- A-Z Publications
- Cardiovascular Journal of Africa
- OA African Journal Archive
- Volume 7, Issue 1, 1996
Cardiovascular Journal of Africa - Volume 7, Issue 1, 1996
Volumes & issues
Volume 7, Issue 1, 1996
Cardiac troponin T - a sensitive and specific new marker of myocardial damage in acute transmural infarctionSource: Cardiovascular Journal of Africa 7, pp 8 –10 (1996)More Less
Troponin T measurement is a relatively new diagnostic test to evaluate myocardial damage. The test was performed on sera from 52 patients, 42 with proven myocardial infarction (WHO criteria) and 10 control patients without myocardial infarction. The serum troponin T levels did not correlate with the serum creatine kinase levels. A raised serum troponin T level had a sensitivity of 95% and a specificity of 100% in predicting myocardial damage in patients with myocardial infarction. It was also raised for a longer period than serum creatine kinase levels, making it a sensitive and specific diagnostic test in the patient who presents 72 hours after a myocardial infarction.
Author C.** Marks, P.H.* & MarksSource: Cardiovascular Journal of Africa 7, pp 12 –16 (1996)More Less
A study of 8 patients with ten primary cardiac tumours, treated by the authors between 1985 and 1993, emphasizes the diagnostic importance of echocardiographic examination. Two-dimensional echocardiography defined the pedunculated or sessile configuration of each tumour and revealed the mobility of left atrial myxomas in their intermittent obstruction of the mitral valve and the effect of tricuspid obstruction by a right atrial myxoma. Seven atrial myxomas were successfully resected in 7 patients. The eighth patient underwent successful resection of three separate extraskeletal osteogenic sarcomas of the heart. The mean age was 36 years (range 21 - 62); there were 5 women and 3 men in the series. The clinical features could be characterised as due to mass effect, arrhythmia, embolisation or constitutional manifestations. Excellent early and late results were obtained in the 7 patients with myxomas. A good cardiac outcome occurred in the patient with osteogenic sarcomas, but ileal intussusception due to an enteric metastasis required bowel resection; the patient died of widespread metastases 18 months later. The familial form of atrial myxoma (Carney syndrome) can be differentiated from the sporadic form.
Author P.J. SwiftSource: Cardiovascular Journal of Africa 7, pp 17 –21 (1996)More Less
Clinical experience in the former Ciskei suggests an association between dietary iron overload (DIO) and idiopathic cardiomyopathy (IC). A literature analysis suggests that a fundamental problem underlies autopsy studies on iron overload/heart disease, i.e. that two assumptions are false: (I) cardiac iron deposits must be demonstrated to prove toxicity; and (ii) the quantity of hepatic iron must correlate with heart disease. In the original studies on IC associated with DIO, the same assumptions led to the exclusion of iron toxicity. A mechanism of iron toxicity based on blood-borne free radical cardiac damage explains the false assumptions, accounts for the contradictory results in the literature and suggests that the exclusion of iron toxicity in IC was incorrect. This study demonstrates an ongoing association between IC and DIO in the Ciskei, and reports an ICIDIO patient whose cardiomyopathy improved following venesection. If blood-borne free radicals are in fact responsible for myocardial damage in iron-overloaded individuals, prognostic factors other than iron quantity per se may be important.
Source: Cardiovascular Journal of Africa 7, pp 22 –24 (1996)More Less
Atrial flutter and atrial fibrillation are associated with palpitations, impaired haemodynamics and a risk of thrombo-embolism, all of which can be corrected by a new surgical procedure. Cox's maze procedure was used to correct surgically a symptomatic paroxysmal atrial flutter in a 31-year-old woman who required closure of a secundum atrial septal defect. Six months postoperatively, she remains asymptomatic in normal sinus rhythm on no medication.
Source: Cardiovascular Journal of Africa 7, pp 25 –29 (1996)More Less
Cost-effectiveness analyses suggest that if outcomes are approximately similar, examination of practice and price variation provides potential targets for improvement in quality and/or reduction in cost. We examined variations in practice patterns and price with regard to congenital heart disease in nine countries. Standardised descriptionptions of 5 typical patients, 1 each with aortic stenosis, pulmonary stenosis, atrioventricular septal defect, tetralogy of Fallot and tricuspid atresia were provided to the investigators who quantitated a typical course (from birth to 21 years of age) for each patient in terms of: clinic visits, outpatient echocardiogram, outpatient Holter, diagnostic catheterisation, therapeutic catheterisation, medical hospitalisation, surgical hospitalization and years on medication. Payments for each service in the public and private system were based on data from each country. We found that in respect of practice patterns, there was an average of 400% variation, with the greatest variation in clinic, outpatient echocardiogram, outpatient Holter and medical hospitalization costs. The overall use of services was lowest in Australian and Japan and highest in Canada and Italy. Pricewise, there was a 380% variation, with the greatest variation in the prices ofï¿½ medication and inpatient services. In the private sector in particular, prices were highest in Japan, the USA and Germany, and lowest in South Africa and France; in the public sector, prices were highest in Canada, Japan and Germany, and lowest in South Africa and Australia. Overall, the average worldwide payments for congenital heart disease from birth to 21 years of age were as follows: mild aortic stenosis $3 851; mild pulmonary stenosis $7 319; tetralogy of Fallot $36 456; atrioventricular septal defect $39 772; tricuspid atresia $74 940. The mean was $32 968. Payments were highest in the USA, Japan and Italy, and lowest in Australia and South Africa. In conclusion: (l) there is significant practice and price variation in paediatric cardiology services. throughout the world; and (il) further study of the need for services in which there is high variation (outpatient echocardiogram, Holter and medical admissions) is warranted, since significant reduction in these services may be possible with considerable savings and no reduction in quality.
Source: Cardiovascular Journal of Africa 7, pp 30 –36 (1996)More Less
The mortality rate from coronary heart disease (CHD) has fallen considerably in many Western populations. Some evidence notes an associated fall in incidence, yet other information indicates a rise. In any case, CHD remains a formidable cause of illness and death. While only about half of the disease's variance can be explained by known risk factors, knowledge is sufficient to attempt avoidance of the disease. Dietary changes involving, for example, reduction in fat intake and changes in fat composition, have had mixed therapeutic success. Since Mediterranean populations have a much lower CHD mortality rate, compared with those of northern Europe - this is also true for diet-related cancers - their diet has attracted considerable attention. The principle features thereof are a high intake of monounsaturated fat, chiefly olive oil, and very high intakes of vegetables and fruit. While the diet's potential role in disease avoidance is undoubted, the chances of its adoption, even by high-risk segments, are remote.
Author J.A. MoolmanSource: Cardiovascular Journal of Africa 7, pp 37 –39 (1996)More Less