Research Articles (Cardiology)
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- Item7-Year experience of transcatheter aortic valve implants (TAVI) in a Western Cape private healthcare setting(South African Heart Association, 2019) Weich, Hellmuth; Liebenberg, Jacques; Van Wyk, Jacques; Vivier, Rocco; Barnard, Barry; Abelson, Mark; Phillips, Andre; Mabin, TomIntroduction: We describe the largest South African transcatheter aortic valve implantation (TAVI) outcome report of a single team in the Western Cape, over a 7-year period from 2009 - 2016. Methods: All patients who received TAVI at Mediclinic Vergelegen and Mediclinic Panorama were prospectively entered into a database. A total of 244 implants (61 CoreValve and 183 Edwards valves) were performed. Results: Patients were high risk with a mean STS score of 7.89 (standard deviation (SD) 5.7) and mean logistic EuroSCORE of 26.5 (SD 12.5). There was a trend toward lower risk over time. Procedures were initially performed mainly via a transapical approach, but this changed to mostly transfemoral with the introduction of smaller delivery systems. Procedural success rate was 91.8% for CoreValve and 88.5% for Edwards cases. Mean length of hospital stay following TAVI was 9 days initially, but this declined to 4 days for the latter part of our experience. One year mortality was 19% and one year stroke rate was 10%. Conclusion: Despite the limitations of a study of this nature, our group could document outcomes similar to international studies, with improvements over time and illustrating successful cooperation between different hospitals to expand exposure and experience in a resource-constrained environment.
- ItemAcute myocardial infarction due to coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case report(Health & Medical Publishing Group, 1983-07) Przybojewski, J. Z.; Heyns, M.H.ENGLISH ABSTRACTION: A case of acute transmural anterior myocardial infarction in a 45-year-old Black employee of an explosives factory during a period of withdrawal from industrial nitroglycerin is documented. Angiography revealed that the patient had normal coronary arteries. Coronary vasospasm could not be induced by the ergometrine (ergonovine) maleate provocation test. It is postulated that the infarction was directly attributable to coronary vasospasm provoked by the 'industrial nitroglycerin withdrawal syndrome', since there was no evidence of any other non-atheromatous aetiological factor. The authors believe this to be the first such case in a Black subject reported in the literature.
- ItemAcute transmural myocardial infarction - coronary vasospasm, thrombosis or coronary embolus? A case report(Health & Medical Publishing Group, 1984-10) Przybojewski, J. Z.ENGLISH ABSTRACTION: A very fit 28-year-old Coloured athlete presented with an acute transmural anteroseptal and non-transmural anterolateral myocardial infarction (MI). He had no apart from moderate cigarette smoking. Cardiac catheterization 2 months later demonstrated a significant area of myocardial damage as well as a large mural thrombus, but the coronary arteries appeared normal apart from a large irregular filling defect in the proximal left anterior descending (LAD) branch, apparently due to a thrombus. Cardiac catheterization a further 4 months later documented no further filling defect in the LAD branch and the coronary arteries appeared free of disease. Ergometrine maleate provocation on this occasion failed to demonstrate any coronary vasospasm. Possible pathophysiological mechanisms for the unexpected MI are outlined.
- ItemAdvancing global health through cardiovascular research, mentorship, and capacity building : in memoriam, professor Bongani Mayosi (1967–2018)(BMC (part of Springer Nature), 2018-10-03) Nachega, Jean B.; Ntsekhe, Mpiko; Volmink, Jimmy; Thabane, LehanaENGLISH ABSTRACT: No abstract available
- ItemAn approach to the patient with a suspected tachycardia in the emergency department(Health & Medical Publishing Group, 2016) Chin, A.; Vezi, B.; Namane, M.; Weich, H.; Scott-Millar, R.ENGLISH ABSTRACT: Patients present to the emergency department with either an ongoing tachycardia or a history suspicious of a tachycardia. Either way, the tachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardia is not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If a tachycardia is confirmed on an ECG, the clinician needs to classify it according to two variables: (i) regularity of the rhythm; and (ii) QRS width. This will allow a differential diagnosis to be made.
- ItemAn approach to the patient with suspected pericardial disease(Health & Medical Publishing Group, 2016) Kyriakakis, Charles G.; Mayosi, Bongani M.; De Vries, Elma; Isaacs, Abdul; Doubell, Anton F.ENGLISH ABSTRACT: Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in sub-Saharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.
- ItemArrhythmias and COVID-19 infection(South African Heart Association, 2020) Chin, Ashley; Moses, Jane; Thornton, AndrewENGLISH ABSTRACT: Arrhythmias can be a clinical manifestation of COVID-19 infection. COVID-19 infection can also be a precipitant of known arrhythmias which can increase the risk of morbidity and mortality. Management of arrhythmias should generally follow standard guidelines of arrhythmia management. Catheter ablation in the midst of the COVID-19 pandemic should be limited to arrhythmias that are immediately life-threatening or which may affect prognosis in the short-term. Some novel treatments like chloroquine, hydroxychloroquine and azithromycin can prolong the QT interval and predispose patients to life-threatening arrhythmias.
- ItemAspects of dyslipidaemia in diabetes mellitus(Health & Medical Publishing Group, 1997) Maritz, F. J.Dyslipidaemia in diabetes was referred to by Joslin as early as 19271 and has been the subject of numerous articles.2.... Very often little attention is paid to dyslipidaemia, which plays a major role in the premature development of atherosclerosis in diabetes. It is now increasingly recognised that diabetes is not only a disorder of carbohydrate metabolism but also of lipid and protein metabolism, and attention should be given to these other metabolic aspects and not only the glycaemic control of the diabetic patient. This article is not intended to be exhaustive, but aims rather to focus attention on the importance of dyslipidaemia in the management of diabetic patients. An overview is given of some of the pathophysiological processes that lead to dyslipidaemia in diabetes, the changes in lipids and lipoproteins that are seen are briefly described, and an outline of the management is presented.
- ItemAsymptomatic iatrogenic right coronary artery dissection with spontaneous resolution. A case report(Health & Medical Publishing Group, 1987-02) Przybojewski, J. Z.ENGLISH ABSTRACT: A young woman with angiographically normal coronary arteries had asymptomtic iatrogenic catheter-induced dissection of her right coronary artery which was managed conservatively. Because of continuing chest pain despite therapy, over a year later she again underwent selective coronary arteriography; a Softip cardiovascular catheter (Angiomedics Inc., Minneapolis) was used without complication. This may be the first report of use of this catheter after previous iatrogenic coronary artery dissection caused by a more conventional type. It is also the first time that this catheter was employed in the RSA. The use of a Softip cardiovascular catheter may significantly reduce this complication of a common coronary angiography.
- ItemAtrialised right ventricular myxoma in a patient with Ebstein’s anomaly(BioScientifica, 2018) John, T. J.; Snyman, H. W.; Janson, J.; Pecoraro, A. J. K.Ebstein’s anomaly is a rare entity affecting around 1 in 200,000 live births and accounts for less than 1% of congenital heart diseases. Ebstein’s anomaly with an associated right-sided myxoma is extremely rare, with only one other case report found in the literature. Previous reports have also noted cases of Ebstein’s anomaly associated with left-sided myxomas. We describe a female patient with, to our knowledge, the first case of a histopathologically confirmed right ventricular myxoma in the setting of Ebstein’s anomaly.
- ItemCardiology training in South Africa – on the brink?(South African Heart Association, 2016) Doubell, AntonENGLISH ABSTRACT: More often than not, when we use the expression “on the brink”, we are referring to an impending bad situation. On the edge of a cliff without wings so to speak…, on the brink of disaster…, on the brink of ruin…, on the brink of collapse…, on the brink of extinction…. In the broad sense, “on the brink” refers to the point where a new or different situation is about to begin and it may not necessarily signal impending doom. On the contrary, it may refer to a sense of anticipation, of being primed, a state of readiness, champing at the bit. It may signal that it is all systems go.
- ItemClosure of pulmonary arterio-venous malformations in a patient with a novel form of Hereditary Haemorrhagic Telangiectasia(South African Heart Association, 2014) Weich, Hellmuth; Ackermann, ChristelleImage in Cardiology: Hereditary Haemorrhagic Telangiectasia.
- ItemComputerised analysis, interpretation, storage and retrieval of electrocardiograms : a study and review of available systems(HMPG, 1974-06) Brink, A. J.; Vivier, C. De W.; Van Wyk, J. D. N.A study was undertaken to determine the feasibility of introducing a computerised electrocardiographic analysis and interpretive system as a service to a teaching and referral hospital. Available computer equipment and programmes are considered. The accuracy and quality of the analysis and interpretation of the electrocardiographic contours are basically dependent on such factors as pattern recognition, the criteria adopted for determining abnormalities, the relative values placed on scalar and orthogonal leads and the role of review by the physician. It is concluded that such systems are at a stage where they can feasibly be introduced and should be of advantage in freeing the physician from routine measuring and screening of electrocardiograms, thus saving many hours of professional and academic time. Furthermore, such systems can contribute greatly as an educational tool and increase the general knowledge of electrocardiography. Systems for storage and retrieval are also being developed and becoming available. The whole field is a developing one and continuous updating of programmes by the addition of more data, particularly for children, and the introduction of electrocardiographic comparison programmes need to be expedited.
- ItemCOVID-19 and cardiovascular imaging : a guide for the practising clinician(South African Heart Association, 2020) Meel, Ruchika; Cupido, Blanche; Pecoraro, Alfonso; Doubell, Anton; Lubbe, Wayne; Ntusi, Ntobeko A. B.ENGLISH ABSTRACT: In the ongoing COVID-19 pandemic, patients with cardiac disease have been the worst affl icted with a high mortality. Cardiac imaging forms an integral part of the armamentarium in the management of these patients. This review focuses on providing a general guide to cardiac imaging in the COVID-19 context for the practising clinician in Africa. These recommendations are likely to be modifi ed as further data emerge on the effect of the SARS-CoV-2 virus on the cardiovascular system.
- ItemDeveloping a new electrophysiology service and training platform - narrowing the gap(South African Heart Association, 2020) Moses, Jane; Doubell, AntonNo abstract available.
- ItemA DNA polymorphism in the human low-density lipoprotein receptor gene(Health and Medical Publishing Group -- HMPG, 1986-07) Kotze, M. J.; Retief, A. E.; Brink, P. A.; Weich, H. F. H.A new restriction fragment length polymorphism (RFLP) in the low-density lipoprotein receptor gene is described using the Stu I restriction endonuclease and a cDNA probe. The frequency of the two RFLP alleles was determined in 60 unrelated white subjects and 11,70/6 of them were found to be heterozygous for the polymorphism. Mendelian segregation of the RFLP was found in 3 informative families. The possible use of the RFLP in the diagnosis of familial nypercholesterolaemia in South Africa is discussed.
- ItemDouble atrial heart sound in a patient with 2:1 atrioventricular block(South African Heart Association, 2017) Pecoraro, Alfonso; Doubell, Anton F.; Herbst, Philip G.No abstract available
- ItemAn evaluation of informed consent comprehension by adult trial participants in South Africa at the time of providing consent for clinical trial participation and a review of the literature(Dove Medical Press, 2019) Burgess, Lesley Jean; Gerber, Berna; Coetzee, Kathleen; Terblanche, Marli; Agar, Gareth; Kotze, Theunis J. V. W.Introduction: The informed consent process is a fundamental part of clinical trials and is driven by both a legal and ethical agenda. The process may be seriously compromised if trial participants sign the informed consent document without fully understanding its contents. In developing countries such as South Africa, this concern is important due to the potential vulnerability of these patients and their risk for research exploitation. Aim: To evaluate the understanding of 11 important components and concepts related to clinical research by adult trial participants in a developing country at the time of providing consent for trial participation. Methods: 46 consecutive adult patients who qualified and consented to being enrolled in ongoing cardiovascular risk clinical trials at TREAD Research in the Western Cape, South Africa, were included in this study. After giving informed consent, participants were subjected to both a close-ended (self-report) and an open-ended method (descriptive narrative) to assess their understanding of various components and concepts related to clinical research pertaining to the initial informed consent document. The descriptive narrative was recorded and then later transcribed and assessed by two independent assessors. Results: There was a marked difference between the two methodologies used to assess patient comprehension of the various components. With the exception of concepts voluntariness and right to withdraw, trial participants’ understanding of the informed consent document was poor – especially with regard to the following concepts: randomization, risks, placebo and blinding. Higher levels of comprehension were obtained for the participant self-reports and lower levels for the narrative descriptions. Conclusion: The participant comprehension at this site was poor, and the process for taking informed consent subsequently needs to be modified so as to improve informed consent comprehension.
- ItemEvaluation of the SUNHEART cardiology outreach programme(South African Heart Association, 2015) Van Deventer, J. D.; Doubell, A. F.; Herbst, P. G.; Piek, H.; Piek, C.; Marcos, E.; Pecoraro, A. J. K.Introduction: The demand for advanced cardiac care and specialised interventions is on the increase and this results in bottlenecks and increased waiting times for patients who require advanced cardiac care. By decentralising cardiac care, and using a hub-and-spoke model, the SUNHEART Outreach Programme of cardiovascular care aims to improve access to advanced cardiac care in the Western Cape. Tygerberg Hospital is the central hub, with the fi rst spoke being Paarl Hospital. Objective: To determine the value of the SUNHEART Outreach Programme to the public health care system. Methods: An audit of patients accessing the Outreach Programme was performed for the period May 2013 - May 2014 and consequently compared to a historical cohort of patients accessing the health care system during the preceding 6 months, from October 2012 - April 2013. Access to advanced cardiac care was measured in time to initial evaluation, time to defi nitive diagnosis or intervention and patient compliance with appointments. The value to the health care system was also assessed by performing a cost analysis of transport of patients and health care workers, as well as compliance with appointments. We documented the spectrum of disease requiring advanced cardiac care to guide future interventions. Results: Data of 185 patients were included in the audit. Sixty four patients were referred to tertiary care from October 2012 - April 2013 and 121 patients were referred to the outreach facility from May 2013 - May 2014. There was a signifi cant reduction in waiting times with the median days to appointment of the historical cohort being 85 days compared to 18 days in the Outreach Programme cohort (p<0.01). Patient compliance with appointments was signifi cantly superior in the Outreach Programme cohort (90% vs. 56%: p<0.01). Valvular (36.5%) and ischaemic heart disease (35.5%) were the major pathologies requiring access to cardiac care services. Transport costs per patient treated was signifi cantly reduced in the outreach programme cohort (R118,09 vs. R308,77). Conclusion: Decentralisation of services in the form of an Outreach Programme, with a central hub, improves access to advanced cardiac care by decreasing waiting time, improving compliance with appointments and decreasing travel costs.
- ItemFDA abandons the declaration of Helsinki : the effect on the ethics of clinical trial conduct in South Africa and other developing countries(Health and Medical Publishing Group (HMPG), 2012-12) Burgess, L. J.; Pretorius, D.Four years ago, the US Food and Drug Administration (FDA) ceased compliance with the Declaration of Helsinki (DoH) (2000 revision and all subsequent revisions) for conduct of clinical trials outside its borders. It instead ruled that compliance with the Good Clinical Practices (GCP) of the International Conference of Harmonization (ICH) is sufficient. However, the ICH-GCP guidelines do not address certain ethical requirements stipulated in the DoH, such as the use of placebos v. standard therapy, post-trial access to treatment and other benefits for participants; public disclosure of trial design; publication of trial results; and disclosure of conflicts of interest. The FDA’s adoption of less morally stringent guidelines could encourage pharmaceutical companies to take ethical short cuts. It could also have practical consequences for trial ethics in developing countries, especially where research ethics committees may not be promoting high standards of protection for participants in clinical trials, due to lack of financial and human resources. Pharmaceutical companies may also pressurise research ethics committees to relax guidelines and legislation, in order to facilitate future clinical trials in developing and emerging countries that lack the resources to conduct their own clinical research on epidemics such as HIV/ AIDS, which have devastating effects on their populations.
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