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- Volume 15, Issue 2, 2004
Cardiovascular Journal of South Africa - Volume 15, Issue 2, 2004
Volume 15, Issue 2, 2004
Source: Cardiovascular Journal of South Africa 15, pp 53 –54 (2004)More Less
Extracted from text ... 53 The current South African Lipid Guidelines were published in the South African Medical Journal in February 2000.1 In these guidelines, lipid-lowering drug therapy was recommended for subjects with: severe genetic dyslipidaemia established vascular disease, and a high risk for cardiovascular disease (CVD) who have a calculated 10-year risk for an acute coronary event of = 20%. The recommended LDL-C target was = 3 mmol/l, but a reduction of at least 45% in LDL-C was recommended as a minimum target in severe cases that were unable to meet this goal. The South African guidelines were based ..
Author Gilbert R. ThompsonSource: Cardiovascular Journal of South Africa 15, pp 56 –58 (2004)More Less
Extracted from text ... 56 New developments in pharmacotherapy The latest developments in the lipid-regulating drug field have been the launching of rosuvastatin, arguably the most potent statin currently available and of ezetimibe, a novel cholesterol absorption inhibitor. Combined administration of these two classes of drug achieves simultaneous inhibition of cholesterol synthesis and absorption, resulting in unprecedented reductions in low-density lipoprotein (LDL). Inhibition of cholesterol synthesis The discovery of statins 30 years ago1 has revolutionised the management of dyslipidaemia. These drugs competitively inhibit HMG-CoA reductase, thereby reducing cholesterol synthesis in the liver; this leads to an increased expression of hepatic LDL receptors and greater ..
Author Edmond BertrandSource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... To the Editor: I was interested to read the paper 'The ECG: what is normal?', but I was disappointed because the author did not discuss the 'normal ECG' of black people. In my experience this ECG is the same as the ECG of white people. In thirty years of medical practice in sub-Saharan Africa, I have never confirmed specific abnormalities in black patients or normal black subjects. In my experience, the anatomy is the same, the physiology is the same, the radiology is the same, cardiac catheterisation is the same ... and ECG won't be different! Of course I have ..
Source: Cardiovascular Journal of South Africa 15, pp 61 –63 (2004)More Less
We recently established that the Dahl salt-sensitive rat, a model for genetic salt-sensitive hypertension, was insulin resistant. This study was undertaken to evaluate whether other features of the metabolic syndrome developed in this animal model. <br>Two groups of 16 Dahl salt-sensitive (DSS) rats and their controls, Dahl salt-resistant (DSR) rats were used. For eight weeks, half of each group was fed a standard diet with low sodium content (85 mmol Na/kg diet) while the remainder was fed a high-sodium diet (340 mmol Na/kg diet). Weekly systolic and diastolic blood pressures were measured for all animals. At the end of eight weeks, the urinary Na<sup>+</sup>/K<sup>+</sup> ratio, fasting blood glucose, plasma uric acid and blood lipids were determined for all animals. The same parameters were measured in two additional matched weanling DSS and DSR groups of eight animals each. <br>Adult DSS rats became hypertensive, with the DSS high-salt group exhibiting both genetic hypertension and the pressor effects of a high-salt diet. The DSS highsalt and weanling groups exhibited a lowered urinary Na<sup>+</sup>/K<sup>+</sup> ratio, indicative of greater sodium retention, when compared to their respective DSR groups (<I>p</I> < 0.05). No strain differences were observed in the uric acid levels. However a high-salt diet in both DSS and DSR groups elevated uric acid levels. Weanling and DSS high-salt groups showed increased total plasma cholesterol when compared to their corresponding DSR groups (<I>p</I> < 0.05). In addition, the DSS high-salt group also had both increased total plasma cholesterol and high-density lipoprotein (HDL) cholesterol when compared to the DSS low-salt group (<I>p</I> < 0.05). No significant differences in blood glucose and plasma insulin were observed in the adult groups. The weanling DSS group showed a marked hyperinsulinaemia, suggesting that DSS rats were possibly insulin resistant even before hypertension was fully established. This could indicate that insulin resistance and hypertension may be inherited as separate traits that develop in a parallel but independent manner.
Source: Cardiovascular Journal of South Africa 15, pp 64 –69 (2004)More Less
The mechanisms causing different supraventricular tachycardias can be identified with the aid of the 12-lead ECG using Tipple's approach. The main aims of this retrospective study were to use the 12-lead ECG to determine the underlying mechanisms of supraventricular arrhythmias and to evaluate the effectiveness of the treatment modalities used. <br>Forty-one patients were included in the study. The main findings were: nine of the 41 patients had atrial tachycardias while junctional tachycardia occurred in 32/41 of our patients. The underlying mechanisms causing the junctional tachycardias were: AVNRT (<I>n</I> = 21), AVRT (<I>n</I> = 10) and JET (<I>n</I> = 1). Of the 10 patients presenting with AVRT, eight were less than one year old. AVNRT occurred more often in the older age group (>1 year of age). Fifteen of the 41 patients had spontaneous cessation of their supraventricular tachycardia. <br>The drug most commonly used during the acute and long-term phases was digoxin. Amiodarone was used in six patients with an 80% success rate. In the early 80s verapamil was used in five patients with a 100% success rate. It is important to note that verapamil is no longer used in children due to its side effects. Lately, adenosine phosphate is the drug of choice in most supraventricular tachycardias. <br>The management of supraventricular tachycardias in paediatric practice is mainly based on clinical studies and individual experience. Care must therefore be taken to choose medication regimens that are likely to be effective with the minimum risk of potentiating abnormal haemodynamics or conduction.
High-dose atorvastatin therapy is required for significant improvement of endothelial function in heterozygous familial hypercholesterolaemic patients : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 70 –75 (2004)More Less
This study evaluated endothelial dysfunction (ED) by measuring flow-mediated vasodilation (FMD) and for six months documented changes in ED, LDL-C levels and serum concentrations of inflammatory markers with high- and low-dose atorvastatin therapy. In 23 heterozygous familial hypercholesterolaemic (FH) patients, FMD, LDL-C and inflammatory markers (sVCAM-1, sICAM-1, E-selectin and highly sensitive C-reactive protein) were measured at baseline (untreated) and on atorvastatin 20 and 80 mg/day. In untreated patients, FMD was significantly reduced (mean <u>+</u> SD = 3.09 <u>+</u> 0.91%) compared with 10 normocholesterolaemic controls (8.71 <u>+</u> 2.41%; <i>p</i> < 0.01). FMD improved non-significantly with atorvastatin 20 mg/day (5.60 <u>+</u> 1.17%), but showed a significant improvement (8.54 <u>+</u> 1.11%; <i>p</i> < 0.01) with atorvastatin 80 mg/day. LDL-C decreased markedly (-42.4%; <i>p</i> < 0.0001) on 20 mg/day and decreased further (-48.6%; <i>p</i> < 0.05) on 80 mg/day. FMD improvement, however, did not correlate with LDL-C reduction. No significant changes occurred in any inflammatory markers. We concluded that ED was present in untreated FH patients and improved significantly on high-dose atorvastatin. There was no correlation between the changes in FMD and LDL-C, suggesting either a LDLC- independent effect on ED, or that a marked reduction in LDL-C is required to normalise ED in FH.
Source: Cardiovascular Journal of South Africa 15, pp 75 –80 (2004)More Less
Extracted from text ... The William Nelson ECG Quiz The answer is provided on page 80. This is the ECG of an 81-year-old woman Why variable QRS complexes? The William Nelson ECG Quiz Answer There is a supraventricular tachycardia of 165/min (uncertain origin) with a frontal plane axis of (+)145 degrees. The precordial leads show LVH and this, plus right axis deviation, makes the diagnosis of biventricular hypertrophy a definite possibility. Back to the question posed: The V1 rhythm strip shows the cyclical oscillation of a 'dyspnea pattern'. But, note also that there is variation in QRS amplitude consistent with electrical alternans - demanding ..
Effectiveness of single detachable COOK(R) coils in closure of the patent ductus arteriosus : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 76 –80 (2004)More Less
<I>Objective:</I> To assess the efficacy and safety of single detachable coils in the closure of PDAs. <br><I>Methods:</I> Review of cases in which a single detachable coil was implanted. The diameter of the ampulla was used to select coil size. Diameters of the PDA, ampulla and residual shunts were measured. <br><I>Results:</I> There were 36 patients with a mean minimal ductal diameter of 2.2 <u>+</u> 0.6 mm. Immediately after implantation, 46% of the patients had residual shunts and after 24 hours, only 28%. A final spontaneous closure rate of 94% was observed after 21 months. There was a significant (p < 0.01) difference when minimal PDA diameter of those who had complete closure within 24 hours (median: 2 mm, interquartile range: 1.7-2.3 mm) was compared to those with a residual shunt (median: 2.5 mm, interquartile range: 2.3-3.2 mm). Negligible complications were experienced. <br><I>Conclusion:</I> Single Cook detachable coils are effective for PDA closure with a low complication rate if properly selected. There is a high rate of spontaneous closure of trivial residual shunts. In patients with a minimal ductal diameter <u>></u> 2 mm and a residual shunt, more coils may be considered.
Transoesophageal atrial pacing stress echocardiography in coronary artery disease : role, principles and methodology : review articleSource: Cardiovascular Journal of South Africa 15, pp 81 –87 (2004)More Less
This article reviews the physiology and methodology of transoesophageal atrial pacing stress echocardiography (TAPSE) and clarifies its place among the other stress modalities. <br>TAPSE correlates well with myocardial perfusion stress scintigraphy and coronary angiography and is a simple and safe diagnostic option for patients with suspected or known CAD, including those with recent myocardial infarction. Furthermore, the results of TAPSE have prognostic significance in patients with uncomplicated MI. <br>Although, it is a highly feasible and safe technique, the cardiologist should be directly involved in the procedure and the personnel must be well trained in a large number of tests, as for any other stress echocardiographic modalities.
Source: Cardiovascular Journal of South Africa 15, pp 88 –91 (2004)More Less
'The efficacy of β-blockers in reducing mortality and morbidity in heart failure has been shown beyond all doubt', stated Dr Theresa McDonagh of Glasgow University, speaking at the SA Heart Congress' Specialist Symposium on Heart Failure, held in Cape Town in October 2003.
Eprosartan dual action offers clinical benefit for elderly and overweight hypertensives : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15, pp 91 –92 (2004)More Less
Extracted from text ... Eprosartan dual action offers clinical benefit for elderly and overweight hypertensives 'High blood pressure represents a chronic and slowly progressing disease and should be regarded as a symptom of an underlying complex disorder, which very often is associated with sympathetic overactivity', noted Prof Heinz Rupp, well-known molecular cardiologist from Marburg University, Germany. Links between visceral obesity, postmenopausal status and sympathetic overactivity A major factor underlying overweightassociated diseases (raised BMI and visceral fat deposition) is a raised sympathetic activity leading not only to hypertension, but also to insulin resistance and other features of the metabolic syndrome. Recently, it has been shown by ..
Source: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... Lipitor stops progression of plaque build-up in arteries Patients taking Pfizer Inc's cholesterollowering medicine Lipitor (atorvastatin calcium) experienced a significant reduction in the progression of atherosclerosis, or hardening of the arteries, compared to patients who received Prava (pravastatin), according to new data presented at the 2003 American Heart Association annual meeting. The Reversing Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study followed 502 patients who were diagnosed with coronary heart disease and required cardiac catheterisation, or angiograms. Patients in the 18-month study had at least one arterial vessel with 20% or more constriction due to plaque build-up. This headto- head study compared ..
Policosanol versus atorvastatin effective in cholesterol lowering and increased HDL-C levels : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 94 Atorvastatin is frequently used as a strong reference for comparing the effects of any other lipid-lowering therapy. Policosanol, a natural cholesterollowering agent, purified from sugar cane wax, has previously been shown to be an effective cholesterol-lowering agent when compared with pravastatin and lovastatin.1, 2 In this small, randomised, singleblind, parallel-group study in older patients (60.80 years)3 with type 2 hypercholesterolaemia (serum LDL-C = 3.4 mmol/l and Tc levels = 5.2 mmol/l and triglyceride levels < 4.52 mmol/l), policosanol (10 mg) and atorvastatin (10 mg) were compared after patients had completed four weeks on a cholesterol-lowering diet. The National Cholesterol Education ..
Source: Cardiovascular Journal of South Africa 15, pp 96 –97 (2004)More Less
Extracted from text ... 96 Data presented at the 2004 meeting of the American College of Cardiology held last month adds weight to the evidence of the value of candesartan cilexetil in the treatment of chronic heart failure in the CHARM study (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity).1, 2 Importantly, an analysis3 found that New York Heart Association (NYHA) functional class improved in a broad spectrum of CHF patients treated with candesartan. Of all CHARM patients, 35.4% taking candesartan improved in NYHA functional class, 55.6% remained unchanged and 9% worsened. This compared with 32.5%, 57.5% and 10.3%, respectively, in ..
Perindopril protects diabetics with coronary disease from cardiovascular death and heart attacks : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 98 The long-acting ACE inhibitor perindopril (Coversyl(r)) appears to reduce the risk of cardiovascular death and heart attacks in diabetic patients with stable coronary disease already receiving standard preventive therapy. This is according to results from the PERSUADE1 (PERindopril SUb study in coronary Artery disease and Diab- Etics), a sub-study of the EUROPA study, announced recently at the American College of Cardiology (ACC) annual congress. PERSUADE assessed the 1 502 diabetic patients with stable coronary disease from the landmark EUROPA study, published in the Lancet last year.2 They were randomised to perindopril 8 mg once daily or placebo, in addition to ..
Source: Cardiovascular Journal of South Africa 15, pp 99 –100 (2004)More Less
Extracted from text ... 99 Aspirin protects women at risk of pre-eclampsia without causing bleeding Does aspirin prevent pre-eclampsia and associated complications in high-risk women? The literature published to date consistently shows the protective effect of low-dose aspirin for women with risk factors for pre-eclampsia, without an increase in bleeding complications including placental abruption. The synopsis of a meta-analysis, published in the 15 November 2003 issue of the British Medical Journal, leads to the conclusion that low-dose aspirin exerts a protective effect without an increase in bleeding complications. The methods used did not permit absolute risk reduction and NNT to be determined. For this ..