcomes and is recognised to be the standard of care, with intra-muscular benzathine penicillin G recommended as the preferred agent by many technical experts. However, ensuring compliance with therapy has proven to be challenging. As part of a public–private partnership initiative in Zambia, we conducted an educational and access-to-medicine programme aimed at increasing appropriate use of benzathine penicillin for the prevention and management of rheumatic heart disease, according to national guidelines. The programme was informed early on by identification of potential barriers to the administration of injectable penicillin, which included concern by health workers about allergic events. We describe this programme and report initial signs of success, as indicated by increased use of benzathine penicillin. We propose that a similar approach may have benefits in rheumatic heart disease programmes in other endemic regions.
- Title: Clinical presentation and outcomes of patients with acute
rheumatic fever and rheumatic heart disease seen at a tertiary hospital setting
in Port Elizabeth, South Africa
Authors: Zongezile Masonwabe Makrexeni, Lungile Pepeta
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 248-250
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DOI Number: 10.5830/CVJA-2017-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-019
Background: The incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) has waned in Western countries, however that is not the situation in developing nations.
Methods: Records were reviewed of patients from the Eastern Cape municipal districts who presented to the Paediatric Cardiology Unit with ARF and RHD from January 2008 to August 2015.
Results: Total of 56 patients with ARF/RHD was reviewed. The majority of patients (n = 52) presented for the first time with RHD. Four patients presented with ARF and two had recurrent ARF. Six patients presented with a combination of RHD and congenital heart disease. Twenty-three patients were operated on for chronic rheumatic valve disease, with good outcomes.
Conclusion: The true burden of ARF/RHD is unknown in the Eastern Cape. Prospective studies are needed to accurately determine the prevalence of RHD in this province.
- Title: Primary care in the prevention, treatment and control of
cardiovascular disease in sub-Saharan Africa
Authors: Dike B Ojji, Kim Lamont, Olubunmi I Ojji, Bibiana Nonye Egenti, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 251-256
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DOI Number: 10.5830/CVJA-2016-082
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-082
Abstract: Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians.
- Title: Reviewing the causes of
electrocardiographic pauses
Authors: Charle Viljoen, Robert Smith, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 257-260
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DOI Number: 10.5830/CVJA-2017-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-041
Abstract: The electrocardiographic term ‘pause’ refers to the prolonged R-R interval that represents the interruption in ventricular depolarisation. This article presents a case of sinus node dysfunction and provides a diagnostic approach to pauses on the ECG..
- Title: Roadmap to achieve 25% hypertension control in Africa by 2025
Authors: Anastase Dzudie, Brian Rayner, Dike Ojji, Aletta E Schutte, Marc Twagirumukiza, Albertino Damasceno, Seringe Abdou Ba, Abdoul Kane, Euloge Kramoh, Jean Baptiste Anzouan Kacou, Basden Onwubere, Ruth Cornick, Karen Sliwa, Benedict Anisiuba, Ana Olga Mocumbi, Elijah Ogola, Mohamed Awad, George Nel, Harun Otieno, Ali Ibrahim Toure, Samuel Kingue, Andre Pascal Kengne, Pablo Perel, Alma Adler, Neil Poulter, Bongani Mayosi, on behalf of the PASCAR task force on hypertension
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 261–272
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DOI Number: 10.5830/CVJA-2017-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-040
Background and aim: The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority for action to reduce heart disease and stroke on the continent. The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025.
Methods: Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension. In 2014, experts in different fields, including physicians and non-physicians, were invited to join. Via faceto- face meetings and teleconferences, the consortium made a situation analysis, set a goal, identified roadblocks and solutions to the management of hypertension and customised the World Heart Federation roadmap to Africa.
Results: Hypertension is a major crisis on the continent but very few randomised, controlled trials have been conducted on its management. Also, only 25.8% of the countries have developed or adopted guidelines for the management of hypertension. Other major roadblocks are either government and health-system related or healthcare professional or patient related. The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025.
Conclusions: Hypertension affects millions of people in SSA and if left untreated, is a major cause of heart disease and stroke. Very few SSA countries have a clear hypertension policy. This PASCAR roadmap identifies practical and effective solutions that would improve detection, treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national settings.
- Title: Illuminating the pathway for the next generation of
cardiovascular medicine practitioners and researchers: Highlights of the Joint
PASCAR–SCC clinical symposium on hypertension and heart failure, Cameroon
Authors:Martin H Abanda, Anastase Dzudie, Ba Hamadou, Yves Monkam, Henry Luma, Marie Solange Douala, Loryane Nganhyim, Bonaventure S Dzekem, Theophile N Nana, George Nel, Ana O Mocumbi, Simon Stewart, Karen Sliwa, Eugene Belley Priso
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: 274-276
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Abstract: The Pan-African Society of Cardiology roadmap aims to achieve a 25% control of hypertension by the year 2025. Whether this is attainable or not depends largely on the capacity of healthcare providers and policy makers to address the rising prevalence of hypertension and its complications, including heart failure. Task sharing is fundamental in optimising hypertension control.
The Clinical Research Education, Networking and Consultancy (CRENC) engaged with the Pan-African Society of Cardiology (PASCAR) and the Cameroon Cardiac Society (SCC) in a joint hypertension and heart failure symposium at the Douala General Hospital in 2016. The primary aims were to foster clinical research in cardiovascular medicine by raising awareness on cardiovascular diseases, to provide evidence-based training of an international standard, to encourage the conduction and dissemination of high-quality research, and to build programmes for continuing medical education. The secondary aim was to potentiate the 2nd Douala Research and Scientific Days.
The symposium, which featured didactic lectures interspaced with oral/poster abstract presentations and a clinical visit, culminated in the launching of the book Heart of Africa, and the Young Investigator award. It is hoped that these served to capacitate existing cardiovascular structures, breed the next generation of cardiovascular physicians and researchers, and imprint a trail of clinical research excellence to be emulated in Cameroon and beyond.
- Title: An unusual case of aorta–right atrial tunnel with windsock
aneurysm: imaging, diagnosis and treatment
Authors: Shehzaadi Aneesah Mohamed Khan, Leonie Scholtz, F Adriaan Snyders, Johan de Villiers
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages: e1-e5
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DOI Number: 10.5830/CVJA-2016-073
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-073
Abstract: The first successfully diagnosed and treated case of aorta– right atrial tunnel was reported by Coto et al. in 1980. The most common cause of aorta–right atrial tunnel is a ruptured aneurysm of the sinus of Valsalva. Sinus of Valsalva aneurysms had been reported as early as 1840 by Thurnam; these were diagnosed at autopsy. With the advances in radiology, many cases of aorta–right atrial tunnel have been reported since then, each with its own subtle variations.
We report on a unique case of aorta–right atrial tunnel with a windsock aneurysm in the right atrium. A 55-year old male presented with abdominal pain and the chest X-ray revealed cardiomegaly. On further investigation with echocardiography and computed tomography angiography, there was an incidental aorta–right atrial tunnel with a windsock aneurysm in the right atrium. He was treated successfully with surgery. A similar case has been reported only once before by Iyisoy et al. in 2014.
- Title: Management of a complicated redo giant dissecting aortic
aneurysm
Authors: Ibrahim Kara, Alper Erkin, Halil Ibrahim Erkengel, Kıyasettin Asil
From: Cardiovascular Journal of Africa, Vol 28, Issue, 4, July/August
Published: 2017
Pages:e6-e8
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DOI Number: 10.5830/CVJA-2016-084
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-084
Abstract: Giant aortic aneurysm is defined as an aneurysm of the aorta of greater than 10 cm in diameter. This rare condition is associated with a high risk of morbidity and mortality and it may lead to fatal complications such as rupture and/or dissection if not managed with proper surgical planning and expertise. Other than atherosclerosis, the main causes of giant ascending aortic aneurysms include Marfan and Ehlers–Danhlos syndromes. Herein we report on a young male patient who had had an aortic valve replacement five years earlier due to a bicuspid aortic valve leading to aortic failure, accompanied by aortic coarctation. He had an aneurysmal expansion rate of 1.81 cm/year to reach a final aneurysmal diameter of 13.25 cm, which, to our knowledge, represents the largest size ever reported in the literature for such lesions, and in which the redo and aneurysmal wall were adjacent to the sternal margins.
- Title: Left ventricular haematoma
mimicking lateral wall myocardial infarction
secondary to percutaneous coronary intervention
Authors: Omer Senarslan, Necdet Batuhan Tamci, Umut Hasan Kantarci, Mehmet Eyuboglu, Dilsad Amanvermez Senarslan
From: Cardiovascular Journal of Africa, Vol 28, Issue 4, July/August
Published: 2017
Pages:e9-e11
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DOI Number: 10.5830/CVJA-2016-090
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-090
Abstract: Dissecting intra-myocardial haematoma is a rare disease and a potentially fatal complication after cardiac surgery. Patients with previous heart surgery have more risk for dissecting intra-myocardial haematoma after percutaneous coronary intervention. Management of this issue is challenging. We describe a rare case of a 63-year-old woman with a left ventricular wall-dissecting intra-myocardial haematoma, which developed 30 minutes after percutaneous coronary intervention. The patient was treated conservatively, with a successful outcome.
