Peripartum cardiomyopathy: an update

Purpose of Review Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. In this review, we outline recent reports about the disease pathogenesis and management and highlight the use of diagnosis and prognosis biomarkers. Recent Findings Novel data strengthen the implication of endothelial function in PPCM pathogenesis. The first international registry showed that patient presentations were similar globally, with heterogeneity in patient management and outcome. Summary Despite large improvement in patient management and treatment, there is still a sub-group of women who die from PPCM or who will not recover their cardiac function. Remarkable advances in the comprehension of disease incidence, pathogenesis, and prognosis could be determined with multi-center and international registries

Dealing with late maternal death due to cardiovascular disease

Globally, cardiac disease is emerging as an important indirect cause of maternal death. Cardiac conditions can be pre-existing, such as the case with rheumatic heart disease or congenital heart disease which can be unmasked by the increased haemodynamic load in pregnancy, or they can be caused by pregnancy, e.g. hypertensive disorders or peripartum cardiomyopathy (PPCM)

Simple actions focusing on research, prevention and treatment of heart disease in South Africa

Cardiovascular diseases, particular those related to atherosclerosis and hypertension, are often perceived to be problems unique to the “developed world”. However, in many regions of the world, active lives have been reduced to inactive ones with people consuming calories out of proportion to daily needs. New ways of processing food promote obesity and are a cause of the atherogenic load causing disease

Perspectives and perceptions on the consumption of a healthy diet in Soweto, an urban African community in South Africa

In Soweto, like in many other urban communities in sub-Saharan Africa, rapid urbanisation and epidemiological transition have left this urban African population vulnerable to diseases of lifestyle such as obesity, cardiovascular disease, hypertension and diabetes. The Heart of Soweto (HOS) study was established to examine the emergence of heart disease in Soweto and other African communities in epidemiological transition and found multiple threats to the current and future heart health of Soweto. Food intake data from the HOS has shown damaging food choices and potential nutritional deficiencies in a subgroup of urban black African patients diagnosed with CHF, living in Soweto. This preliminary data focused on the impact of changing dietary patterns, low income levels and a probable lack of knowledge of what constitutes a healthy diet and the contribution of these, to cardiovascular disease. It seems that the traditional diet is being abandoned in favour of a more Western diet typified by increased consumption of processed and convenience foods, and therefore an increased intake of salt, sugar and saturated fat. The decreased intake of fruit and vegetables has lead to a decreased consumption of fibre and vitamins and minerals. The traditional diet is associated with a low prevalence of degenerative diseases, whereas the Western diet is associated with increased prevalence. Factors that might possibly contribute to the change in dietary patterns include socio-economic circumstances, urbanisation, food insecurity, awareness around healthy food choices, as well as perceptions on obesity and overweight. Our comparison, based on currently available food prices, shows that the consumption of a healthy diet in Soweto represents a more cost effective and affordable choice than an unhealthy diet. Healthy food choices therefore, should be promoted both from a health, as well as a financial perspective. Creating awareness around risk factors that might contribute to chronic diseases of lifestyle and the prevention thereof, has become essential in this urban African population. Nutrition education and intervention programmes should focus on foods that are varied, available, culturally acceptable and popular, with the emphasis on affordability, as well as being consistent with the South African Food Based Dietary Guidelines

Lessons from the Heart of Soweto Study and future directions

South Africa is concurrently experiencing epidemiological transition with diseases of lifestyle on the increase, while still burdened by poverty related diseases. Chronic diseases of lifestyle such as CVD are rapidly becoming major causes of death in developing countries and by all predictions, will continue rising.(4,7,8,9) Of concern is the fact that in developing countries, CVD is occurring in younger individuals than in the developed countries and as the epidemic evolves, the poor are affected the most in both developed and developing countries.(1) The Heart of Soweto (HOS) study aimed to investigate and describe this emerging problem of CVD, and especially heart disease, amongst the urban African population in Soweto, who presented for the first time to a tertiary-care centre. Overall we found multiple challenges to the community of Soweto and surrounding regions from a combination of high levels of modifiable CV risk factors (with the exception of lipid disorders) and surprisingly high levels of advanced and deadly forms of heart disease affecting predominantly younger cases and women. Lessons learned from the HOS include, (1) building partnerships, (2) establish clear objectives with achievable goals, (3) think big and assume nothing, (4) provide an enabling environment, (5) be innovative and (6) never compromise on quality. The prevention of CVD other chronic diseases of lifestyle, as well as the management thereof, needs to be a multidisciplinary effort with all the necessary healthcare workers involved, implemented at the primary, as well secondary level. Our goal is the development of specific community based intervention programmes directed towards prevention and management of chronic diseases of lifestyle in Soweto and to document the aetiology, presentation and management thereof. Our data collection will be not only meaningful for the population in Soweto, but also in other areas of South Africa and the broader Africa. It will be indicative of any urban African population in transition

The causes, treatment, and outcome of acute heart failure in 1006 Africans From 9 countries

Background: Acute heart failure (AHF) in sub-Saharan Africa has not been well characterized. Therefore,wesought to describe the characteristics, treatment, and outcomes of patients admitted with AHF in sub-Saharan Africa. Methods: The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with AHF admitted to 12 university hospitals in 9 countries. Among patients presenting with AHF, we determined the causes, treatment, and outcomes during 6 months of follow-up. Results: From July 1, 2007, to June 30, 2010, we enrolled 1006 patients presenting with AHF. Mean (SD) age was 52.3 (18.3) years, 511 (50.8%) were women, and the predominant race was black African (984 of 999 [98.5%]). Mean (SD) left ventricular ejection fraction was 39.5% (16.5%)... Conclusions: In African patients, AHF has a predominantly nonischemic cause, most commonly hypertension. The condition occurs in middle-aged adults, equally in men and women, and is associated with high mortality. The outcome is similar to that observed in non- African AHF registries, suggesting that AHF has a dire prognosis globally, regardless of the cause

Gender differences in clinical characteristics and outcome of acute heart failure in sub-Saharan Africa: results of the THESUS-HF study

Background: The impact of gender on the clinical characteristics, risk factors, co-morbidities, etiology, treatment and outcome of acute heart failure in sub-Saharan Africa has not been described before. The aim of this study was to evaluate the sex diffe rences in acute heart failure in sub-Saharan Africa using the data from The sub-Saharan Africa Survey of Heart Failure (THESUS-HF). Methods and results: 1,006 subjects were recruited into this prospective multicenter, international observational heart failure survey. The mean age of total population was 52.4 years (54.0 years for men and 50.7 years for women). The men were significantly older (p = 0.0045). Men also presented in poorer NYHA functional class (III and IV), p = 0.0364). Cigarette smoking and high blood pressure were significantly commoner in men (17.3 vs. 2.6 % and 60.0 vs. 51.0 % respectively). On the other hand, atrial fibrillation and valvular heart disease were significantly more frequent in women. The mean hemoglobin concentration was lower in women compared to men (11.7 vs. 12.6 g/dl, p ≤ 0.0001), while the blood urea and creatinine levels were higher in men (p \u3c 0.0001). LV systolic dysfunctional was also seen more in men. Men also had higher E/A ratio indicating higher LV filling pressure. Outcomes were similar in both sexes. Conclusions: Although the outcome of patients admitted for AHF in sub-Saharan regions is similar in men and women, some gender differences are apparent suggesting that in men more emphasis should be put on modifiable life risk factors, while in women prevention of rheumatic heart diseases and improved nutrition should be addressed vigorously