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- Volume 15, Issue 1, 2004
Cardiovascular Journal of South Africa - Volume 15, Issue 1, 2004
Volume 15, Issue 1, 2004
Author A.J. BrinkSource: Cardiovascular Journal of South Africa 15, pp 5 –7 (2004)More Less
Extracted from text ... 5 A bibliometric quantitative parameter, termed the impact factor (IF), evolved from the 1961 Science Citation Index (SCI) and its by-product, the Journal Citation Reports (JCR).1 The factor is derived from the total number of citations received from a particular journal in a specific year, divided by the number of papers published in that journal in the previous two years. The IF would be an indicator of reader interest in the journal. It was intended as a useful tool for comparing the performance of different journals. Mainly, it was meant to facilitate the assessment of journals for acquisition by ..
Source: Cardiovascular Journal of South Africa 15, pp 7 –37 (2004)More Less
Extracted from text ... The answer is provided on page 37. This is the ECG of a 17-year-old male. ? Post-op repair ASD ? No Rx The ladder diagram depicts the problem: The sinus node is frequently 'sluggish' after ASD surgery and the junction has taken over. Its stimuli are conducted retrogradely to the atria, turn around and 'echo' back to the ventricles - this is called 'reciprocal rhythm'. On its return, the impulse encounters refractoriness in the left anterior fascicle and right bundle branch and is aberrantly conducted with a pattern of RBBB and LAFB. Therapy with IV atropine resulted in an increase in ..
Pattern of occurrence of microalbuminuria among dippers and non-dippers (essential hypertensives) in a Nigerian university teaching hospital : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 9 –12 (2004)More Less
<I>Objectives</I>: Hypertensives who fail to manifest the normal circadian nocturnal fall in blood pressure have a higher incidence of cardiovascular complications, early glomerular injury and microalbuminuria. This study aims to quantify the proportion of dippers and nondippers among the essential hypertensive population, and determine the frequency of occurrence of microalbuminuria among them. <br><I>Materials and methods</I>: Early morning urine specimens were taken from 50 patients with essential hypertension and 20 healthy, normotensive subjects. Combined negative results from albustic strip testing and sulfosalicylic acid tests were taken as excluding microalbuminuria. While collecting urine for 24-hour urinary protein and creatinine clearance, hourly blood pressure readings were recorded. Readings obtained between 07:00 and 23:00 were taken as daytime blood pressure readings, whereas readings obtained between 23:00 and 07:00 were considered night-time blood pressures. Dippers were considered to be those patients in whom the difference between mean daytime systolic/diastolic blood pressure and mean night-time systolic/diastolic blood pressure was 10/5 mm Hg or more. <br><I>Results</I>: Thirty-six (72%) and 14 (28%) patients with essential hypertension fulfilled the criteria for dippers and non-dippers, respectively. The night-time systolic and diastolic blood pressures were significantly higher in non-dippers than in dippers (<I>P</I> < 0.05). The mean daytime systolic and diastolic blood pressures were not different between these two groups. Twenty-nine out of 36 (80.6%) urinary specimens from dippers were without microalbuminuria, against six out of 14 (42.9%) specimens from non-dippers, <I>p</I> < 0.05. Eighteen out of 20 controls (90%) were without microalbuminuria. <br><I>Conclusion</I>: This study demonstrated that about 28% of the local essential hypertensive population was nondippers and 57.1% of these had microalbuminuria with the attendant cardiovascular and renal risks.
Source: Cardiovascular Journal of South Africa 15, pp 14 –20 (2004)More Less
<I>Introduction</I>: Isolating aetiological agents in patients with infective endocarditis (IE) remains problematical. We postulated that the high local incidence of culturenegative IE resulted from antibiotic exposure prior to blood cultures and that a structured delay in therapy in the subacute presentation would improve the diagnostic yield. <br><I>Aim</I>: We aimed to prospectively observe the diagnostic approach and give an overview of supplementary laboratory tests. <br><i>Study design</I>: Patients with suspected IE were enrolled into this analytical observational study and followed up for six months (<I>n</I> = 92). We compared the diagnostic yield and outcome in cases where antibiotics were withheld for 72 hours, with those cases who received early antimicrobials, despite being deemed safe for delayed therapy. <br><I>Results</I>: Definitive diagnoses (definite or excluded IE) were made in 92.8% of patients where antibiotics were delayed, compared to 60% of patients who received empirical treatment (<I>p</I> = 0.08). The mortality rates were 18.4% and 30.0% respectively (<I>p</I> = 0.18). Twenty-three of 26 patients with definite culture-negative IE received antibiotics during the 48 hours preceding cultures, compared to eight of 21 culture-positive patients (<I>P</I> < 0.001). Screening for atypical bacteria did not improve the yield. C-reactive protein (CRP) had a sensitivity of 97.9% (negative predictive value 87.5%), whereas a positive rheumatoid factor (RF) had a specificity of 93.8% (positive predictive value 91.7%). <br><I>Conclusions</I>: We observed tendencies towards a greater diagnostic yield and lower mortality where antibiotics were initially withheld. Antibiotics prior to blood cultures were an important cause of culture-negative IE. A normal CRP proved useful in excluding IE; a positive RF strongly favoured IE.
Renin-angiotensin system and associated gene polymorphisms in myocardial infarction in young South African Indians : cardiovascular topicsSource: Cardiovascular Journal of South Africa 15, pp 22 –26 (2004)More Less
The renin-angiotensin system plays an important role in cardiovascular regulation. Abnormalities in genetic components of this system, such as the angiotensinconverting enzyme (ACE) gene, angiotensin II type 1 (AT<sub>1</sub>) receptor gene and angiotensinogen (AGT) gene, may cause a variety of adverse cardiovascular effects. <br>It was the aim of this study, therefore, to investigate the involvement of the ACE insertion/deletion (I/D), AT<sub>1</sub> receptor 1166 A-->C and AGT M235T polymorphisms as predisposing factors for myocardial infarction (MI) in 195 young South African Indians (<u><</u> 45 years). Results were compared with those obtained in 107 unaffected siblings (18-45 years old) and 300 healthy age- and racematched control subjects. <br>The distribution of the ACE genotypes was the same in each of the three study groups (<i>p</I>-value ranged between 0.83 and 0.98). No differences were observed in the 1166 A-->C AT<sub>1</sub> receptor polymorphism with respect to both genotype and allelotype (<I>p</I> > 0.70), or in the genotype or allele frequency distribution of the AGT M235T polymorphism (<I>p</I> > 0.44). However, a significant increase was noted for both the AT<sub>1</sub> receptor C variant (<I>p</I> = 0.025) and the AGT T variant (<I>p</I> = 0.047) in hypertensive patients compared with those who were normotensive. <br>In conclusion, results of this study indicate that the ACE I/D, the 1166 A-->C AT<sub>1</sub> receptor and AGT M235T polymorphisms do not confer any increased risk for MI in young South African Indians.
Source: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... First South African summit on atherothrombosis to address critical CV conditions During 2003, the Prevention of Atherothrombotic Disease Network, an international multidisciplinary group, published a Call-to-Action paper with the aim of increasing the awareness, detection and treatment rates of peripheral arterial disease (PAD). In response to the Network's Call to Action, Sanofi-Syntelabo will sponsor the first South African summit of atherothrombosis during March 2004. Experts from all the interrelated disciplines - vascular medicine, neurology, cardiology and interventional radiology as well as other interest groups - will meet to discuss and expand their knowledge of the correct diagnosis and management of these ..
Source: Cardiovascular Journal of South Africa 15, pp 28 –31 (2004)More Less
<I>Objective</I>: Atrial septal defects and patent foramen ovale can now be closed percutaneously. This report describes our initial and follow-up experience, especially in relation to efficacy and complications. <br><I>Methods</I>: During a 2-year period, seven atrial septal defects and one patent foramen ovale were closed. The Amplatzer<sup>(R)</sup> atrial septal defect occluder was used in five, the Cardioseal<sup>(R)</sup> device in two and the Amplatzer<sup>(R)</sup> patent foramen ovale occluder in one. A compliant sizing balloon was used to assess the stretched diameter of the defects. <br><I>Results</I>: Percutaneous closure was successful in all patients. The median age was 5.4 years (range: 3.7-16.6 years) and median weight was 18 kg (range: 14-65 kg). The mean duration of the procedure was 2.3 hours. There were no acute complications. Patients were followed up for a mean of 1.1 years. One child experienced severe headaches and another developed an atrial flutter and a small leak 7 months after implantation, both of which resolved. <br><I>Conclusion</I>: Percutaneous closure of atrial septal defects and patent foramen ovale is effective and safe. In selected children, this may be offered as an alternative to surgery.
Potential renoprotective effects of the angiotensin receptor blocker eprosartan : a review of preliminary renal studies : review articleSource: Cardiovascular Journal of South Africa 15, pp 32 –37 (2004)More Less
The importance of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of hypertension and in renal disease, particularly in patients with diabetes, has become increasingly evident. Pharmacological blockade of the RAAS offers potential for the therapeutic management of these pathologies. Angiotensin converting enzyme (ACE) inhibitors and angiotensin II (AII) receptor blockers have been shown to exhibit effectiveness in the treatment of hypertension. AII receptor blockers have a renal protective effect owing to their ability to reduce systemic blood and intraglomerular pressures. Eprosartan is a chemically distinct AII blocker, which displays a dual mode of action whereby it blocks both pre- and postsynaptic AT<sub>1</sub> receptors, potentially benefiting patients with hypertension and renal disease. In addition, evidence suggests that eprosartan is well tolerated by both healthy subjects and patients with varying degrees of renal impairment, such that the dose does not need to be - modified in patients with mild to moderate renal impairment. <br>Results from preliminary studies demonstrate that eprosartan doses well below those required for blood pressure control have a pronounced effect on the kidney and do not compromise renal autoregulatory mechanisms. Therefore, eprosartan may have a benefit in the prevention or delay of renal damage in hypertensive patients with renal impairment, although this remains to be determined in a clinical setting.
Carrying short-acting nitrates is not a contra-indication to the use of PDE5 inhibitors : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 38 Drug Trends Carrying short-acting nitrates is not a contra-indication to the use of PDE5 inhibitors A recent round-table meeting on the management of erectile dysfunction, held in London and involving specialist cardiologists and physicians, reported on the use of PDE5 inhibitors in men with coronary heart disease.1 The aim of the meeting was to look at the cardiac safety of the products and provide guidance on their use in patients with cardiac risk. The main differences between the three major PDE5 inhibitors relate to duration of action and specificity with regard to inhibition of PDE5. Sildenafil (Viagra) is effective ..
Source: Cardiovascular Journal of South Africa 15, pp 40 –41 (2004)More Less
Extracted from text ... New Premier study suggests Preterax(r) as a first-line antihypertensive Once a patient has been diagnosed with essential hypertension, and lifestyle changes have proven less than satisfactory, the physician needs to make a decision as to which anti-hypertensive agent to use initially. In hypertensive patients without other cardiovascular risk factors, monotherapy is the likely first option. However, hypertension is frequently exacerbated by other cardiovascular risk factors, including type 2 diabetes and albuminuria.1 Both of these co-existing risk factors are associated with a poor cardiovascular and renal outcome. A number of studies indicate that aggressive, tight control of blood pressure in diabetic ..
The CHARM programme raises the profile of candesartan cilexetil in the treatment of chronic heart failure : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15, pp 42 –45 (2004)More Less
Extracted from text ... 42 The interest in determining the role of angiotensin receptor blockers (ARBs) across the whole continuum of cardio - vascular disease from hyper tension to heart failure lead to the CHARM (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity) programme, a com po site of three trials designed to examine a wide range of patients with chronic heart failure (CHF). Three South African cardiologists and a physician who participated in the CHARM programme met recently to review their experiences following the presentation of the results at the September 2003 European Society of Cardiology Meeting. The meeting was ..
VALIANT trial results support use of valsartan in acute myocardial infarction : drug trends in cardiologySource: Cardiovascular Journal of South Africa 15, pp 45 –47 (2004)More Less
Extracted from text ... 45 The Valsartan in Acute Myocardial Infarction (VALIANT) study results, announced last week at the American Heart Association Meeting, confirmed the value of using valsartan (Diovan(r)) in early post-MI heart failure or left ventricular dysfunction, while also adding additional pharmacological insights into this acute cardiac condition.1, 2 The VALIANT trial that started in 2000 compared the effects of the angiotensin receptor blocker valsartan, the ACE inhibitor captopril, and the combination of valsartan and captopril, in a population of high-risk patients with clinical or radiological evidence of heart failure, evidence of left ventricular systolic dysfunction, or both, after acute myocardial infarction. ..
Source: Cardiovascular Journal of South Africa 15 (2004)More Less
Extracted from text ... 48 On 14 November 2003, the Christiaan Barnard Department of Cardiothoracic Surgery at Groote Schuur Hospital and the University of Cape Town, together with other departments involved in cardiovascular medicine and related research and teaching, celebrated two major events. The first was the official opening of the significantly upgraded 'Christiaan Barnard Cardiothoracic wards and Academic suite'. The redevelopment has been made possible by generous donations from members of the medical devices industry, as well as funding from the Public Works Department. The aim was to rebuild and reinvigorate the once world-famous Heart Surgery Department at Groote Schuur Hospital into one ..