- A-Z Publications
- Cardiovascular Journal of South Africa
- Previous Issues
- Volume 15, Issue 4, 2004
Cardiovascular Journal of South Africa - Volume 15, Issue 4, 2004
Volume 15, Issue 4, 2004
Source: Cardiovascular Journal of South Africa 15, pp 1 –15 (2004)More Less
Extracted from text ... ii SCIENTIFIC PROGRAMME SATURDAY, 14 AUGUST SESSION I: APOPTOSIS, NECROSIS AND REPAIR Chairpersons: RA Gottlieb, A Lochner 09h00 - 09h30 RA Gottlieb, C Huang, V Paromov, Y Tsukada, P Wentworth Jr The Scripps Research Institute, La Jolla, CA, USA Role of cytochrome P450 in myocardial reperfusion injury. 09h30 - 09h55 S Kostin Max Planck Institute, Bad Nauheim, Germany Types and mechanisms of myocyte cell death in diseased human hearts. 09h55 - 10h20 G Norton University of the Witwatersrand, Johannesburg, South Africa Progression of pressure overload to heart failure. SESSION II: ENERGY METABOLISM IN CELLULAR INJURY AND ISCHAEMIA Chairpersons: G Lopaschuk, ..
Author Y.K. SeedatSource: Cardiovascular Journal of South Africa 15, pp 157 –158 (2004)More Less
Extracted from text ... The available data from a few countries in sub-Saharan Africa (SSA) have highlighted the increasing importance of non-communicable diseases (NCD) in this region and these countries have taken steps to develop relevant policies and programmes to address this issue. It is likely that cardiovascular diseases (CVD) are particularly poorly detected and treated in primary healthcare settings in SSA. There is evidence that the prevalence of CVD and hypertension is increasing rapidly in SSA. Two recent surveys in SSA showed that control of BP (< 140/90 mm Hg) was less than 1% in Tanzania1 and 15% in blacks in South Africa.2 ..
Differences in cardiovascular function of rural and urban African males : the THUSA study : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 161 –165 (2004)More Less
<I>Introduction:</I> South Africa's black population has been in a process of transition from rural monocultural environments to industrialised urban environments since the early 1990s. This transition has led to an increased susceptibility to cardiovascular diseases such as hypertension, which in this group commonly leads to stroke. Besides the already observed increases in blood pressure, there is still uncertainty as to how the factors associated with urbanisation influence the cardiovascular system as a whole. <br><I>Aim:</I> To obtain a more complete cardiovascular profile and its association with the lipid profile and subcutaneous fat distribution of the African in transition. <br><I>Methods:</I> A cross-sectional epidemiological study was performed which included 433 men from the North- West Province. The Finapres apparatus and Modelflow software program were used to obtain a more elaborate cardiovascular profile. The lipid profile and subcutaneous fat were also determined. <br><I>Results:</I> An increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed in the urban group. The heart rate (HR) did not differ while the stroke volume (SV) and cardiac output (CO) was lower in the urban group. Arterial compliance (CW) also showed a decrease in the urban group along with an increased total peripheral resistance (TPR), compared with the rural group. The lipid profile and BMI did not differ between the two groups. <br><I>Conclusions:</I> The factors associated with urbanisation elevate blood pressure via a peripheral mechanism. This peripheral mechanism may be due to endothelial damage associated with low-density lipoprotein cholesterol (LDL-C) and a truncal subcutaneous fat distribution.
Source: Cardiovascular Journal of South Africa 15, pp 165 –181 (2004)More Less
Extracted from text ... The William Nelson ECG Quiz This is the ECG of a 58-year-old man. How do you identify right chest leads? The answer is provided on page 181. The William Nelson ECG Quiz The value of right chest leads recorded during inferior wall infarction is acknowledged. If there is ST segment elevation of 1 mm or more in leads V4R or V5R or V6R, it serves to identify coexistent RV infarction. The computer is not programed to recognise these abnormal leads and will incorrectly interpret the decreasing V-lead voltage as due to anterolateral MI. Right chest leads are obtained with 'mirror-image' location ..
Serum lipid parameters and the prevalence of corneal arcus in a dyslipidaemic patient population : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 166 –169 (2004)More Less
<I>Aim:</I> To determine whether an association exists between plasma lipoprotein constituents and the prevalence of corneal arcus in dyslipidaemic patients. <br><I>Methods:</I> Adult patients (<I>n</I> = 115) were included if their fasting total serum cholesterol concentrations exceeded the 95th percentile or their serum low-density lipoprotein (LDL) : high density lipoprotein (HDL) ratios exceeded 5. Slit-lamp assessment of the corneas was performed. <br><I>Results:</I> The study group divided into a subgroup with arcus 37% (43) and a subgroup without arcus 63% (72). Total serum cholesterol and triglyceride levels were not associated with corneal arcus. A significant difference was found (<I>p</I> < 0.05) between the mean levels of LDL cholesterol (LDL-C) in the group without arcus (5.61 <u>+</u> 1.74 mmol/l) and the group with arcus (5.96 <u>+</u> 1.71 mmol/l). The mean serum HDL-cholesterol (HDL-C) in the group with corneal arcus was 1.04 <u>+</u> 0.30 mmol/l as opposed to 1.31 <u>+</u> 0.38 mmol/l in the group without arcus (<I>p</I> < 0.005 for difference). The mean LDL-C : HDL-C ratio in the group without arcus was 4.28 (SD: 1.99), and 5.73 (SD: 2.09) in the group with a corneal arcus (<I>p</I> < 0.05). <br><I>Conclusions:</I> Low HDL-C levels, high LDL-C levels and LDL-C : HDL-C ratios > 5 have been implicated as risk factors of numerous circulatory diseases. The observations in this study suggest that the presence of corneal arcus in the dyslipidaemic patient correlates strongly with these same risk indicators.
EVAR : critical applied aortic morphology relevant to type-II endoleaks following device enhancement in patients with abdominal aortic aneurysms : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 170 –177 (2004)More Less
Endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) is an established alternative option to conventional surgery for AAA, provided optimal anatomical morphology of the aneurysm sac, neck and outflow exists. In most documented series of EVAR, type-II endoleak occurrence is a universal procedural drawback. This is referred to as the Achilles heel of EVAR. This morphological study, addressing predominantly non-aneurysmal aortic anatomy, reveals the dyssynchronous origins of the renal ostia, ectopia of the superior mesenteric artery and median sacral artery, variations in the length of the infrarenal abdominal aorta, multiple mainstem renal arteries, and the presence of accessory renal arteries (in 13% of cadavers). Such potential vascular anomalies need careful consideration pre-operatively prior to EVAR. <br>In a prospective, clinical study of EVAR in 163 patients over 60 months, using four different aortic stent devices, we demonstrated an intraprocedural type-II endoleak rate, before exclusion, of 3% (5/163). Most were related to patent lumbar arteries. An active policy of intraprocedural aneurysm pressure sac measurement and angiography was used to demonstrate type-I and type-II endoleaks, focusing on the applied anatomy of aortic side branches and variations. Selective intraprocedural coil embolisation and thrombin injection into the sac was utilised to thrombose persisting and large lumbar arteries that predisposed to retroleaks. We recorded a low incidence of persisting type-II endoleaks using this proactive treatment strategy by addressing variant aortic morphology and patent lumbar arteries during EVAR. One aneurysm-related death (0.6%) was observed due to late rupture after EVAR, and a single intraprocedural death was related to unpredictable aneurysm rupture. <br>In conclusion, comprehensive anatomical knowledge of the abdominal aorta and its main collateral side branches, including variations, is a fundamental prerequisite if satisfactory and predictable results are to be achieved after EVAR, especially regarding prevention, diagnosis and treatment of type-II endoleaks. Intraprocedural aneurysm sac pressure monitoring, coil embolisation and the use of injection of thrombin into the aneurysm sac of selected patients is useful in reducing the incidence of post-EVAR type-II persisting endoleaks.
Pre-operative intercostal nerve blockade for minimally invasive coronary bypass surgery : a standardised anaesthetic regimen for rapid emergence and early extubation : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 178 –181 (2004)More Less
<I>Background:</I> Minimally invasive direct coronary artery bypass grafting (MIDCAB) has become a popular adjunct to cardiac bypass surgery in selected patients. Although MIDCAB without cardiopulmonary bypass is considered to be a relatively noninvasive procedure, the trauma to the muscle tissue caused by the anterolateral thoracotomy often leads to more pain than that of patients undergoing routine sternotomy. The purpose of our study was to evaluate the pre-operative application of an intercostal nerve blockade, combined with general anaesthesia for peri- and postoperative pain control, and its efficacy for early extubation. <br><I>Methods and Results:</I> Nine consecutive patients undergoing MIDCAB surgery were evaluated. Pre-operative ipsilateral intercostal nerve blockade was employed in all patients. After induction, isofluran (0.4-0.8%) and nitrous oxide in combination with the pre-operative nerve blockade provided sufficient anaesthesia throughout the procedure (mean operative time: 147 min). Only 2/9 patients required additional small doses of narcotics. All patients could be safely extubated within 15 minutes of skin suture. Postoperative discomfort and pain were minimal. <br><I>Conclusion:</I> From our initial experience with preoperative intercostal nerve blockade for the MIDCAB procedure, we concluded that it provides profound somatic analgesia as an effective adjunct to general anaesthesia with reduced doses of narcotics and sedatives. MIDCAB impresses with its ease of technical performance, its reliability and safety. The minimised chest-wall pain improves patients' chances of early tracheal extubation. In accordance with the minimally invasive surgical approach, it provides a contribution towards 'minimally invasive anaesthesia'. The surgeons' and the patients' acceptance is excellent. <br>Because the results of this study are based on observation and verbalisation of the investigators' impressions, and no objective measurements were made which would have allowed a comparison between the MIDCAB technique and the golden standard of general anaesthesia with opioid analgesia, a further study should be conducted to prove our theory.
Diaphragmatic hernia mimicking an atrial mass : a two-dimensional echocardiographic pitfall and a cause of postprandial syncope : case reportSource: Cardiovascular Journal of South Africa 15, pp 182 –183 (2004)More Less
A large hiatal hernia constitutes a form of posterior mediastinal mass that can encroach on the posterior aspects of the heart. During two-dimensional echocardiography this phenomenon may be confused with an intra-atrial mass or various other posterior mediastinal masses. Furthermore, such a large hiatal hernia encroaching on the heart may cause syncope. We present such a case and the various possible mechanisms of syncope, as well as review the two-dimensional echocardiographic pitfalls in these patients.
Author Carola U. NieslerSource: Cardiovascular Journal of South Africa 15, pp 184 –189 (2004)More Less
The vast developmental repertoire of embryonic stem cells is well recognised. These primitive stem cells can differentiate <I>in vivo</I> and <I>in vitro</I> into cells of all three embryonic germ layers (endoderm, mesoderm, ectoderm), making them attractive potential agents to target for enhanced tissue repair and regeneration. Adult stem cells on the other hand are considered more restricted in their lineage differentiation capabilities. Recent research has challenged this dogma with the finding that bone marrow-derived stem cells can differentiate into a wide variety of cell types including muscle (skeletal and cardiac). Furthermore, although the myocardium has for decades been regarded as a post-mitotic organ, a series of studies has indicated that a population of stem cells exists which is capable of at least partial reconstitution of the myocardium following an ischaemic insult. It is therefore now accepted that adult stem cells could be used to enhance myocardial repair. This review discusses the current status of adult stem cell research in the light of its potential for improving myocardial repair.
LDL cholesterol goals rapidly achieved at various starting doses of Pfizer's atorvastatin : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 190 Drug Trends LDL cholesterol goals rapidly achieved at various starting doses of Pfizer's atorvastatin This study provides new information on the benefits of customising treatment based on the patient's cardiovascular risk. Patients with high cholesterol can rapidly achieve target goals for LDL (low-density lipoprotein), or 'bad' cholesterol when given starting doses of 10 mg to 80 mg of the cholesterol- lowering medicine Lipitor(r) (atorvastatin calcium), according to findings from a clinical trial presented recently at the European Atherosclerosis Society (EAS).1 In the ATGOAL (Atorvastatin Goal Achievement Across Risk Levels) study, 86% of patients taking starting doses of Lipitor ..
VALUE study highlights the need for aggressive BP lowering in high-risk patients : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15, pp 191 –192 (2004)More Less
Extracted from text ... 191 VALUE study highlights the need for aggressive BP lowering in high-risk patients Valsartan (Diovan(r)) achieves 23% reduction in new-onset diabetes and reduction in heart failure incidence and admissions in VALUE study The results of the VALUE (Valsartan Anti-hypertensive long-term use Evaluation) study, announced recently at the EHS (European Hypertension Society) Congress in Paris, will not only change the future of hypertension trials, 1 but will also add further impetus to the current emphasis on achieving target recommended BP control within a relatively short time, 2 according to the authors of the VALUE trial. The VALUE study of 15 ..
Author Rajen MoodleySource: Cardiovascular Journal of South Africa 15, pp 194 –195 (2004)More Less
Extracted from text ... Comments by a South African cardiologist at the meeting Q: Why is the VALUE study important? Dr Moodley: I think that this study has taught us some very valuable lessons; first and foremost, that it is important to control blood pressure early on, and to control it well. If you do not, you will get cardiovascular events. That has been amply demonstrated in VALUE. Secondly, in valsartan we have a very user-friendly drug that has been tested in a group of very high-risk patients and it fares well against tried and tested agents. It is reassuring to know that when ..
Aggressive cholesterol-lowering treatment in type 2 diabetes mellitus : an update : drug trends in cardiologyAuthor Rhena DelportSource: Cardiovascular Journal of South Africa 15, pp 195 –196 (2004)More Less
Extracted from text ... Following the recently revised guidelines by the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program (NCEP), which is based on a review of five major clini - cal trials of statin therapy, 1 the American College of Physicians guidelines for con - trolling cholesterol in patients with type 2 diabetes, 2 and the early halting of the Collaborative AtoRvastatin Diabetes Study (CARDS)3 due to the significant treatment benefits (http://www. pfizer.com/are/news_releases/2004pr/ mn_2004_0607.html), guidelines for South African physicians on chole sterollowering in patients with type 2 diabetes need to be revised urgently. The recommendations and findings of the ..
INVEST study adds important data for clinical practice in new-onset diabetes : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... The INVEST (International Verapamil SR/Trandolapril) study with its multicultural patient profile and gender balance (52% female and 14% African) continues to add relevant perspectives for our clinical practice, according to Dr Adri Kok, specialist physician from Johannesburg. Commenting from the 7th CDE Update on Diabetes Management held at Stellenbosch recently (22-23 July), Dr Kok noted that the incidence of new-onset diabetes has to be considered in the selection of drug treatment for at-risk hypertensive patients. Further analysis of the INVEST trial, an equivalence trial of calcium channel blocker (CCB) versus ?-blocker (BB)- based strategy, 1 was presented at the 2004 ..
Added benefits of nifedipine (Adalat(R) GITS) beyond lowering blood pressure : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15, pp 198 –199 (2004)More Less
Extracted from text ... 198 Added benefits of nifedipine (Adalat(r) GITS) beyond lowering blood pressure New knowledge may strengthen the rationale for early intervention in cardiovascular patients. At a press seminar in Frankfurt, Germany, leading experts discussed the growing base of evidence demonstrating that Adalat(r) GITS (nifedipine GITS) offers cardiovascular patients a number of advantages beyond effective blood pressure control. While nifedipine GITS has become one of the world's leading and best-investigated antihypertensive drugs, it is not only the antihypertensive effects that have been fascinating experts in recent years. Mounting data from studies like INSIGHT and ENCORE show that nifedipine GITS also has vascular-protective ..
Source: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 200 Cardio News 3M supports Korle-Bu Hospi tal's Cardiothoracic Centre A donation was made to Professor Frimpong-Boateng, President of the Ghana Heart Foundation and representative of the National Cardiothoracic Centre at Korle-Bu Teaching Hospital, marking the second phase of an on going partnership with the Hospital. The Centre provides the most advanced treatment to people in West Africa suffering from heart, lung and related diseases. The Centre is equipped with all major medical equipment, instruments, laboratories and operating theatres. In addition, many European doctors are employed by the Centre in an effort to provide patients with the best medical care. ..