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SA Heart Journal and Newsletter, issue 1 of 2020 now online

Posted on Tuesday, 5 May 2020 17:20

This issue is dedicated to “2019 – the year in review” highlighting different aspects of cardiovascular disease, insights and progresses made. The editor, Prof Ntobeko Ntusi reviews a number of papers published in the SA Heart Journal during that year in his editorial.

A review and summary of key publications related to preventative cardiology (Kausik K. Ray et al), heart failure (John G.F. Cleland et al), imaging (Dudley Pennell et al and valvular heart disease (Ronald K Binder, Marc Dweck and Bernard Prendergast)  ) are included in this issue.

The issue is also one of many editorials, with Prof Ntusi giving insight into Covid-19 and cardiovascular disease  and an obituary for Prof Lionel Opie

Dr Fenny Shidhika et al are giving an overview of cardiac catheterisation and surgery in Namibia

K. Koolash and E.GM. Hoosen report on The short and one-year outcome of transcatheter Patent Ductus Arteriosus closure at Inkosi Albert Luthuli Central Hospital, Durban, South Africa: A Descriptive retrospective chart review ; while F. Mpisane et al summarise Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A five-year experience 

This issue includes another ECG quiz to test your knowledge  (with answer) and an image in cardiology contribution where Philasande Mkoko and Blanche Cupido report on a case of Non-compliant left atrium masquerading as severe mitral regurgitation on cardiac catheterisation haemodynamics. 

As has become tradition, the journal also includes the SA Heart Newsletter with reports from our and other congresses as well as society, special interest group and other news and information on scholarships.

SA Heart Journal is now CPD accredited, the questionnaire for this issue (1 clinical point) has been loaded on the MPC Journal CPD platform  and is free to take for members. You can also access the questionnaire for the last issue of 2019 on this site (2 clinical points) which has unfortunately been unduly delayed for upload until now.

With great thanks to the Journal and newsletter editors Prof Ntusi and Dr Cupido as well as the production team at iDesign for providing another informative and professional issue, to Dr Derick van Vuuren for uploading the Journal to the website and the MPC group for facilitating the CPD CMEs.


SA Heart Journal 17-1.png 432.4K 5 May 20 17:20

Hatter Institute for Cardiovascular Research in Africa invites to research meeting regarding COVID-19

Posted on Friday, 24 April 2020 17:17

We are delighted to have two prestigious Scientists present at our weekly (Zoom) Research meeting.
Prof Junbo Ge (China) and Assoc. Prof Friedrich Thienemann (Switzerland).
As both their presentations are extremely relevant in the present times that we find ourselves in, we would therefore like to invite you to join us
on Wednesday 29th April 2020 to learn more from both Prof Junbo Ge and Assoc. Prof Friedrich Thienemann. 

For a full programme and speaker biosketch, please consult the attachment. 


HICRA Research Meeting Wed 29Apr2020 Invitation.pdf 442.6K 24 Apr 20 17:17

Should ACE Inhibitors and Angiotensin Receptor Blockers Be Withdrawn in the Current Setting of COVID-19 Infection?

Posted on Wednesday, 22 April 2020 09:15

Refer to Prof Pravin Manga's update in the Wits Journal of Clinical Medicine, 2020, 2(SI) 25–28 http://dx.doi.org/10.18772/26180197.2020.v2nSIa4 


wjcm_v2_si1_a7.pdf 71.4K 22 Apr 20 09:15

COVID-19 Preparedness in a Neonatal Unit at a Tertiary Hospital in Johannesburg, South Africa

Posted on Wednesday, 22 April 2020 09:10

Robert T Saggers et al on recommendations an actions in a paper published in Wits Journal of Clinical Medicine, 2020, 2(SI) 43–46 http://dx.doi.org/10.18772/26180197.2020.v2nSIa8 

WITS Journal of Clinical Medicine Special Issue 1 on Covid-19 released

Posted on Wednesday, 22 April 2020 09:02

The special issue on COVID 19 includes a host of papers and resources related to COVID-19 research, clinical practice and ethical considerations including case studies and recommendations in the South African context. 

Consult the issue here.  - you can download individual articles from the SABINET site. 

SAMA Guidance for managing ethical issues during the COVID-19 outbreak

Posted on Friday, 17 April 2020 14:26

The SAMA Human Rights, Law and Ethics (HRLE) Committee has developed the SARS-CoV-2 (COVID-19): Guidance for Managing Ethical Issues.

 This is a detailed guideline, which highlights the duties and obligations of Doctors and provides ethical guidelines for Doctors during the COVID-19 pandemic.

 To our knowledge this is one of the first guidelines of its kind in the world.

 Although this guideline largely provides ethical guidance for Doctors, the duties and obligations of government and society, in general, are also highlighted.

 The SARS-CoV-2 (COVID-19): Guidance for Managing Ethical Issues is available in two formats (refer attachments):


  •         The full guideline with all the detail
  •         An abridged version below, for ease of reading.


The abridged version should be read together with the full comprehensive guideline which will soon be made available under the SAMA Governance and Legal tab for all SAMA members, as well as on the SAMA COVID-19 main page.

 SAMA urges practitioners to consider the ethical concepts addressed by the guidance and implement practices recommended with regard to patient- and self-care.


Kind Regards

Dr Mark Human

Chair SAMA Human Rights Law and Ethics Committee

 The guidelines are also available on the SAMA COVID19 Webpage under "Doctor resources guidelines and protocols" or at https://www.samedical.org/files/covid19/doctor_resource/SAMA_Ethics%20Guidance%20_COVID-19%20Ethics_2020%207%20Apr.pdf 






Dr Mark Human

Chair SAMA Human Rights Law and Ethics Committee


SAMA_Abridged GDL - Covid8 Apr2020.pdf 773.8K 17 Apr 20 14:26
SAMA_GDL_COVID-19 Ethics_2020 7 Apr.pdf 949.4K 17 Apr 20 14:26

COVID-19 and Cardiovascular Disease

Posted on Thursday, 16 April 2020 12:20

As many as 25% of patients infected by COVID-19 will have cardiovascular disease and many of them are elderly. Well known cardiologist Dr Tony Dalby of Life Fourways Hospital, Johannesburg provides expert opinion on the management of this high-risk group. He provides valuable guidance on the management of patients with concomitant hypertension, heart failure, arrhythmias and other cardiovascular conditions. He also discusses the controversy about RAAS blockers and reinforces international advice that these agents should not be discontinued. Watch the full presentation here with sincere thanks to deNovo Medica who made this MEDTalksZA available. 

Last updated Thursday, 16 April 2020 12:26

Covid-19 Infection prevention and control guidelines

Posted on Tuesday, 14 April 2020 12:10

Version 1 issued by National Deptartment of Health. 


IPC guideline Covid-19 Version 1 April 2020.pdf 1.9M 14 Apr 20 12:10

COVID-19 infection and risk with angiotensin converting enzyme inhibitors (ACE-I’s) and Angiotensin Receptor Blockers (ARBs)

Posted on Tuesday, 14 April 2020 11:19

The SARS-CoV-2 that causes COVID-19, infects human cells by binding to ACE2 receptors and some animal studies have suggested that this mechanism upregulates ACE2 expression in the heart. A recent article (Lancet Respiratory medicine) speculates that in patients with diabetes and hypertension, ACE2 upregulation from ACEIs and ARBs could increase the risk of developing severe and fatal COVID-19 infection –  https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext.


There has since been much publicized concerns and hence in response four professional cardiology societies have issued counter statements, despite theoretical concerns that their use might worsen outcomes.The Council on Hypertension of the European Society of Cardiology (ESC) strongly recommends that physicians and patients should continue their usual anti-hypertensive therapy and there is no clinical or scientific evidence to suggest that ACE-I’s and ARBs should be discontinued because of Covid-19 infection – link - https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang. There is also evidence from animal studies that these medications might be paradoxically protective against serious lung complications. A joint statement by the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Failure Society of America (HFSA) has similarly endorsed ongoing renin–angiotensin–aldosterone system (RAAS) antagonists  https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19. A recent comprehensive special report in the New England Journal of Medicine (NEJM) reviews this issue and supports the positive guidelines from the above societies -  https://www.nejm.org/doi/full/10.1056/NEJMsr2005760. The key NEJM points concluded are:

  •        Abrupt withdrawal of RAAS inhibitors in high-risk patients, including those who have heart failure or have had myocardial infarction, may result in clinical instability and adverse health outcomes.


  •        Until further data are available RAAS inhibitors should be continued in patients in otherwise stable condition who are at risk for being evaluated for, or with Covid-19.

Compiled by Dr David Jankelow

Please also check this article released on 17 March


ACE Inhibitors and ARBs During the COVID-19 Pandemic

Allan S. Brett, MD and David M. Rind, MD reviewing Patel AB and Verma A. JAMA 2020 Mar 24 Gurwitz D. Drug Dev Res 2020 Mar 4 American College of Cardiology. 2020 Mar 17

Last updated Wednesday, 22 April 2020 08:48

General guidance for QTc monitoring in Covid 19 patients

Posted on Tuesday, 14 April 2020 09:19

Dear cardiology community,

I hope you are you staying safe in these unprecedented times.

As many of you are aware, many novel therapies for the treatment of COVID-19 are currently under investigation. Some of these therapies can prolong the QT interval and increase the risk of torsade de pointes (TDP).

Chloroquine, hydroxychloroquine, azithromycin and the lopinavir/ritonavir combination have been shown to increase the QT interval and increase the risk of TDP.  Other modifiable risk factors that can increase the risk of TDP include electrolyte abnormalities (e.g. hypokalaemia) and the use of other potential QT prolonging drugs (a comprehensive list can be found on the website crediblemeds.org or credMeds app).

A baseline QTc interval should be obtained in all patients prescribed these drugs. I have attached a recently published article by the American heart Association, American College of Cardiology and Heart Rhythm Society “Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment”. Chloroquine/hydroxychloroquine plus/minus azithromycin should NOT be prescribed in patients with a baseline QTc interval >=500ms.  These drugs should also be stopped if the QTc interval exceeds 500ms.

I have also attached an article and a link to a video on how to calculate and risk stratify patients according to the baseline QTc interval with Professor Michael Ackerman from the Mayo clinic. https://vimeo.com/404736329

As the pandemic evolves, new data will be forthcoming and I will keep you informed of any new developments.

Stay safe.


Ashley Chin and Andrew Thornton


HRS COVID19 Task Force Message- General guidance for QTc monitoring in COVID-19 patient.pdf 110.9K 14 Apr 20 09:19
MCP_Possible-COVID-19-Pharmacotherapies.pdf 1.5M 14 Apr 20 10:16

Last updated Tuesday, 14 April 2020 11:17

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