Cardiovascular medicine in primary healthcare in sub-Saharan Africa: Minimum standards for practice (part 3)

Cardiovascular disease (CVD) is the leading causeof death worldwide. Approximately 80% of allcardiovascular-related deaths occur in low- to middleincomecountries and at a younger age comparedwith high-income countries. The economic burdenimposed by CVD on developing countries in terms ofloss of productive years of life and amount of fiscal resources spent onsecondary and tertiary care is considerably high

Studies in cardiomyopathy: looking beyond the familiar

Background: Little is known about the mechanisms, clinical characteristics, natural history and outcomes of cardiomyopathy amongst Africans. Familial aggregation of cardiomyopathy has not been studied systematically in an African setting. Further, it is not clear whether the various phenotypic expressions of cardiomyopathy represent disparate clinical entities, or whether they are merely different forms of the same disease manifested differently in different circumstances. Methods: Two cohorts of patients with cardiomyopathy were utilised for this study: (1) patients with cardiomyopathy seen at the specialist cardiomyopathy clinic at Groote Schuur Hospital, Cape Town between February 1, 1996 and December 31, 2009; and (2) a group of hypertrophic cardiomyopathy (HCM) patients and first degree relatives seen in a specialist cardiogenetic clinic at Tygerberg Hospital, who underwent cardiovascular magnetic resonance (CMR) imaging at Groote Schuur Hospital

Cardiovascular medicine in primary healthcare in sub-Saharan Africa: Minimum standards for practice (part 1)

Cardiovascular disease (CVD) accounts for approximately30% of deaths worldwide, with 80% of thisCVD burden occurring in developing countries. Theepidemiological transition occurring in sub-SaharanAfrica (SSA) has the consequence of economic andsocial transformation, resulting in dramatic shifts in the disease spectrumfrom communicable diseases and malnutrition to CVD and cancer

Pregnancy-associated heart failure: a comparison of clinical presentation and outcome between hypertensive heart failure of pregnancy and idiopathic peripartum cardiomyopathy

AIMS: There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome. Methods and RESULTS: We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up. CONCLUSION: There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM

An approach to the diagnosis and management of valvular heart disease

Valvular heart disease poses a common yet difficult problem in everyday clinical practice. A thorough clinical evaluation with basic commoninvestigations such as an electrocardiogram (ECG) and a chest radiograph (CXR) remains the cornerstone of diagnosis. Echocardiographyand more invasive testing, if needed, are usually performed at specialist level to confirm the diagnosis, assess severity and assist in definitivedecision-making.The causes and clinical, ECG and CXR features of the common valve lesions are described. Patients with symptomatic valve lesions shouldbe referred for specialist assessment. In most cases, medical therapy serves as a bridge to definitive mechanical or surgical therapy

Utility of cardiovascular magnetic resonance in pregnancy

Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of different imaging modalities, the clinical manifestations of existent CVD in pregnancy and features of new CVD. Cardiovascular magnetic resonance (CMR) imaging is safe in pregnancy and is not associated with any adverse foetal effects, provided there are no general contra-indications to magnetic resonance (MR) imaging. CMR also does not involve any ionising radiation. In pregnancy, CMR is useful to confirm diagnosis of CVD, assess disease severity, to stratify risk and prognosticate, to plan appropriate management, and to assess response to therapy. Use of any imaging test in pregnancy needs to have safety considerations balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. This review summarises the evolving role of CMR in evaluation of known or suspected new CVD in pregnancy