It is time to reclaim “holistic heart care”

The theme of the 2010 SA Heart Annual congress was “Holistic Heart Care”. In Greek “holos” means total, entire, all or whole. Holistic health encompasses all aspects of people’s needs: psychological; spiritual; physical; and social. It implies our health system in general and its component parts in particular cannot determine our patient management. It should rather be the patient who should determine how the medical profession cares for them holistically. Conventional medicine seems to have lost claim to the term “holistic care”, a term which is now associated with “alternative medicine” practitioners

South African Dyslipidaemia Guideline Consensus Statement

Prepared on behalf of the South African Heart Association and Lipid and Atherosclerosis Society of Southern Africa. The European Society of Cardiology together with the European Atherosclerosis Society published updated dyslipidaemia guidelines in 2011. SA Heart and the Lipid and Atherosclerosis Society of Southern Africa officially adopt these guidelines. This statement adapts aspects of the guidelines to the South African situation. Using the updated Framingham risk charts, interventional strategies are based according to the cardiovascular risk score and low-density lipoprotein cholesterol (LDL-C) levels. The Framingham risk score refers to the 10-year risk of any cardiovascular event, and includes four categories of risk. Treatment targets are those of the European guidelines. The LDL-C goal is 1.8 mmol/l for the very high-risk group (>30%), 2.5 mmol/l for the high-risk group (15 - 30%), and 3 mmol/l for those below 15% risk. Intensive management of dyslipidaemia in South Africa will significantly reduce the cardiovascular disease health burden

The effect of perindopril, a new angiotensin converting enzyme inhibitor on the hormonal response to brisk exercise in healthy subjects

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, for the Degree of Master of Medicine. Johannesburg 1994.Cardiovascular drugs have varying effects on haemodynamic, metabolic, and hormonal responses to exercise. Angiotensin converting enzyme inhibitors (ACEI) have been used for the treatment of systemic hypertension, left ventricular dysfunction with or without congestive heart failure, and increasingly, for occlusive coronary artery disease and its complications..IT201

Evaluation of eplerenone in the subgroup of EPHESUS patients with baseline left ventricular ejection fraction ≤30%

Aims: Because of the prognostic importance of LV dysfunction following an AMI and the increasing use of electrical and/or mechanical interventions in patients with LV systolic dysfunction, this retrospective analysis of EPHESUS patients with LVEF ≤30% at baseline was conducted to determine the value of eplerenone in this setting. Methods and Results: In EPHESUS, 6632 patients with LVEF ≤40% and clinical heart failure (HF) post‐AMI who were receiving standard therapy were randomized to eplerenone 25 mg/day titrated to 50 mg/day or placebo for a mean follow‐up of 16 months. Treatment with eplerenone in the subgroup of patients with LVEF ≤30% ( N =2106) resulted in relative risk reductions of 21% versus placebo in both all‐cause mortality ( P =0.012) and cardiovascular (CV) mortality/CV hospitalization ( P =0.001), and 23% for CV mortality ( P =0.008). The relative risk of sudden cardiac death (SCD) was reduced 33% ( P =0.01) and HF mortality/HF hospitalization was reduced 25% ( P =0.005) with eplerenone compared with placebo. Within 30 days of randomization, eplerenone resulted in relative risk reductions of 43% for all‐cause mortality ( P =0.002), 29% for CV mortality/CV hospitalization ( P =0.006), and 58% for SCD ( P =0.008). Conclusions: Treatment with eplerenone plus standard therapy in patients with post‐AMI HF and LVEF ≤30% provided significant incremental benefits in reducing both early and late mortality and morbidity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102725/1/ejhf2005-11-008.pd

The South African SHARE-TAVI registry: incidence and risk factors leading to conduction disturbances requiring permanent pacemaker implantation

Background: One of the most common complications post transcatheter aortic valve implantation (TAVI) is the development of heart block requiring permanent pacemaker implantation (PPM). The incidence of PPM in international registries ranges from 13% - 17.5%. Methods: The aim of this observational study was to report the PPM rate in the SHARE-TAVI registry and determine the clinical, electrocardiographic and procedural predictors of PPM as well as the effect of PPM on clinical outcomes. Results: Three hundred and fi ve subjects were analysed. The PPM rate was 9%. Third degree atrioventricular block at the time of implant was the most common indication for PPM. Self-expanding valves (PPM rate 14% vs. 6% for balloon-expandable valves, p=0.02) were correlated with the need for PPM. Baseline ECG predictors of PPM were axis deviation, QRS duration and conduction delay, most notably a pre-existing right bundle branch block (OR 15.88, p<0.01). PPM infl uenced functional class at 30 days, but not the need for repeat hospitalisation or mortality at 30-day and 1-year follow-up. Conclusions: A PPM rate lower than that reported in large international registries was found. Predictors of PPM and the infl uence of PPM on outcomes were similar to those reported in the international data