Cardiovascular Journal of Africa - Volume 26, Issue 3, 2015
Volumes & issues
Volume 26, Issue 3, 2015
Source: Cardiovascular Journal of Africa 26, pp 1 –3 (2015) http://dx.doi.org/10.5830/CVJA-2014-071More Less
Systemic inflammatory response syndrome (SIRS) complicated with ST-elevation myocardial infarction has rarely been reported, and the precise mechanisms of myocardial injury remain unclear. Here, we present a case involving a 45-year-old man who developed SIRS secondary to diabetes-induced infection, and who ultimately developed ST-elevation myocardial infarction with acute heart failure, fulminant diabetes, acute liver dysfunction, acute kidney dysfunction and rhabdomyolysis. The patient eventually recovered due to early detection, correct diagnosis and powerful treatment. Clinicians should be aware of this new type of myocardial infarction, which is induced by inflammatory injury, but is not due to a primary coronary event such as plaque erosion and/or rupture, fissuring or dissection.
Source: Cardiovascular Journal of Africa 26, pp 4 –6 (2015) http://dx.doi.org/10.5830/CVJA-2014-072More Less
Percutaneous coronary intervention (PCI) is widely used to treat stenotic coronary arteries caused by coronary heart disease. Coronary artery perforation is a rare but dreaded complication of PCI. Here, we report the successful treatment of a patient with coronary perforation of the right ventricular cavity. To our knowledge, this is the first report of its kind. The patient was a 69-year-old woman with intermittent chest tightness and chest pain of about five years' duration who was hospitalised for severe chest tightness and pain persisting for three days. She had a history of hypertension and hyperlipidaemia; routine admission examination showed no other abnormalities. Results of routine blood, urine and stool tests, liver and kidney function, clotting time, electrocardiogram, chest radiography and echocardiography were normal. Although coil embolisation rather than balloon is safe and effective for treating coronary artery perforation, it may be not the best choice overall. If the perforation breaks through into the right ventricle, we may just monitor closely rather than treat. That course may be beneficial for patients in that it reduces the risk of myocardial cell necrosis. This case provides useful information for the treatment of such patients in the future.
Source: Cardiovascular Journal of Africa 26, pp 7 –10 (2015) http://dx.doi.org/10.5830/CVJA-2014-075More Less
The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing less-common causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.
A fatal complication after repair of post-infarction ventricular septal rupture : heparin-induced thrombocytopenia with thrombosis : case reportSource: Cardiovascular Journal of Africa 26, pp 11 –15 (2015) http://dx.doi.org/10.5830/CVJA-2015-001More Less
Heparin-induced thrombocytopenia (HIT) is a rare but potentially devastating and life-threatening complication from using heparin. HIT not only causes thrombocytopenia, but it also carries an increased risk for fatal thrombotic complications. In this report, we describe the case of a patient in whom fatal HIT developed after successful surgical repair of a posterior post-infarction ventricular septal rupture with cardiopulmonary bypass.
Author Pat CommerfordSource: Cardiovascular Journal of Africa 26 (2015)More Less
A patient presenting with a large pericardial effusion of uncertain aetiology is a relatively common clinical problem facing practitioners in Africa. The optimal management of such patients, particularly in resource-constrained environments, remains unclear. Tuberculosis is generally considered to be the most important likely cause, particularly if numerous fibrin strands are seen to be present on echocardiography, and many practitioners would advocate the immediate institution of treatment for this disease under these circumstances. The issue is far from clear however.
Comparison of MMF with prednisone in terms of rejection and duration of activity of transplant in rabbits that underwent retroperitoneal heterotopic heart transplantation : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 104 –108 (2015) http://dx.doi.org/10.5830/CVJA-2014-032More Less
Aim: In this study, mycophenolate mofetil (MMF) and methylprednisolone (MP) were compared in terms of rejection and duration of activity of the transplant in New Zealand rabbits that underwent retroperitoneal heart transplantation.
Methods: Retroperitoneal heart transplantation was performed in New Zealand white rabbits. The animals were divided into two groups. MMF group (group 1) (10 donors, 10 recipients): 12.5 mg/kg MMF was administered orally for two days prior to the surgery; MP group (group 2) (nine donors, nine recipients): 2 mg/kg MP was administered intramuscularly for two days prior to the surgery. After the operation, we waited until all motor activity in the transplanted heart had stopped. The transplant was then removed and the recipient was sacrificed. A donor in the MP group was excluded since it died before the motor activity had stopped.
Results: No statistically significant difference was found between the groups in terms of rejection score (p = 0.865). However, duration of motor activity was found to be statistically significantly longer in the MMF group, compared to the MP group (p = 0.013).
Conclusion: In this experimental study, MMF was similar to MP in terms of rejection but had better efficacy in terms of duration of motor activity of the transplant.
Right ventricular function and its relationship with grade of hepatosteatosis in non-alcoholic fatty liver disease : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 109 –113 (2015) http://dx.doi.org/10.5830/CVJA-2014-068More Less
Objective: This study was designed to assess right ventricular systolic and diastolic function and its relationship with grade of hepatosteatosis (HS) in non-alcoholic fatty liver disease (NAFLD) patients using conventional and tissue Doppler echocardiography.
Methods: NAFLD was diagnosed in 32 individuals (15 males, 17 females; 59% were grade I HS, 41% grade II-III HS) by means of ultrasonography. Twenty-two individuals, whose ultrasonography data did not show HS, comprised the control group (11 males, 11 females) and were included in the study. Right ventricular systolic and diastolic function and their relationship with grade of HS were assessed by conventional and tissue Doppler echocardiography. Additionally, right ventricular global function was assessed by myocardial performance index (MPI).
Results: When compared by conventional echocardiographic parameters, there were no significant differences between the two groups. With tissue Doppler parameters, the tricuspid annulus peak early diastolic velocity and ratio of early-tolate diastolic velocity were lower in the patients than in the controls (p = 0.03, p = 0.02, respectively). The isovolumetric relaxation time and MPI were significantly higher (p < 0.001, p < 0.001, respectively) in the patient group. HS grade was positively correlated with right ventricular isovolumetric relaxation time and MPI index (r = 0.295, p = 0.03, r = 0.641, p < 0.001, respectively).
Conclusion: These results show that right ventricular diastolic dysfunction (RVDD) in patients with NAFLD and degree of HS was associated with RVDD.
Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 114 –119 (2015) http://dx.doi.org/10.5830/CVJA-2014-070More Less
Objective: In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking.
Method: A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area-length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated.
Results: The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively).
Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively).
Conclusion: We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.
Source: Cardiovascular Journal of Africa 26, pp 120 –124 (2015) http://dx.doi.org/10.5830/CVJA-2014-069More Less
Introduction: The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma.
Methods: Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed.
Results: Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P-wave dispersion (OR: 1.11, 95% CI: 1.003-1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001-1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients.
Conclusions: P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.
Sickle cell trait is not associated with chronic kidney disease in adult Congolese patients : a clinic-based, cross-sectional study : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 125 –129 (2015) http://dx.doi.org/10.5830/CVJA-2014-076More Less
Objective: The aim of this study was to evaluate the determinants of chronic kidney disease (CKD) with special emphasis on sickle cell trait (SCT).
Methods: Three hundred and fifty-nine patients (171 men and 188 women), aged 18 years or older, with reduced kidney function (eGFR < 90 ml/min/1.73 m2) and seen at secondary and tertiary healthcare in Kinshasa were consecutively recruited in this cross-sectional study. Serum creatinine and haemoglobin electrophoresis were performed in each patient. CKD was defined as < 60 ml/min/1.73 m2. Logistic regression analysis was used to assess determinants of CKD with a special emphasis on SCT. A p-value < 0.05 defined the level of statistical significance.
Results: SCT was present in 19% of the study population; its frequency was 21 and 18% (p > 0.05) in patients with and without CKD, respectively. In multivariate analysis, sickle cell trait was not significantly (OR: 0.38; 95% CI: 0.559-1.839; p = 0.235) associated with CKD; the main determinants were dipstick proteinuria (OR: 1.86; 95% CI: 1.094-3.168; p = 0.02), the metabolic syndrome (OR: 1.69; 95% CI: 1.033-2.965; p = 0.03), haemoglobin ≥ 12 g/dl (OR: 0.36; 95% CI: 0.210-0.625; p = 0.001), and personal history of hypertension (OR: 2.16; 95% CI: 1.202-3.892; p = 0.01) and of diabetes mellitus (OR: 2.35; 95% CI: 1.150-4.454; p = 0.001).
Conclusion: SCT was not an independent determinant of CKD in the present case series. Traditional risk factors emerged as the main determinants of CKD.
Analysis of clinical outcomes of intra-aortic balloon pump during coronary artery bypass surgery : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 130 –133 (2015) http://dx.doi.org/10.5830/CVJA-2015-010More Less
Aim: The mortality rate in coronary artery bypass surgery increases with advancing patient age. This study was conducted to analyse and compare older (above 65 years of age) with younger patients (below 65 years of age) who had undergone coronary artery bypass surgery and had an intra-aortic balloon pump (IABP) inserted, comparing hospital stay, clinical features, intensive care unit stay, postoperative complications, and morbidity and mortality rates.
Methods: One hundred and ninety patients who had undergone coronary artery bypass surgery and required IABP support were enrolled in this study. Patients younger than 65 years of age were considered young, and the others were considered old. Ninety-two patients were young and 98 were old. The mortality rates, pre-operative clinical characteristics, postoperative complications, and duration of intensive care unit and hospital stays of the groups were compared. The risk factors for mortality and complications were analysed.
Results: One hundred and thirty-eight of the patients were male, and the mean patient age was 62.7 ± 9.9 years. The mortality rate was higher in the older patient group than the younger group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The cross-clamp time, mean ejection fraction, cardiopulmonary bypass time, and length of stay in the intensive care unit were similar among the groups (p > 0.05). Cardiopulmonary bypass time was the single independent risk factor for mortality in both groups.
Conclusion: In this study, high mortality rates in the postoperative period were similar to prior studies regarding IABP support. The complication rates were higher in the older patient group. Prolonged cardiopulmonary bypass and advanced age were determined to be significant risk factors for mortality.
Can empirical hypertonic saline or sodium bicarbonate treatment prevent the development of cardiotoxicity during serious amitriptyline poisoning? Experimental research : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 134 –139 (2015) http://dx.doi.org/10.5830/CVJA-2015-014More Less
Objective: The aim of this experimental study was to investigate whether hypertonic saline or sodium bicarbonate administration prevented the development of cardiotoxicity in rats that received toxic doses of amitriptyline.
Method: Thirty-six Sprague Dawley rats were used in the study. The animals were divided into six groups. Group 1 received toxic doses of i.p. amitriptyline. Groups 2 and 3 toxic doses of i.p. amitriptyline, plus i.v. sodium bicarbonate and i.v. hypertonic saline, respectively. Group 4 received only i.v. sodium bicarbonate, group 5 received only i.v. hypertonic saline, and group 6 was the control. Electrocardiography was recorded in all rats for a maximum of 60 minutes. Blood samples were obtained to measure the serum levels of sodium and ionised calcium.
Results: The survival time was shorter in group 1. In this group, the animals' heart rates also decreased over time, and their QRS and QTc intervals were significantly prolonged. Groups 2 and 3 showed less severe changes in their ECGs and the rats survived for a longer period. The effects of sodium bicarbonate or hypertonic saline treatments on reducing the development of cardiotoxicity were similar. The serum sodium levels decreased in all the amitriptyline-applied groups. Reduction of serum sodium level was most pronounced in group 1.
Conclusion: Empirical treatment with sodium bicarbonate or hypertonic saline can reduce the development of cardiotoxicity during amitriptyline intoxication. As hypertonic saline has no adverse effects on drug elimination, it should be considered as an alternative to sodium bicarbonate therapy.
Prevalence of anaemia among patients with heart failure at the Brazzaville University Hospital : cardiovascular topicsSource: Cardiovascular Journal of Africa 26, pp 140 –142 (2015) http://dx.doi.org/10.5830/CVJA-2015-021More Less
Background: Heart failure (HF) is a frequent cause of hospitalisation in cardiology. Its prognosis depends on several risk factors, one of which is anaemia.
Objectives: We aimed to determine the prevalence of anaemia in patients with heart failure, and evaluate its impact on their prognosis.
Methods: This article describes a cross-sectional study with prospective collection of data, carried out from 1 January to 31 December 2010 in the Department of Cardiology at Brazzaville University Hospital, Congo. Patients admitted for heart failure were included. Anaemia was defined as a haemoglobin level < 12 g/dl for men and < 11 g/dl for women.
Results: In total, 130 men (47.8%) and 142 women (52.2%) were recruited, mean age 56.9 ± 16.5 years. The prevalence of anaemia was 42%. Average levels of haemoglobin were 9.4 ± 1.8 and 13.8 ± 4.9 g/dl for the anaemic (A) and non-anaemic (NA) patients, respectively (p = 0.0001). Two hundred and forty-nine patients (91.5%) were in NYHA functional class III-IV. Forty-seven patients (17.3%) were on oral anticoagulation and 15 (5.5%) were on aspirin. The average duration of hospital stay was 19.1 ± 16.7 days, without a significant difference between the A and NA groups (19.4 ± 12 vs 18.8 ± 13.8 days; p = 0.79, respectively). Total mortality rate was 17%, with a significant difference between the A and NA groups (26 vs 10%; p = 0.001).
Conclusion: This preliminary study showed a high prevalence of anaemia in patients with heart failure, and it had a negative effect on the prognosis.
Source: Cardiovascular Journal of Africa 26, pp 143 –145 (2015) http://dx.doi.org/10.5830/CVJA-2015-006More Less
We describe the case of a patient who developed torsade de pointes during temporary pacemaker insertion after administration of intravenous erythromycin. The case highlights the dangers of administering drugs that prolong the QT interval in patients with complete atrioventricular block, and we discuss the underlying pathophysiological recipe that can lead to a potential arrhythmic disaster.
Source: Cardiovascular Journal of Africa 26, pp 146 –147 (2015)More Less
It is difficult to be a dispassionate observer at a PCR course organised by the Europa Organisation. Sessions are designed to stimulate audience participation and dialogue, and AfricaPCR 2015 exemplified that approach. Held from the 26-28 March at the Forum, the Campus, in Bryanston, Johannesburg, the 2015 course had an audible buzz, with delegates being as interactive as the presenters, making for highly stimulating and informative sessions, with much take-home value.
South African hospital the first in the Middle East, Africa, central Asia and Turkey to implant the world's smallest, minimally invasive cardiac pacemaker : drug trends in cardiologySource: Cardiovascular Journal of Africa 26 (2015)More Less
Groote Schuur Hospital in Cape Town is the first hospital in the Middle East, Africa, central Asia and Turkey to implant the world's smallest pacemaker: the Medtronic Micratranscatheter pacing system (TPS). The device was implanted recently as part of the Medtronic global pivotal clinical trial.