Cardiology

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7-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, Tom
Introduction: 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.
Acute 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.
Acute 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.
Advancing 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, Lehana
ENGLISH ABSTRACT: No abstract available
An 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.
An 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.
Arrhythmias and COVID-19 infection
(South African Heart Association, 2020) Chin, Ashley; Moses, Jane; Thornton, Andrew
ENGLISH 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.
Aspects 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.
Asymptomatic 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.
Atrialised 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.
Cardiology training in South Africa – on the brink?
(South African Heart Association, 2016) Doubell, Anton
ENGLISH 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.
Chronic coronary syndromes - time to reassess the evidence
(South African Heart Association, 2018) Kyriakakis, Charles
No abstract available.
Closure of pulmonary arterio-venous malformations in a patient with a novel form of Hereditary Haemorrhagic Telangiectasia
(South African Heart Association, 2014) Weich, Hellmuth; Ackermann, Christelle
Image in Cardiology: Hereditary Haemorrhagic Telangiectasia.
Computerised 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.
COVID-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.
Delivering cardiac care : the next frontier
(South African Heart Association, 2016) Pecoraro, Alfonso J. K.
ENGLISH ABSTRACT: The 17th annual South African Heart congress, co-hosted with the annual meeting of the World Society of Cardiothoracic surgery, brings together both local and international pioneers in the field of cardiology and cardiothoracic surgery. The combination of adult and paediatric cardiologists, cardiothoracic surgeons and allied professionals epitomises the emergence of the the “Heart team” as an integral component of providing optimal cardiac health care.
Developing a new electrophysiology service and training platform - narrowing the gap
(South African Heart Association, 2020) Moses, Jane; Doubell, Anton
No abstract available.
A 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.
Double 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
Echocardiographic screening for subclinical rheumatic heart disease: Improving screening through simplification of the diagnostic criteria
(Stellenbosch : Stellenbosch University, 2020-12) Hunter, Luke David; Herbst, Philip George; Doubell, A. F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine: Cardiology.
ENGLISH ABSTRACT: Rheumatic heart disease (RHD) remains one of the leading causes of cardiovascular morbidity and mortality in developing countries withSub-Saharan Africa being identified as an endemic area. The early detection and initiation of secondary prophylaxis in children with ‘latent’ RHD remain attractive primary health care interventions, particularly in endemic regions with no or limited access to specialist cardiac services. However, the current consensus-derived screening criteria endorsed by the World Heart Federation (WHF criteria) are overly complex, require the use of expensive echocardiographic equipment with Doppler functionality and identify a large borderline diagnostic group that demonstrates a predominantly benign outcome in longitudinal study. This raises concerns regarding the feasibility of large-scale screening in resource-poor regions and questions the utility of early echocardiographic case-detection of RHD. The primary purpose of this thesis was to critically appraise the performance of the WHF criteria and todetermine whether a set of screening criteria based on a novel, focused morphological and mechanistic evaluation would simplify the current WHF guideline and reduce the number of cases ‘misclassified’ with borderline RHD whilst maintaining a similar degree of sensitivity. A literature review was undertaken that critically appraised the performance of the current WHF criteria and its impact in African RHD screening programs. This highlighted important logistical and methodological shortcomings that have curtailed the implementation of large-scale RHD screening in RHD endemic regions. The five-year experience of a large-scale, high-risk RHD screening program (Echo in Africa [EIA] project) was analysed. The results from this project highlightRHD as an ongoing, significant healthcare challenge amongst underserved communities within the Western Cape, South Africa.The estimated prevalence of WHF ‘definite-’ and ‘borderline-RHD’ of 9.1 cases/1000 and 19.5 cases/1000 reported by EIA is significantly higher thanthatpreviously described in this region. Furthermore, a critical appraisal of the WHF criteria’s performance in the EIA cohort highlighted various redundant and ambiguous criteria that require revision.Inter-scallop separations (ISS) of the posterior mitral valve leaflet (PMVL) were described in both our high-and very low-risk populations. They were a common finding and the principal cause of WHF ‘pathological’ mitral regurgitation (MR) in the ‘borderline RHD’ group in both cohorts. This supported theirstatus as a normal and importantly, non-rheumatic variant.The reliability of the current WHF anterior mitral valve leaflet (AMVL) thickness assessment was evaluated and was demonstrated to be poor amongst readers despite controlling for systematic bias. This raised the possibility of introducing a non-measurement-based AMVL thickness evaluation. A novel screening definition of AMVL restriction was introduced, enabling the description of a variable spectrum of AMVL restriction amongst children.This definition reliably identified two subtypes of leaflet restriction: a normal, ‘gradual bowing’ variant that localised predominantly to the medial portion of the leaflet and a ‘distal tip’ variant seen to affect at least the central portion of the leaflet in all cases of WHF ‘definite RHD’ in this cohort. Finally, this thesis culminated in the development and evaluation of a novel set of morpho-mechanistic (MM) echocardiographic screening criteria for RHD. Together with an abbreviated ‘rule-out’ screening test, the MM criteria were assessed alongside the current WHF criteria in a gold standard RHD-negative cohort and a gold standard RHD-positivecohort. The MM criteria significantly reduced the false-positive rate of a borderline diagnosis inthe gold standard RHD-negative cohort (2.7/1000 vs 41.8/1000) whilst maintaining a similar screening sensitivity (99.7%) compared to the WHF criteria (95.9%) within thegold standard RHD-positivecohort. Similarly, the MM RHD ‘rule-out’ test performed well by excluding the majority of cases (98%) within the gold standard RHD-negative cohort while including all cases within the gold standard RHD-positive cohort. The work presented in this thesis addresses key research needs and gaps in our current understanding of ‘screen-detected’ latent RHD. It representsa significant contribution that will impact on policy, practice and further research in the field. The discovery that ISS of the PMVL are a normal finding and the principal cause of isolated ‘pathological’ MR in the borderline group represents a key element in solving the ‘borderline conundrum’. This discovery supported the adoption of a morpho-mechanistic screening approach over a predominantly functional MV assessment. Centred around a novel definition of AMVL restriction, the MM criteria significantly improve the specificity of RHD detection by markedly reducing the size of the borderline group. Importantly, this was achieved without a reduction in the sensitivity of the criteria when compared to the current WHF criteria. Together with a simple ‘rule-out’ test, the MM criteria bring us closer to the objective of implementing large-scale screening programs that identify children with latent RHD who will benefit from secondary prophylaxis.

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