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

Barriers and challenges for primary and secondary prevention of heart disease in sub-Saharan Africa

The diverse people of sub-Saharan Africa face a number of paradoxical challenges arising from economic development and urbanisation, including an increasing prevalence of noncommunicable forms of heart disease. Prevention programmes designed not only to detect those with established and often disabling forms of heart disease, but prevent disease progression and a premature death, are an obvious priority in this setting. This review article reflects on the barriers and challenges to effective primary and secondary prevention of heart disease in sub-Saharan Africa by (a) examining what residual issues challenge effective prevention in high-income countries? (b) what are the key ingredients to an integrated programme of primary and secondary prevention across the lifespan (from the population to individual)? and (c) considering the first two points, what are the barriers and challenges in sub-Saharan Africa to implementing cost-effective primary and secondary prevention using a systematic approach to “who, what and how”

Cardiac obstetric care in Botswana

Cardiovascular diseases (CVD) in pregnancy are significant causes of maternal mortality in Botswana. Like other developing countries, acquired CVD such as hypertensive disorders, rheumatic heart disease and cardiomyopathy are common in Botswana. CVD-related maternal deaths are often attributed to failure to provide risk-appropriate care. A multidisciplinary pregnancy heart team is an essential approach in managing CVD in pregnancy and improving maternal and foetal outcomes. Given that more women with CVD are becoming pregnant in Botswana, we review the current practice, gaps, and potential areas of improvement

Heart Failure in Sub-Saharan Africa

Sub-Saharan Africa (SSA) is currently experiencing multiple burden of disease as a result of demographic and epidemiologic transition. This is occasioned rapid urbanization, unhealthy diets rich in fats and salt, western lifestyle and sedentary living. Heart failure (HF) has become a global public health issue. It is associated with high morbidity and mortality, frequent hospitalization and high economic cost. In SSA, HF is a disease of young and middle-aged adults with the attendant high disability-adjusted life years. This is unlike to the clinical profile and pattern of HF in high-income countries of North America, Western Europe and Japan where HF is a disease of the elderly. In addition, while ischaemic heart disease is the commonest aetiologic risk factor for HF in high income countries, HF in SSA is essentially non-ischaemic in origin. Hypertensive heart failure, dilated cardiomyopathy, rheumatic heart disease, pericardial diseases and HIV associated cardiomyopathy are the common risk factors. The chapter reviews the contemporary information on HF in SSA in terms of socio-demographic features, clinical characteristics, aetiological risk factors, management, prognosis and economic burden