Cardiovascular Journal of Africa - Volume 25, Issue 6, 2014
Volumes & issues
Volume 25, Issue 6, 2014
A case of shoshin beriberi presenting as cardiogenic shock with diffuse ST-segment elevation, which dramatically improved after a single dose of thiamine : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 1 –5 (2014) http://dx.doi.org/10.5830/CVJA-2014-053More Less
Shoshin beriberi is a fulminant form of cardiac beriberi caused by thiamine deficiency. We report on a case of an 87-year-old man with shoshin beriberi presenting as cardiogenic shock with diffuse ST-segment elevation, which dramatically improved after thiamine administration. Because of the rarity of the occurrence, lack of diagnostic test and atypical presentation, diagnosing shoshin beriberi is challenging and requires a high index of clinical suspicion. Shoshin beriberi leads to rapid haemodynamic collapse and death. Therefore, clinicians should consider shoshin beriberi (or cardiac beriberi) as one of the differential diagnoses in patients with heart failure or cardiogenic shock.
Clinical ventricular tachycardia and surgical epicardial ICD implantation in a patient with a Fontan operation for double-inlet left ventricle : online article - case reportSource: Cardiovascular Journal of Africa 25, pp 6 –10 (2014) http://dx.doi.org/10.5830/CVJA-2014-057More Less
The Fontan operation is the primary surgical technique used for palliation of patients with single-ventricle physiology. Arrhythmias are frequently observed and associated with morbidity and mortality in Fontan patients. The frequency of arrhythmias after the Fontan procedure increases over time and it was reported to reach 50% in a 20-year follow up. Atrial tachyarrhythmias, especially atrial tachycardia and sinus bradycardia, are most frequently observed in these patients. Ventricular arrhythmias are rarely observed.
Generally, medical therapy, catheter ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation are options in the treatment of these arrhythmias. It may be difficult to implant either a pacemaker or an ICD in patients on whom the Fontan procedure has been performed. In conditions where access to the right ventricle is from the venous system, it is anatomically impossible. Where there is no functional right ventricle, device implantation can be performed with alternative methods other than the conventional transvenous approach.
In this report, we discuss a middle-aged woman with a Fontan operation performed 14 years earlier, who presented with ventricular tachycardia (VT) and in whom an epicardial ICD was implanted. The literature on this issue is also reviewed.
Author P.J. CommerfordSource: Cardiovascular Journal of Africa 25 (2014)More Less
Food and the eating thereof is a universal part of the human condition, and life is obviously impossible without adequate nutrition. The fact that the composition of diets varies so dramatically across the globe and that human populations survive and thrive fairly successfully despite seemingly very different nutrient intakes provides food for thought! Either the exact composition of the diet is irrelevant or else humans are biologically remarkably adaptable to great variation in the composition of their diet. If either of the statements in the previous sentence is correct then those individuals in what I refer to as the 'diet industry', an industry with enormous media appeal and reward, should feel seriously threatened.
Towards developing guidelines and systems of care to facilitate early reperfusion for ST-elevation myocardial infarction in Africa : editorialSource: Cardiovascular Journal of Africa 25, pp 256 –258 (2014)More Less
The theme for the 15th annual SA Heart Congress for 2014, 'Bridging the divide' between best practice and current challenges in the management of cardiovascular conditions, inspired this editorial on the feasibility of implementing the European Society of Cardiology 'Stent-for-Life' initiative in sub-Saharan Africa or alternate measures of ensuring early reperfusion for myocardial ischaemia. This editorial explores the changing burden of non-communicable diseases (NCD) in Africa that impact on the occurrence of ST-elevation myocardial infarction (STEMI) in Africa, revisits international guidelines on early reperfusion and implementation of systems of care, and identifies factors related to timely myocardial reperfusion in remote areas.
Effect of standard versus patient-targeted in-patient education on patients' anxiety about self-care after discharge from cardiovascular surgery clinics : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 259 –264 (2014) http://dx.doi.org/10.5830/CVJA-2014-048More Less
We compared standard and patient-targeted in-patient education in terms of their effect on patients' anxiety. One hundred and ninety-eight patients who were hospitalised for coronary artery bypass surgery were given standard education (group 1) or individualised education (group 2) on the management of their healthcare after discharge. Patients in group 2 were assessed on the patient learning needs scale and were given education according to their individual needs. The level of anxiety was measured by the state-trait anxiety inventory. Anxiety scores were significantly lower in group 2 than group 1 after education (p < 0.001). While state anxiety did not change after education in group 1 (p = 0272), it decreased significantly in group 2 (p < 0.001). For cardiovascular surgery patients, patient-targeted in-patient education was more effective than standard education in decreasing anxiety levels, therefore the content of the education should be individualised according to the patient's particular needs.
Source: Cardiovascular Journal of Africa 25 (2014)More Less
The second AfricaPCR course will be taking place in Johannesburg from 26-28 March 2015 at the forum, the campus in Bryanston. The 2015 course will build on the objective of exploring clinical challenges specific to Africa, and forging solutions through a highly interactive process of sharing, learning, questioning, and challenging by the facilitators.
Congenital heart disease in the Niger Delta region of Nigeria : a four-year prospective echocardiographic analysis : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 265 –268 (2014) http://dx.doi.org/10.5830/CVJA-2014-055More Less
Introduction : Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease. No previous prospective studies have been done on the prevalence of congenital heart disease (CHD) in the Niger Delta area. This study was done to determine the frequency and pattern of congenital heart disease, using echocardiography as a diagnostic tool.
Methods : All patients presenting to the Paediatric Cardiology clinics of two centres, the University of Port Harcourt Teaching Hospital and the Paediatric Care Hospital between April 2009 and March 2013, were recruited and all had echocardiography performed.
Results : Prevalence of CHD in this study was 14.4 per 1 000 children; 277 (83.4%) of the patients had acyanotic CHD and 55 (16.6%) had cyanotic CHD. Ventricular septal defect and tetralogy of Fallot were the commonest acyanotic and cyanotic heart defects, respectively.
Conclusion : The high prevalence of CHD in this study is the highest in the country and Africa, and may be attributable to the increased oil spillage and gas flaring from petroleum exploitation in this region.
Prevalence of hypertension in the Gambia and Sierra Leone, western Africa : a cross-sectional study : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 269 –278 (2014) http://dx.doi.org/10.5830/CVJA-2014-058More Less
Background : Hypertension (HTN) is one of the causes of cardiovascular disease (CVD) in Africa, and may be associated with lower socio-economic status (SES). The prevalence of HTN is not well established in the Gambia or in Sierra Leone.
Methods : A cross-sectional, population-based study of adults was conducted in the Gambia in 2000 and in Sierra Leone from 2001 to 2003 and in 2009. The study was conducted as part of the annual visit to countries in western Africa sponsored by a medical delegation from California. People from the Gambia and Sierra Leone were examined by the medical delegation and blood pressures were measured.
Results : A total of 2 615 adults were examined: 1 400 females and 1 215 males. The mean systolic blood pressure (SBP) of the females was 134.3 ± 29.7 mmHg, mean diastolic blood pressure (DBP) was 84.5 ± 17.5 mmHg, and 46.2% were hypertensive. The mean SBP of the males was 132.8 ± 28.5 mmHg, mean DBP was 82.8 ± 16.2 mmHg, and 43.2% were hypertensive. Overall prevalence of HTN in the subjects was 44.8%. Mean SBP, mean DBP and HTN prevalence increased with age decade, both in males and females. In addition, after age adjustment (known age), females had higher mean SBP (p = 0.042), mean DBP (p = 0.001) and rate of occurrence of HTN (p = 0.016) when compared with males.
Conclusions : Prevalence rates of HTN in the Gambia and Sierra Leone were higher than 40% in males and females, and may be a major contributor to CVD in both countries. Due to the association of HTN with low SES, improvements in educational, public health, economic, non-governmental and governmental efforts in the Gambia and Sierra Leone may lead to a lower prevalence of HTN. The cause of the higher prevalence in women may be due to post-menopausal hormonal changes.
Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery? : cardiovascular topicSource: Cardiovascular Journal of Africa 25, pp 279 –281 (2014) http://dx.doi.org/10.5830/CVJA-2014-061More Less
Background : Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery.
Methods : There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD.
Results : There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality.
Conclusion : The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.
Author Ebrahim MansoorSource: Cardiovascular Journal of Africa 25, pp 282 –287 (2014) http://dx.doi.org/10.5830/CVJA-2014-067More Less
Atrial fibrillation (AF) is the most common complication post cardiac surgery and results in elevated morbidity and mortality rates and healthcare costs. A pilot, retrospective study of the medical records of all adult patients developing de novo AF post surgery was undertaken at the cardiac surgical unit in Durban between 2009 and 2012. We aimed to describe the local experience of AF with a view to suggesting an adapted local treatment policy in relation to previously published data. Fifty-nine patients developed AF during the study period. AF occurred predominantly three or more days post surgery. Thirty-five patients required cardioversion and amiodarone to restore sinus rhythm. Return to the general ward (RGW) was 4.6 days longer than the institutional norm. Liberal peri-operative β-blocker and statin use is currently preferred to a formal prophylaxis strategy. Randomised, controlled trials are required to evaluate measures curbing prolonged length of stay and morbidity burdens imposed by AF on the local resource-constrained environment.
Source: Cardiovascular Journal of Africa 25, pp 288 –294 (2014) http://dx.doi.org/10.5830/CVJA-2014-062More Less
Outcomes : Extensive data from many randomised, controlled trials have shown the benefit of treating hypertension (HTN). The target blood pressure (BP) for antihypertensive management is systolic < 140 mmHg and diastolic < 90 mmHg, with minimal or no drug side effects. Lower targets are no longer recommended. The reduction of BP in the elderly should be achieved gradually over one month. Co-existent cardiovascular (CV) risk factors should also be controlled.
Benefits : Reduction in risk of stroke, cardiac failure, chronic kidney disease and coronary artery disease.
Recommendations : Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. Lifestyle modification and patient education are cornerstones of management. The major indications, precautions and contra-indications are listed for each antihypertensive drug recommended. Drug therapy for the patient with uncomplicated HTN is either mono- or combination therapy with a low-dose diuretic, calcium channel blocker (CCB) and an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB). Combination therapy should be considered ab initio if the BP is ≥ 160/100 mmHg. In black patients, either a diuretic and/or a CCB is recommended initially because the response rate is better compared to an ACEI. In resistant hypertension, add an alpha-blocker, spironolactone, vasodilator or β-blocker.
Validity : The guideline was developed by the Southern African Hypertension Society 2014©.
Author Brian L. RaynerSource: Cardiovascular Journal of Africa 25, pp 296 –297 (2014)More Less
The management of chronic diseases crosses the line between primary healthcare and tertiary academic medicine. New technologies are constantly being developed and treatment options being better defined. This has resulted in the development of multiple guidelines in order to standardise appropriate therapy for chronic diseases and to disseminate the information. Guidelines highlight current literature and new evidence, and they create an easy step-wise approach to the management of diseases, the targets for disease control and the standards of care.
Source: Cardiovascular Journal of Africa 25, pp 298 –301 (2014) http://dx.doi.org/10.5830/CVJA-2014-063More Less
Currently, there is widespread interest in many different diets. The best-known diets include the New Atkins diet in the USA, the Dukan diet in France, and in South Africa the Noakes diet. Two different approaches have emerged, one focusing on a life-long healthy lifestyle and the other emphasising weight loss. These are in fact complementary aims, as will be reviewed and reconciled. Furthermore, besides the dietary approach, there is a valid case for added drug therapy for selected lipid disorders with the use statins. In addition, new drugs are emerging that in the future might eventually considerably reduce the negative health impact of coronary artery disease.
Author F.J. RaalSource: Cardiovascular Journal of Africa 25 (2014)More Less
The global burdens of cardiovascular disease, obesity and type 2 diabetes mellitus continue to rise in both developed and developing countries. Much of these burdens are preventable as they are the result of sub-optimal lifestyle, which includes poor diet, excess calorie intake, physical inactivity and cigarette smoking.
Source: Cardiovascular Journal of Africa 25, pp 303 –304 (2014)More Less
A pioneering cardiac service in radial angiography, currently not available elsewhere on the continent, will now be offered at a new cardiac care centre at the Division of Cardiology, Tygerberg Hospital in the Western Cape. Launched on 10 November 2014, the new state-of-the art facility, under the directive of SUNHEART and the Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, has seen a multi-million rand investment by key private and public partners, of which Medtronic is the principle partner. This will enable the Division of Cardiology to offer advanced cardiac care to more patients, especially from previously disadvantaged communities in and around the Western Cape, and alleviate current angiography bottlenecks in the region.
Source: Cardiovascular Journal of Africa 25 (2014)More Less