Best Practice Guidelines for treatment of hypercholesterolaemia: a statement from the Caribbean Cardiac Society.

There is an increase prevalence of chronic non-communicable diseases in the Caribbean as the region undergoes an epidemiologic transition from infectious to chronic non-communicable diseases. Numerous studies have identified hypertension, obesity, diabetes mellitus and hyperlipidaemia as risk factors for the development of coronary atherosclerosis. The Caribbean Cardiac Society recognizes that there is an increased prevalence of these disease entities and in an effort to foster best practice guidelines for the region, implemented a consensus conference for the discussion of hypercholesterolaemia, hypertension, diabetes mellitus and obesity in 2005. This statement outlines the recommendations of the consensus group of the Caribbean Cardiac Society on the Best Practice Guidelines for the therapy of hypercholesterolaemia.

Intracoronary stent implantation in Jamaica. The initial experience.

Intracoronary stent implantation resulted in the complete or near complete dilatation of high grade occlusions of the left anterior descending coronary arteries in the four patients in whom it was undertaken. Intracoronary stent implantation is a useful adjunct to Percutaneous Transluminal Angioplasty (PTCA) and is applicable in selected patients with symptomatic ischaemic heart disease in a developing country with limited health resources like Jamaica. This is so since financial data presented here document the significant savings this technique (when appropriately utilised) could realise compared to the use of balloon angioplasty alone.

Intracoronary stent implantation in Jamaica. The initial experience

Intracoronary stent implantation resulted in the complete or near complete dilatation of high grade occlusions of the left anterior descending coronary arteries in the four patients in whom it was undertaken. Intracoronary stent implantation is a useful adjunct to Percutaneous Transluminal Angioplasty (PTCA) and is applicable in selected patients with symptomatic ischaemic heart disease in a developing country with limited health resources like Jamaica. This is so since financial data presented here document the significant savings this technique (when appropriately utilised) could realise compared to the use of balloon angioplasty alone.

Percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis in Jamaica: the initial experience.

Although percutaneous balloon mitral valvuloplasty has been performed in the Caribbean before, there has not been any detailed description in the English-speaking West Indian Medical literature hitherto. This report provides a description of the first four cases of percutaneous balloon mitral valvuloplasty performed in Jamaica.

Percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis in Jamaica: the initial experience

Although percutaneous balloon mitral valvuloplasty has been performed in the Caribbean before, there has not been any detailed description in the English-speaking West Indian Medical literature hitherto. This report provides a description of the first four cases of percutaneous balloon mitral valvuloplasty performed in Jamaica.

Percutaneous transluminal coronary angioplasty (PTCA) in Jamaica. Preliminary results

This is the first detailed report from the Anglophone Caribbean of percutaneous transluminal coronary angioplasty (PTCA). The procedure resulted in complete dilatation of the occluded vessels in the five patients in whom it was undertaken, with significant improvement in exercise duration in the Bruce protocol (p < 0.001; 95CI 2.5 to 4.1 minutes) in the four patients who were studied. PTCA can be undertaken in developing countries with limited resources, and should be offered to selected patients with symptomatic coronary artery disease who need a revascularisation procedure.

Percutaneous transluminal coronary angioplasty (PTCA) in Jamaica. Preliminary results.

This is the first detailed report from the Anglophone Caribbean of percutaneous transluminal coronary angioplasty (PTCA). The procedure resulted in complete dilatation of the occluded vessels in the five patients in whom it was undertaken, with significant improvement in exercise duration in the Bruce protocol (p < 0.001; 95% CI 2.5 to 4.1 minutes) in the four patients who were studied. PTCA can be undertaken in developing countries with limited resources, and should be offered to selected patients with symptomatic coronary artery disease who need a revascularisation procedure.

Asymptomatic cardiac involvement in systemic lupus erythematosus.

Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cardiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age- and sex-matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24%), ventricular enlargement (20%), mitral regurgitation (19%) and tricuspid regurgitation (14%). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiographic values in both groups of SLE patients differed significantly from those observed in normal controls (p < 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p < 0.05) and fractional shortening (p < 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement.

Pulmonary artery pressure and the acute chest syndrome in homozygous sickle cell disease.

OBJECTIVE: To investigate whether attacks of acute chest syndrome affected pulmonary artery pressure in patients homozygous for sickle cell disease. MAIN OUTCOME MEASURES: Pulmonary artery pressure, assessed by non-invasive echocardiographic techniques. PATIENTS: 20 patients with homozygous sickle cell disease with a history of at least six episodes of acute chest syndrome and in 20 age, sex, and height matched controls with homozygous sickle cell disease without a history of acute chest syndrome. RESULTS: There was no difference in any of the echocardiographic or Doppler indices between these two groups. CONCLUSIONS: Repeated attacks of acute chest syndrome by the mean age of 12 (range eight to 16) years have not had a discernible effect upon pulmonary artery pressure.

Cardiac performance in children with homozygous sickle cell disease.

Cardiac function was evaluated in 24 children from a Jamaican sickle cell cohort study. Ten patients with sickle cell disease underwent echocardiographic studies on their eighth birthday. The results were compared with 14 age- and sex-matched control children born within hours of the index patients. Left ventricular dimension index (systolic 2.89 +/- 0.31 versus 2.33 +/- 0.42 cm and diastolic 4.70 +/- 0.35 versus 3.64 +/- 0.48 cm, p = 0.001), diastolic volume (79.4 +/- 17.1 versus 60.8 +/- 7.8 ml, p = 0.01), left ventricular mass index (116.3 +/- 3.4 versus 74.3 +/- 15.2 g/m2, p = 0.001) and cardiac index (5.51 +/- 1.32 versus 3.38 +/- 0.85 liters/min per m2 p = 0.001) were significantly increased in patients with sickle cell disease compared with values in control subjects. However, there was no statistically significant difference between the two groups for ejection fraction, velocity of circumferential fiber shortening, percent fractional shortening, systolic time intervals, wall stress and ratio of wall stress-systolic volume. Although two mean ratios of wall stress-systolic volume index were lower in children with sickle cell disease as compared with control subjects (4.0 +/- 0.7 versus 5.4 +/- 1.7, p = 0.02 and 5.9 +/- 1.2 versus 8.3 +/- 2.5, p = 0.005, respectively), the range of ratios remained within normal limits (3.4 to 5.8 in children with sickle cell disease versus 2.8 to 9.5 in controls and 4.2 to 8.3 versus 3.8 to 12.5, respectively). Furthermore, only body surface area predicted group status independent of other variables (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Conduction defects, ventricular arrhythmias, and late death after surgical closure of ventricular septal defect.

One hundred and eighty-seven patients who had surgical closure of a ventricular septal defect between 1958 and 1975 were followed for up to 21 years. there were 17 late sudden deaths of which eight occurred in completely fit patients while nine were already under medical care. In an attempt to elucidate possible risk factors and reoperative and serial postoperative electrocardiograms of all patients were studied. Fifty-one unselected healthy follow-up patients agreed to 24 hour ambulatory monitoring. Progressive exercise testing (Bruce protocol) was carried out on 31 of them and an additional seven patients. There was a significant correlation between recorded ventricular arrhythmias and conduction defects, particularly progressive conduction defects. Transient complete heart block carried a bad prognosis and grade 3-4b ventricular arrhythmias were a major risk factor and recorded in 10 of the 17 patients who died. Long-term postoperative electrocardiographic follow-up is recommended and 24 hour ambulatory monitoring and exercise testing complement the findings of the resting electrocardiogram. The long-term treatment of survivors found to have ventricular arrhythmias must be considered.

Renal phosphate clearance in fetal lambs.

The purpose of this study was to investigate the possible role of diminished phosphate clearance by the fetal kidney in production of relative fetal hyperphosphatemia. Stimuli known to affect renal phosphate clearance in adults were investigated in young fetal lambs. Our studies confirm that the fetal lamb kidney responds to exogenous and endogenous parathyroid hormone (PTH) with inhibition of tubular phosphate reabsorption. Renal tubular phosphate reabsorption in the fetus is in part related to sodium reabsorption. These studies indicate that so-called "immaturity" of renal phosphate clearance in utero is not a significant factor in production of fetal hyperphosphatemia.