CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 16, ISSUE 4, JULY 2005
- Title: Cardiac markers - optimising
proBNP in cardiac diagnosis and management :
editorial
Authors: Jordaan, Pierre J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.192-193
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- Title: Review of manuscripts for the
Cardiovascular Journal of South Africa : from
the editor's desk
Authors: Brink, A.J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.193
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- Title: Dyslipidaemia among black
patients with type 2 diabetes : cardiovascular
topic
Authors: Vezi, Z.B.; Naidoo, D.P.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.194-198
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Abstract: Objective: To analyse the lipid profile of black patients with type 2 diabetes mellitus (type 2 DM) irrespective of duration or control of the disease.
Methods: This cross-sectional study evaluated the lipid profile of 62 black patients with type 2 DM. Clinical examination, fasting blood specimens for biochemistry, and urine analysis for proteinuria was determined in all patients.
Results: Only 25% of patients had adequately controlled blood pressure (BP < 140/90). Mean fasting plasma glucose (FPG) was 10.9 mmol/l (HbA1c : 10.6%). Mean body mass index (BMI) was 32.5. The total number of patients with diabetic dyslipidaemia (DD) was 56 (90.3%). Significant differences between men and women were noted for high-density lipoprotein cholesterol (HDL-C) (0.99 vs 1.22 mmol/l, p = 0.005) and triglycerides (TG) (2.7 vs 1.8 mmol/l, p = 0.045), respectively. The commonest isolated abnormality was high LDL-C (66.1%) followed by low HDL-C (60.7%) and then high TG (57.1%).
Conclusion: Over 90% of the black patients with type 2 DM displayed one or more features of DD affecting all major subclasses of cholesterol and triglyceride. The most frequent abnormality depicted by these patients was not the 'typical' DD (i.e. low HDL and high TG) often reported in other ethnic groups.
- Title: Sustained white cell cytokine
activation in idiopathic dilated cardiomyopathy
despite haemodynamic improvement with medical
therapy : cardiovascular topic
Authors: Brooksbank, Richard; Woodiwiss, Angela; Sliwa, Karen; Deftereos, Dawn; Essop, Mohammed R.; Sareli, Pinhas; Norton, Gavin R.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.200-204
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Abstract: Cytokine production in idiopathic dilated cardiomyopathy (IDC) may depend on neurohumoral stimulation, haemodynamic impairment or auto-antibody production. We aimed to ascertain the impact of haemodynamic improvements with standard medical therapy and neurohumoral blockade on white cell tumour necrosis factor-a (TNF-a) production in patients with IDC.
Twenty-seven patients with IDC and NYHA class I to IV heart failure but without evidence of oedema, reduced peripheral perfusion, or elevated plasma endotoxin concentrations were evaluated for indicators of cytokine activation. Plasma TNF-a concentrations were raised (p < 0.001) in patients prior to commencement of medical therapy as compared to controls (n = 27). In addition, endotoxin-free cultured whole blood TNF-a production was enhanced (p < 0.02) in the patients. Although plasma TNF-a tended to decrease, excessive whole blood TNF-a production remained unaltered following marked improvements in haemodynamics and functional class (increase in absolute left ventricular ejection fraction = 8.7 + 2.6%, p < 0.01, 37% in NYHA functional class I after therapy) with six to 12 months of medical therapy (diuretic, angiotensin converting enzyme inhibitor and b-blocker). Against a role for neurohumoral substances in promoting excessive white cell TNF-a synthesis the angiotensin II receptor antagonist, losartan, failed to modulate white cell TNF-a production in patients with IDC.
We concluded that white cell TNF-a overproduction is sustained in patients with IDC despite haemodynamic improvement with standard medical therapy and blockade of angiotensin II receptors. These data suggest that mechanisms other than haemodynamic impairment and neurohumoral activation contribute to excess white cell TNF-a production in IDC.
- Title: Cardiac findings in children
admitted to a hospital general ward in South
Africa : a comparison of HIV-infected and
uninfected children : cardiovascular topic
Authors: Brown, S.C.; Schoeman, C.J.; Bester, C.J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.206-210
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Abstract: The aim of this prospective observational study was to determine the presence of cardiac abnormalities in HIV-infected versus uninfected children who were admitted to a general paediatric ward during a two-month period. HIV status was determined by antibody and p24 antigen testing. Clinical information, echocardiography and electrocardiography (ECG) were performed for all children. There were 90 HIV-infected and 118 uninfected children. The median age was 9.6 and 11.8 months for infected and uninfected children, respectively. Baseline left ventricular dysfunction, defined as a shortening fraction < 25%, was found in 13 (17%) of the HIV-infected children compared to 5 (8%) uninfected children (p < 0.05). Left ventricular end-diastolic enlargement above the 98th percentile for age was found in 24% of the infected and 20% of uninfected children. Pericardial effusions, although common, were sub-clinical and not different in the groups. ECG findings and resting heart rates were also similar. Left ventricular dysfunction was the most significant cardiac abnormality present in hospitalised HIV-infected children. Other abnormalities, although common, were mostly asymptomatic and found with the same frequency in uninfected children. Further studies are indicated.
- Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.210, 214
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- Title: Transient ischaemic attack :
is routine use of computerised cerebral
tomography worthwhile? : cardiovascular topic
Authors: Mulaudzi, T.V.; Robbs, J.V.; Woolgar, J.; Pillay, W.; Pillay, B.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.212-214
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Abstract: Aim: To evaluate the role of routine computerised cerebral tomography (CCT) in patients undergoing carotid endarterectomy (CEA) following transient ischaemic attach (TIA).
Method: A retrospective review was carried out of data collected on patients with TIA who were managed at the Durban Metropolitan Vascular Service over an 11-year period. All patients underwent carotid duplex scanning and CCT, followed by carotid endarterectomy (CEA) under general anaesthesia.
Results: The records of 140 patients were reviewed. There were 85 (61%) men and 55 (39%) women (F:M = 1:1.6). The mean age was 63 years (range 40-95 years). The presenting symptoms were amaurosis fugax, syncope and speech deficit. Risk factors for arterial disease were smoking (73%), hypertension (55%), diabetes mellitus (28%) and hyperlipidaemia (6%). Duplex ultrasonography showed significant internal carotid artery stenosis in 138 patients and occlusion in two. Arch angiography of the latter two patients showed pre-occlusive carotid stenosis. CCT scans showed abnormalities in 34 (24%) patients. These were lacunar infarcts (56%), old infarcts involving grey and white matter (32%), and cortical infarcts (12%). The findings did not influence management. All patients underwent routine CEA with selective shunting in 51 (36%) patients. Postoperative stroke rate was 2.9%.
Conclusion: Routine CCT scanning in patients with TIA did not influence patient management and outcome. It is not cost effective and its routine use is questioned.
- Title: The effect of compressed air
massage on skin blood flow and temperature :
cardiovascular topic
Authors: Mars, Maurice; Maharaj, Sunil S.; Tufts, Mark
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.215-219
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Abstract: Aim: Compressed air massage is a new treatment modality that uses air under pressure to massage skin and muscle. It is claimed to improve skin blood flow but this has not been verified. Several pilot studies were undertaken to determine the effects of compressed air massage on skin blood flow and temperature.
Methods: Skin blood flow (SBF), measured using laser Doppler fluxmetry and skin temperature was recorded under several different situations: (i) treatment, at 1 Bar pressure using a single-hole (5-mm) applicator head, for 1 min at each of several sites on the right and left lower legs, with SBF measured on the dorsum of the left foot; (ii) at the same treatment pressure, SBF was measured over the left tibialis anterior when treatment was performed at different distances from the probe; (iii) SBF and skin temperature of the lower leg were measured with treatment at 0 or 1 Bar for 45 min, using two different applicator heads; (iv) SBF was measured on the dorsum of the foot of 10 subjects with treatment for 1 min at 0, 0.5, 1, 1.5 and 2 Bar using three different applicator heads.
Results: (i) SBF of the left foot was not altered by treatment of the right leg or chest, but was significantly increased during treatment of the left sole and first web, p < 0.0001. (ii) SBF over the tibialis anterior was increased when treatment was 5 cm from the probe, p < 0.0001, but not when 10 cm away. (iii) SBF was significantly elevated throughout the 45-min treatments at 1 Bar and returned to normal within 1 min of stopping treatment. Skin temperature fell by 6.8oC and 4.3oC after 45-min treatments at 1 Bar, and slight rewarming occurred within 15 min. At 0 Bar, no change in SBF or temperature was noted. (iv) A near-linear increase in SBF was noted with increasing treatment pressure for two of the three applicator heads.
Conclusion: Compressed air massage causes an immediate increase in SBF, and an immediate fall in SBF when treatment is stopped. The effect appears to be locally and not centrally mediated and is related to the pressure used. Treatment cools the skin for at least 15 min after a 45-min treatment.
- Title: Biventricular pacing for
heart failure alters electro-mechanical coupling
of both ventricles : cardiovascular topic
Authors: Munclinger, Miroslav J.; Thornton, Andrew S.; Wasiak, Malgorziata M.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.220-226
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Abstract: Aim: The exact mechanisms whereby biventricular pacing enables cardiac resynchronisation are not completely understood. This study looked at the effect of biventricular pacing on interventricular asynchrony in patients submitted to biventricular pacing.
Methods: A prospective series of 13 consecutive patients were selected from those referred for biventricular pacing. Criteria used included heart failure and QRS factors, as well as echocardiographic evidence of both intraventricular and interventricular asynchrony. Midterm follow-up of clinical and echocardiographic parameters are presented.
Results: All patients' clinical conditions improved significantly. Expectedly, diastolic filling parameters, ejection fraction and mitral regurgitation also improved significantly. The difference in the timing of left and right ventricular ejections of 65 ms at the baseline was corrected to 3 to 5 ms during six-month follow-ups after biventricular pacing. This effect was achieved by significant shortening of the left ventricular pre-ejection interval by 29 to 39 ms (p < 0.01) and by significant prolonging of the right ventricular pre-ejection interval by 18 to 30 ms (p < 0.01).
Conclusion: Complete interventricular mechanical resynchronisation due to biventricular pacing occurred not only by the expected advancement in left ventricular ejection, but also by a delay in right ventricular ejection. The specific significance of correcting interventricular asynchrony with regard to the benefit and selection of patients for resynchronisation therapy remains to be fully established.
- Title: Frans Jacobus Maritz :
30-01-1949 to 23-06-2005 : obituary
Authors: Brink, A.J.; Nell, Haylene; Naude, Linda
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.226
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- Title: The prevalence of risk
factors for coronary artery disease in patients
who had had CABG : short communication
Authors: Swart, M.J.; Coetzer, S.; Korb, A.; Schoeman, C.; Joubert, G.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.227-228
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Abstract: The conclusion of Ranjith and his co-workers from their study 'Demographic data and the outcome of acute coronary syndrome in the South African Asian Indian population' drew our attention. Young South African Indians frequently have premature atherosclerosis with diffuse and aggressive disease. This should be taken into account for risk intervention. We would like to add to this.
- Title: Cardiovascular disease :
hormone replacement therapy and the window of
opportunity : letter to the editor
Authors: Cheifitz, R.L.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.229-230
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- Title: ESPRIT study results show
benefit of telmisartan in severe kidney disease
: drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.231
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- Title: ESC guidelines - new studies
of ARBs included and more device-orientated :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.231-232
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- Title: Diabetic patients on
atorvastatin calcium experience major reductions
in heart attack and stroke : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.234
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- Title: Oral anti-diabetic drugs show
regression of carotid IMT in type 2 diabetes :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.235
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- Title: DIRECT study evaluates
prevention of diabetic retinopathy on intensive
candesartan cilexetil therapy : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.236
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- Title: Treatment of chronic stable
angina - a synergy of symptomatic benefit and
long-term outcome : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.236, 238
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- Title: Potassium as a complement to
a low-sodium diet in hypertension prevention :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.238
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 16, Issue 4, Jul / Aug
Published: 2005
Pages: p.240
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