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- Cardiovascular Journal of Africa
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- Volume 8, Issue 2, 1997
Cardiovascular Journal of Africa - Volume 8, Issue 2, 1997
Volumes & issues
Volume 8, Issue 2, 1997
Source: Cardiovascular Journal of Africa 8, pp 75 –80 (1997)More Less
A cross-sectional analytic study was conducted to determine the prevalence of hypertension and its associated risk factors in elderly coloured (Euro-Afro-Malay ancestry) South Africans. A random sample of 200 noninstitutionalised subjects aged greater than or equal to 65 years, resident in urban Cape Town, was drawn by means of a two-stage cluster design. The survey procedure included a dietary assessment by means of a quantified food frequency questionnaire method, anthropometric measurements and the drawing of blood for plasma lipid analyses. Blood pressure was determined according to the American Heart Association's recommendations. The prevalence of hypertension (systolic pressure 2:: 160 mmHg and/or diastolic greater than or equal to 95 mmHg) was 66.7% (95% CI: 57.3 - 76.1 %) for men and 76.5% (95% CI: 68.3 - 84.7%) for women. The prevalence of isolated systolic hypertension (greater than or equal to 160/< 95 mmHg) was 33.85'0 (95% CI: 18.2 - 30.2%). Over one-third of hypertensive subjects (37.3%) were previously undiagnosed. Only half of the hypertensives were being treated for the condition, and 72 % of these still had blood pressure levels 2 greater than or equal to 160/95 mmHg. No association was found between either systolic or diastolic pressure and plasma lipids, salt intake, or alcohol intake. The results of this study suggest an inadequate diagnosis and poor management of hypertension in the elderly coloured population. Improved medical care and preventive strategies in respect of the early diagnosis, treatment and monitoring of hypertension require special attention in this age group.
Source: Cardiovascular Journal of Africa 8, pp 82 –84 (1997)More Less
We measured respiratory muscle function in 54 patients with heart failure and 45 normal subjects controlled for age, height and weight. All the patients were clinically examined for severity of heart failure using Boston criteria. Maximum inspiratory pressure (MIP) at residual volume (inspiratory muscle strength), and maximum expiratory pressure (MEP) at total lung capacity (expiratory muscle strength) were recorded in both groups according to the method of Black and Hyatt. Endurance was measured as the maximum voluntary ventilation (MVV) for 12 seconds. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also measured. The mean age of patients was 52.3 ï¿½ 13 and that of controls 50.8 ï¿½ 12.9 years. Results. The FVC was 73 ï¿½ 19.2 I (105 ï¿½ 17.7 in controls), the FEV1 as percentage of predicted 71 ï¿½ 22 (105 ï¿½ 18.5 in controls), the MIP 84.9 ï¿½ 29.3 cmH20 (113.3 ï¿½ 19.2 in controls), (P < 0.0001), the MEP 92.1 ï¿½ 25.1 cmH20 (106.4 ï¿½ 21.8 in controls (P < 0.004)), and the MVV 75.4 ï¿½ 27.41 (117.9 ï¿½ 20.6 in controls) (P < 0.0001). Boston criteria as a measurement of clinical severity were inversely correlated with MVV (r = -0.70; P < 0.001), MIP (r = 0.65; P < 0.001) and MEP (r = - 0.37; P < 0.01). Conclusion. Heart failure significantly reduces respiratory muscle strength and endurance.
Author H.F.H. Smedema, J.P. & WeichSource: Cardiovascular Journal of Africa 8, pp 86 –89 (1997)More Less
The number of cardiac catheterisations performed annually in South Africa is currently unknown. These include percutaneous transluminal coronary angioplasties, intracoronary stent implantations and balloon valvuloplasties. Based on international literature, an estimated several hundred vascular complications (frequently needing surgical repair) will occur per year. The accompanying prolonged admission time, diagnostic procedures and therapy will lead to a significant rise in costs. In this article the possible causes, diagnostic techniques, complications and therapies are discussed. Suggestions are made on how vascular complications can possibly be prevented.
Source: Cardiovascular Journal of Africa 8, pp 91 –96 (1997)More Less
It is well-established that B-blockers, particularly those without intrinsic sympathomimetic activity (lSA), are cardioprotective and prevent secondary recurrences of myocardial infarction (MI) when given within hours of onset of symptoms as well as during late intervention. The reduction in mortality in patients with MI appears significant for those agents without ISA, suggesting that magnitude of reduction in heart rate is an important factor. There is now convincing evidence that B-blockade also produces beneficial effects in 'heart failure (HF). In the early stages of HF, adrenergic support mechanisms help to maintain cardiac output but the long-term effects are deleterious; as a result increased adrenergic drive in HF is directly related to an adverse outcome. Early studies with B-blockers were undertaken primarily in Sweden and subsequently, in the 1980s, the same workers reported beneficial effects of long-term B-blockade with metoprolol in dilated cardiomyopathy. To date, studies have been undertaken with a variety of different B-blockers in patients with idiopathic dilated cardiomyopathy, as well as ischaemic HF. Until the 1990s the results of these studies were inconclusive, but showed a trend towards improvement in congestive HF (CHF). In the past 5 years, several placebo-controlled randomized trials of at least 12 months' duration and involving greater patient numbers have provided more compelling evidence for the use of these agents in CHF. Because cardiac decompensation may occur secondary to their negative inotropic effects, B-blockers are still rarely used in patients with CHF. This has led to the development of B-blockers with vasodilatory effects in an attempt to improve tolerance of these drugs. Initiated gradually, most patients with mild-to-moderate CHF can safely be treated with B-blockers except for some 10 -15% who develop hypotension. Treatment should be initiated in a controlled setting at low doses (carvedilol 6.25 mg twice daily, metoprolol 5 mg twice daily) and titrated upwards gradually. Despite a remarkable reduction in mortality in recent studies with carvedilol, routine management of heart failure with B-blockade can only be recommended when further confirmatory evidence from large, unconfounded randomised clinical trials on an intention-to-treat basis becomes available.
Source: Cardiovascular Journal of Africa 8, pp 97 –100 (1997)More Less
Williams syndrome is a multisystem disorder caused by a quantitative reduction in elastin. The cardiovascular anomalies often require extensive surgery. We descriptionbe a bleeding tendency in a child with Williams syndrome. Health care workers managing such patients should be aware of possible bleeding tendencies in children with Williams syndrome and be prepared for prolonged bleeding during investigative and surgical procedures.
The 44th annual scientific meeting of the Cardiac Society fo Australia and New Zealand, 3-7 August 1996Author L.J. DislerSource: Cardiovascular Journal of Africa 8, pp 102 –105 (1997)More Less