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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
4
AFRICA
The article by Beringer and Celliers in this edition (page
5) highlights the rarity of RSH but also the importance
of an early diagnosis to ensure optimal planning and good
long-term outcomes.
5
Their local experience correlates with
international data. Mortality rate, as expected, increased with
the complexity of the cardiac and associated lesions. As noted in
the article, it is important to do a complete work-up, including
chest roentgenography, echocardiography, electrocardiography,
cardiac catheterisation and foetal ultrasonography, and to have
a high index of suspicion of associated lesions and syndromes
(e.g. Kartagener and scimitar) to determine the prognosis and
treatment options. An accurate diagnosis is essential for surgical
planning and possible correction.
References
1.
Bohun CM, Potts JE, Casey BM, Sandor GS. A population-based study
of cardiac malformations and outcomes associated with dextrocardia.
Am J Cardiol
2007;
100
(2): 305–309.
2.
Calcaterra G, Anderson RH, Lau KL, Shinebourne EA. Dextrocardia
– value of segmental analysis in its categorization.
Br Med J
1979;
42
:
497–507.
3.
Maldjiian PD, Saric M. Approach to dextrocardia in adults: Review.
Am
J Roentgen
2007; 188: S39–S49.
4.
Offen S, Jackson D, Caniffe C, Choudhary P, Celermajer DS.
Dextrocadia in adults with congenital heart disease.
Heart Lung Circ
2015;
25
: 352–357.
5.
Beringer N, Cilliers A. A retrospective review of right-sided hearts at a
South African tertiary hospital.
Cardiovasc J Afr
2019;
30
: 4–7.
Women under-treated for heart attack die at double the rate of men
A study of 2 898 patients (2 183 men, 715 women) reveals
that six months after hospital discharge, death rates and
serious adverse cardiovascular events in women presenting
with ST-elevation myocardial infarction (STEMI) in the past
decade were more than double the rates seen in men. Gender
differences in the management and outcomes of patients
with acute coronary syndromes such as STEMI have been
reported in the medical literature, but most studies fail to
adjust for ‘confounding’ factors that can affect the accuracy
of findings.
This new study, authored by leading cardiac specialists
and researchers from across Australia, offers robust insights
into this life-threatening condition by adjusting for factors
that could affect treatment and health outcomes. ‘We focused
on patients with STEMI because the clinical presentation
and diagnosis of this condition is fairly consistent, and
patients should receive a standardised management plan,’
said the University of Sydney’s Professor Clara Chow, who
is a cardiologist at Westmead Hospital, the study’s senior
author.
‘The reasons for the under-treatment and management of
women compared to men in Australian hospitals aren’t clear.
It might be due to poor awareness that women with STEMI
are generally at higher risk, or by a preference for subjectively
assessing risk rather than applying more reliable, objective
risk prediction tools. Whatever the cause, these differences
aren’t justified. We need to do more research to discover
why women suffering serious heart attacks are being under-
investigated by health services and urgently identify ways to
redress the disparity in treatment and health outcomes.’
Professor David Brieger, co-author of the study and
leader of the CONCORDANCE (Cooperative National
Registry of Acute Coronary care, Guideline Adherence
and Clinical Events) registry from which the findings were
extracted, agrees: ‘While we have long recognised that older
patients and those with other complicating illnesses are less
likely to receive evidence-based treatment, this study will
prompt us to refocus our attention on women with STEMI.’
A STEMI (heart attack) happens when a fatty deposit on
an arterial wall causes a sudden and complete blockage of
blood to the heart, starving it of oxygen and causing damage
to the heart muscle. A STEMI diagnosis is typically made
initially by administering an ECG that reveals a tell-tale ECG
signature. These heart attacks can cause sudden death due to
ventricular fibrillation (a serious heart rhythm disturbance)
or acute heart failure (when the heart can’t pump enough
blood to properly supply the body).
STEMI represents about 20% of all heart attack
presentations. In 2016, an average of 22 Australians died
from a heart attack each day.
Researchers collected data from 41 hospitals across all
Australian states and territories between February 2009 and
May 2016. Twenty-eight hospitals (68%) are in metropolitan
regions and 13 are in rural locations.
Data was sourced from the CONCORDANCE registry,
intended for use by clinicians to help improve the quality of
patient care in line with treatment guidelines.
Main outcome measures: the primary outcome was
total revascularisation, a composite endpoint encompassing
patients receiving PCI (percutaneous coronary intervention),
thrombolysis, or coronary artery bypass grafting (CABG)
during the index admission. Secondary outcomes: timely
vascularisation rates; major adverse cardiac event rates;
clinical outcomes and preventive treatments at discharge;
mortality in hospital and six months after admission.
The average age of women presenting with STEMI was
66.6 years; the average age of men was 60.5 years.
More women than men had hypertension, diabetes, a
history of prior stroke, chronic kidney disease, chronic
heart failure, or dementia. Fewer had a history of previous
coronary artery disease or myocardial infarction, or of prior
PCI or CABG.
Source:
Medical Brief 2018