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- Volume 14, Issue 4, 2003
Cardiovascular Journal of South Africa - Volume 14, Issue 4, 2003
Volume 14, Issue 4, 2003
Author Miroslav J. MunclingerSource: Cardiovascular Journal of South Africa 14, pp 172 –175 (2003)More Less
Extracted from text ... 172 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003 The old questions of cardiac pacing for whom and how have remained the focus of clinical research in the last decade. The most significant development has occurred in the management of heart failure. However, the electrophysiological background of multi-site (biventricular) pacing for the correction of impaired intraventricular conduction is firmly based in concepts of cardiac pacing. Technological advances in cardiac pacemakers have accelerated recently and this has significantly improved memory and diagnostic capabilities as well as the sophistication of cardiac pacing. Cardiac pacing for bradycardias It has become evident ..
Balloon angioplasty of native coarctation of the aorta in a local group of children : acute results and midterm angiographic re-assessment : cardiovascular topicsSource: Cardiovascular Journal of South Africa 14, pp 177 –181 (2003)More Less
<i>Objective</i> : Balloon angioplasty of native coarctation of the aorta is gaining acceptance as an alternative to surgery in children. The aim of this study was to assess the acute and midterm effectiveness and safety of the procedure. <br><i>Methods</i> : During a 3-year period, nine patients with native coarctation underwent balloon angioplasty at a median age of 2.9 years (range: 4 mo - 12 y) and median weight of 11 kg (range : 3.1 - 51 kg). Balloon diameter selected was at least twice the diameter of the narrowed segment, but never more than the diameter of the aorta at diaphragmatic level. <br><i>Results</i> : There was a significant improvement in the mean systolic gradient across the coarctation from 36 ± 13 mm Hg to 4 ± 4 mm Hg (<i>p</i> < 0.001), and in the mean diameter of the narrowed segment from 4 ± 1.3 mm to 7.2 ± 2.7 mm (<i>p</i> < 0.001). There was no immediate mortality or complication. Follow-up catheterisation was done in eight patients, a mean of 2.7 years (range: 0.8 - 4 y) after the initial procedure. No evidence of restenosis was found, but one patient developed an aneurysm that was surgically resected. <br><i>Conclusion</i> : Balloon angioplasty is effective and safe for the treatment of native coarctation in children. Radiographic follow-up is advisable in the midterm. Balloon angioplasty offers an alternative to surgery in the treatment of selected children older than 3 months with native coarctation of the aorta.
Prosthetic valve obstruction at Tygerberg Hospital between January 1991 and February 2001 : cardiovascular topicsSource: Cardiovascular Journal of South Africa 14, pp 182 –188 (2003)More Less
<i>Background</i> : Prosthetic valve obstruction is a relatively rare, but potentially fatal complication in patients with prosthetic heart valves. The diagnosis and appropriate management of these patients present a challenge to both the cardiologist and the cardiac surgeon. Despite efforts over the last 30 years to prevent this complication, it remains a lifelong risk. Obstruction is caused by pannus formation, thrombus formation or a combination of pannus and thrombus. Valve replacement has traditionally been the treatment of choice. <br><i>Methods</i> : Patients were selected from echocardiography and surgical reports between January 1991 and February 2001. All patients were analysed with regard to demographic information, clinical features, imaging results, treatment and outcome data. INR values on presentation were obtained from haematology archives. <br><i>Results</i> : A total of 32 patients presented on 34 occasions. There were 25 women and seven men. Obstruction occurred in the mitral position in 56% of cases and in the aortic position in 44% of cases. All but two valves were St Jude bileaflet valves. Patients generally presented with severe dyspnoea (NYHA class IV in 64.7%) and poor anticoagulation control (INR < 2.5 in 75.8%). The initial imaging modality used in all cases was transthoracic echocardiography. Fluoroscopy was used in five cases and transesophageal echocardiography in only two cases. Valve replacement was performed on 20 patients, six patients received thrombolysis and the remaining eight patients did not receive any treatment. Outcome was poor with an overall mortality of 64.7%. <br><i>Conclusions</i> : Given the extremely high mortality rate with current management, the treatment of prosthetic valve obstruction with thrombolysis in selected patients deserves consideration in a prospective study.
Source: Cardiovascular Journal of South Africa 14, pp 191 –194 (2003)More Less
The knowledge pertaining to mitral valve prolapse is mainly based on studies in adults. In this study, the clinical profile as described in adults was compared with that found in children up to the age of 13 years. Forty-five children with echocardiographic-proven mitral valve prolapse and who met the inclusion criteria were included in the study. <br>The male : female ratio in this study was 1 : 1.37 and was not statistically significantly different from reported ratios. Most of the children were asymptomatic. Twenty-one of the 31 patients referred from outside the hospital had an incidentally found murmur. The symptoms found in this study were not similar to those described in adults. The most commonly found symptoms were shortness of breath and fatigue, in contrast to those of chest pain and palpitations described in adults. Comparing males to females in this study, significantly lower weight (<i>p</i> = 0.005) and body mass index (<i>p</i> = 0.003) were found in girls, and a significantly lower pulse rate (<i>p</i> = 0.002) in boys. Left-sided cardiac enlargement was diagnosed in 11 patients on chest X-ray and in six patients on electrocardiogram. One patient had Marfan syndrome and four others had a Marfanoid appearance. <br>In conclusion, most children with mitral valve prolapse are asymptomatic. Mitral valve prolapse is not an uncommon finding in children younger than 13 years of age. Patients with mitral valve regurgitation were advised to take infective endocarditis prophylaxis prior to invasive procedures.
Ability of Nigerian hypertensive patients to perceive changes in their blood pressure : cardiovascular topicsSource: Cardiovascular Journal of South Africa 14, pp 195 –198 (2003)More Less
The objective of this study was to examine the ability of hypertensive patients to predict correctly when their blood pressure (BP) was elevated, and the symptoms they felt when such changes occurred. We also sought to determine whether literacy levels or the number of years that a patient had been diagnosed as hypertensive had a correlation with whether a patient was a predictor and whether he was an accurate predictor. One hundred and seventy-seven patients were studied, of which 101 (57.1%) claimed they could tell when their BP was elevated. Only 45 (44.5%) of the predictors were right in their prediction. <br>Although being literate and longer time of being hypertensive was found to be likely to make a patient a predictor, neither of these variables was likely to make a predictor accurate. Predictors were also likely to be younger than non-predictors. The symptoms the patients were likely to complain about as denoting a rise in BP included headache (20.4%), weakness / tiredness (20.4%) and palpitation (18.5%). <br>The study has shown that the majority of predictors were not accurate and so hypertensive patients should be counseled not to depend on how they feel but to visit physicians regularly for BP checks.
Source: Cardiovascular Journal of South Africa 14, pp 198 –214 (2003)More Less
Extracted from text ... 198 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003 7. Familoni OB. High blood pressure. Med Digest 1992; 18: 54-55. 8. Morgan M, Watkin C. Managing hypertension: beliefs and responses to medication among cultural groups. Social Health Illness 1988: 10: 561-578. 9. Meyer D, Leventhral H, Gutmann M. Commonsense models of illness: The example of hypertension. Health Psychol 1985; 4: 115-135. 10. Cantillon P, Morgan M, Dundas R, et al. Patients perception of changes in their blood pressure. J Hum Hypert 1997; 11: 221-225. 11. Banmann L, Leventhral H. I can tell when my blood pressure is ..
Is there a role for 99mTc-HMPAO leucocyte scintigraphy in infective endocarditis? : short communicationSource: Cardiovascular Journal of South Africa 14, pp 199 –203 (2003)More Less
Infective endocarditis is an important disease in developing countries. A combination of clinical findings, typical organisms cultured from blood, and specific echocardiographic features are used to establish the diagnosis. The diagnosis is often difficult because cultures are not always positive and transthoracic echocardiography lacks sensitivity and specificity, leading to delayed treatment or inappropriate therapy. As <sup>99m</sup>Tc-HMPAO labelled leucocyte scintigraphy is used routinely to evaluate patients with suspected infectious processes, it was postulated that this technique might also aid in the diagnosis of infective endocarditis in patients with underlying chronic rheumatic heart disease or other valvular disease. <br>Six patients were referred for <sup>99m</sup>Tc-HMPAO-labelled leucocyte scintigraphy. The white blood cells were labelled according to standard procedures. Whole-body planar imaging and single photon emission tomography of the chest area, with imaging at 30 minutes, 3 hours and 24 hours after the administration of the labelled leucocytes, were performed on all patients. All the scintigrams were negative. The reasons for the negative findings are not entirely clear, but probably reflect the pathological nature of vegetations, which consist mainly of masses of fibrin, clotted platelets and blood cell debris, containing the causative organisms. Leucocytes do not play a major role in the pathological process. Although only six patients were studied, it appears that <sup>99m</sup>Tc-HMPAO leucocyte scintigraphy is of little value in the evaluation of patients with infective endocarditis. A study after the administration of radiolabelled antibiotics may be of greater value and should be considered in these patients.
Source: Cardiovascular Journal of South Africa 14, pp 204 –205 (2003)More Less
Extracted from text ... 204 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003 A 56-year-old female smoker presented to hospital with the sudden onset of chest tightness and dyspnoea, lasting for 4 hours. Clinical and radiological examination revealed dextrocardia and situs inversus. The admission ECG, performed with the electrodes in the conventional position, showed features of dextrocardia (rS complexes and poor QRS amplitude progression from lead V1 to V6, the tall R wave in lead aVR, and P wave and QRS axes directed at +120?) and widespread changes suggestive of myocardial ischaemia/injury (ST segment elevation of 1-2 mm in aVR, ST segment ..
Cardiovascular therapy. Evidence-based medicine : questions and answers, W. Scultz, H. Darius and G. Kober : book reviewAuthor Andries BrinkSource: Cardiovascular Journal of South Africa 14 (2003)More Less
Extracted from text ... 206 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003 With contributions by P. Kenedi Translated by Richard Harthorn 36 figures, 22 tables and 38 study charts Hard cover, 514 pages Medpharm Scientific Publishers: Stuttgart, 2002 In a review of the first edition of this book in the Cardiovascular Journal of South Africa [Cardiovasc J South Afr 13(5); 2002], the need for evidence-based medicine was comprehensively discussed. Here, the user-friendly and unique presentation of knowledge in this field was outlined. The appearance of a second edition so soon after the first is testimony to the readers' quick acceptance of ..
Source: Cardiovascular Journal of South Africa 14, pp 207 –208 (2003)More Less
Extracted from text ... COMET challenges paradigm of ACE inhibition in mild heart failure 'The results of the COMET study in chronic heart failure show the clear survival benefits of carvedilol (Dilatrend(r)) to a level far greater than anyone had anticipated', noted Prof. P. Poole- Wilson, Chairman of the Steering Committee of the COMET Study at the recent presentation of final results in Strasbourg. South African primary-care physicians were also recently given the opportunity to view these results via video during a satellite CME on heart failure treatment presented by leading South African specialists with sponsorship from Roche Pharmaceuticals. Focusing firstly on the remodelling ..
INVEST endorses VerapamilSR in hypertensives with CAD and highlights diabetes prevention : drug trends in cardiologySource: Cardiovascular Journal of South Africa 14, pp 208 –211 (2003)More Less
Extracted from text ... INVEST endorses VerapamilSR in hypertensives with CAD and highlights diabetes prevention The results of INVEST (International VerapamilSR/Trandolapril Study) were presented recently at the American College of Cardiology Meeting by chief investigator, Carl J. Pepine of the Cardiovascular Medicine Division, University of Florida. A follow-up satellite meeting was held in South Africa in June in order to brief local specialists on the importance of this exciting new study. The INVEST study of 22 576 hypertensive patients with CAD compared the risk for adverse outcomes [all-cause mortality, non-fatal myocardial infarction (MI) or non-fatal stroke] using either a non-dihydropyridine calcium antagonist-based (VerapamilSR) or ..
Source: Cardiovascular Journal of South Africa 14, pp 211 –212 (2003)More Less
Extracted from text ... ACE inhibitors: the impact of the EUROPA study on CAD Over the past three decades, risk-factor modification for primary and secondary prevention has resulted in significant reductions in coronary end points. However, despite lifestyle modifications, use of aspirins, statins and coronary revascularisation techniques, coronary artery disease (CAD) is still one of the principal causes of death worldwide1 (one in every two men and one in every three women aged 40 years are at risk of developing CAD).2 New strategies for secondary prevention are therefore urgently needed. The EUROPAstudy3 is an important landmark, long-term trial that is investigating the prevention of ..
INSIGHT shows value of calcium antagonist (nifedipine) in diabetic hypertension : drug trends in cardiologySource: Cardiovascular Journal of South Africa 14, pp 212 –213 (2003)More Less
Extracted from text ... INSIGHT shows value of calcium antagonist (nifedipine) in diabetic hypertension The INSIGHT study, which demonstrated that nifedipine (Adalat XL) and diuretic therapy with co-amilozide had a comparable efficacy in preventing overall cardiovascular and cerebrovascular complications in patients with hypertension, has recently been evaluated with regard to cardiovascular outcomes in patients with diabetes at baseline (1 302 patients).1 This evaluation found that significantly fewer nifedipine-treated patients with diabetes had secondary outcomes (a composite of all-cause death, death from a vascular cause, and death from a non-vascular cause) than co-amilozidetreated patients (14.2% vs 18.7%: relative risk, 0.76; 95% CI, 0.59, 1.42; P ..
Source: Cardiovascular Journal of South Africa 14, pp 213 –214 (2003)More Less
Extracted from text ... Preventative protection by atorvastatin in lipid-lowering arm of ASCOT The lipid-lowering arm of ASCOT, involving 10 305 patients, has shown significant reduction in major cardiovascular events in hypertensive patients who are not conventionally deemed dyslipidaemic. These findings will have important implications for clinical practice. Treatment was stopped in the study after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin (10 mg) group compared with 154 events in the placebo group [hazard ratio 0.64 (95% CI 0.50-0.83), p = 0.0005]. This benefit emerged in the first year of followup. There was no ..
Source: Cardiovascular Journal of South Africa 14 (2003)More Less
Extracted from text ... 216 CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 4, July/August 2003 Astrazeneca appoints new clinical research manager Dr Christo van Niekerk has been appointed clinical research manager at AstraZeneca Pharmaceuticals, with the task of managing the AstraZeneca Global Clinical Development Programme in South Africa. AstraZeneca manages the largest pharmaceutical development programme in sub- Saharan Africa. The company's research focuses on five key therapeutic areas, including oncology and infection, pain and CNS, respiratory and inflammation, CV and GI. The budget for AstraZeneca's current clinical trial programme in South Africa is about R150-million and the majority of products brought onto the South ..