Implications of hypertension in Barbadians: findings from the Barbados Eye Study Group

Hypertension is the most significant chronic disorder in the Caribbean, affecting approximately 45 percent of adults aged 45 years and older. This condition has significant clinical and public health implications, as elevated blood pressure is associated with considerable morbidity and mortality in populations of black African descent. Here we report some of the cardiovascular implications of blood pressure in Barbadians. The Barbados Eye Study commenced in 1988 and included 4 709 participants or 84 percent of a simple random sample of the island's population aged 40 to 84 years. Measurements included blood pressure (two random zero sphygmomanometer measurements), anthropometry including weight, height and body circumferences, visual acuity, perimetry and applanation tonometry measured by trained observers, and assay of glycated haemoglobin. The median age of the study population was 58 years, 57 percent were female and 93 percent reported their race as black. Among black participants the overall prevalence of hypertension (mean systolic blood pressure > 140 mmHg and/or mean diastolic blood pressure > 90 mmHg and/or a history of antihypertensive treatment) was 55.4 percent with 49.8 percent of men and 59.6 percent of women being affected. The prevalence of self-reported angina in men (based on the Rose questionnaire) was 1 percent in normotensives, 1.3 percent in untreated hypertensives, and 1.5 percent in treated hypertensives. Corresponding prevalences of angina were higher in women, being 2.0 percent, 2.4 percent and 4.5 percent, respectively. The prevalence of self reported myocardial infarction in men was 1.3 percent in normotensives, 2.3 percent in untreated hypertensives and 5.7 percent in treated hypertensives; and, in women, 2.2 percent in normotensives, 2.1 percent in untreated hypertensives and 5.0 percent in hypertensives. The prevalences of cerebrovascular accidents was higher in men than in women: 1.4 percent in normotensive men vs 0.9 percent in normotensive women; 2.3 percent in untreated hypertensive men vs 1.6 percent in untreated hypertensive women; and 6.5 percent in treated hypertensive men vs 4.4 percent in treated hypertensive women.(AU)

Management of heart failure in the Caribbean

Heart disease and in particular, heart failure, has become the number one cause of death in most Caribbean countries, following the epidemic increase in obesity, hypertension and diabetes. The most common cause of heart failure is uncontrolled hypertension. Effective management demands major health care expenditure with relatively unrewarding long term results. The priority for Caribbean countries must be primary and secondary prevention with emphasis on weight reduction, blood pressure control and a healthy life-style, to avoid the high costs of drugs and tertiary care. (AU)

An assessment of the health behaviour of chronic disease clients and health centres in St. Georges West, Trinidad

This study was aimed at assessing the health behaviours of clients through their knowledge, perceptions and practices in relation to diet, exercise, weight control and medication and identifying the factors that impact on those behaviours, including the services offered to clients. The questionnaire survey was administered July-August, 1994 to 230 clients who attended chronic disease clinics at the eight health centres in the country of St. George West, Trinidad. Results revealed that the majority of clients were hypertensive, female pensioners of African descent who were obese with a family history of diabetes mellitus, hypertension or heart disease. The health professionals who were in a position to advise clients about lifestyle changes, did not provide them with sufficient knowledge and skills necessary for the adoption of healthy lifestyles. Clients thought it was important to practise the recommended behaviours and recognised a relationship between health behaviour and health status. However, clients failed to practise the desired behaviours due to other reasons such as insufficient financial resources, inadequate social support and lack of motivation. There was an absence of combined clinical and psychosocial management strategy, and clients' illnesses were being managed by drug therapy only, with little client responsibility for their well-being through the use of non-drug methods. The study identified a need for health professionals to be equipped with communication and counselling skills in relation to diet, exercise and weight control for health promotion/health education programmes for clients' families to reduce the risk to family members and also to create a supportive environment for the clients (AU)

An invasive cardiac and open heart surgical programme in Barbados: historical aspects and early results

Heart disease represents the leading cause of death in Barbados and the Organization of Eastern Caribbean States (OECS). The North Shore University Hospital, N.Y., through its Lifeline Programme offered the only regular outlet for approximately 450 patients who had cardiac surgery there between 1982 and 1992. A changing US health care policy, however, predicted an end to this programme and in 1989 a decision was made to develop a cardiac catheterisation and an open heart surgical programme at the Queen Elizabeth Hospital (QEH) in Barbados, to serve Barbados and the OECS. This programme was implemented in December 1993 and between then and September 1995, 231 patients, aged two weeks to 75 years, underwent cardiac catheterisation. Of these patients, 186 were suspected of having coronary artery disease (CAD), 21 of having congenital heart disease (CHD) and 24 of having valvular disease. Fifteen patients were from countries other than Barbados, 70 have had open heart surgery (with a surgical mortality of 2.8 percent) and 12 have had closed heart procedures. One hundred and twenty-four (124) trans-oesophageal echocardiograms were done. A successful cardiac surgical programme has been set up at the QEH in Barbados with the cooperation of the Government and the private sector. The results are excellent and the spinoffs to the hospital have been many. In particular, a significant improvement in "critical care". What is more important, however, the programme has been set up at a "low" cost and is cost-effective, saving the country significant foreign exchange. Plans are in place to introduce Interventional Cardiology in the near future (AU)

Myocardial perfusion scintigraphy using Tc99m labelled compounds: correlation with coronary angiography

The increasing incidence of ischaemic heart disease with high mortality rate and the recent introduction of Tc99m labelled myocardial perfusion imaging agents, along with the advent of a coronary angiography programme in Trinidad and Tobago, prompted the comparison of the sensitivity and specificity of myocardial perfusion scintigraphy (MPS) with coronary angiography (CA). Using a standard one-day code-differential imaging protocol single photon emission computed tomography (SPECT), images of the left ventricular myocardium of 30 patients were obtained at rest and following exercise: These images were analyzed for perfusion defects to assess each of the three main coronary arteries; the left anterior descenting artery (LAD), the right coronary artery (RCA) and the left circumflex artery (LCx). The data were then correlated with the angiographic findings. MPS yielded an overall sensitivity of 97.5 percent and a specificity of 83.6 percent when compared to CA. Discordant data were obtained in the analysis of nine vascular territories with scintigraphy producing eight false positive and one false negative. The false positive cases were seen in two males and four females. Of the males, one was discovered to have intramyocardial tunnelling of the LAD artery and the other demonstrated differential perfusion between the LAD and LCx arteries. Of the females, one was classified as having Syndrome X and another demonstrated differential perfusion between the LAD and LCx arteries; the other two cases were attributed to breast attenuation. The one false negative was obtained in a patient who demonstrated good collateral circulation on angiography. MPS thus compares very well with CA in assessing the three main myocardial vascular territories (AU)

Asymptomatic cardiac involvement in systemic lupus erythematosus

Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cadiopulmonary 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 percent), ventricular enlargement (20 percent), mitral regurgitation (19 percent) and tricuspid regurgitation (14 percent). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiacgraphic 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 (AU)

The development of echocardiography at the UWI - abstract

Echocardiography was first performed at University Hospital of the West Indies in 1981. The M-mode technique was employed, utilizing a Smith-Kline-French echocardiograph with a strip chart recorder. Two-dimensional echocardiographic studies began to be offered in 1984, utilizing a General Electric (General Ultrasound) machine sited in the X-ray Department. The resolution of the images obtained, however, was limited. From 1988 to 1989, better resolution was attained by the use of an Ultramark 4 echocardiograph which the Medical Research Council Laboratories (Jamaica) allowed use of for University Hospital patients. Basic pulsed wave doppler capability could also be offered. In 1989, the UWI Department of Medicine obtained an Ultramark 6 echocardiograph which allowed full two-dimensional imaging, pulsed and continuous wave doppler and colour flow mapping. Between July 1989 and December 1992, 5,276 echocardiograms (50 percent males, 50 percent females) were performed, using this machine, and a wide variety of cardiovascular diagnoses were made. Future plans include the development of transoesophageal echocardiography at the UHWI which will greatly expand diagnostic capabities (AU)

Fatal metastatic calcification in a patient with HTLV-I-associated lymphoma

Metastic calcification of the heart, lungs and kidneys is described in a 42-year-old male who had an HTLV-I-associated lymphoma. This fatal complication of HTLV-I-associated lymphoma has been infrequently reported, and the case in question is the first to be recorded in the Caribbean, where HTLV-I is common. Aggressive therapy of hypercalcaemia should be instituted early in its genesis in these lymphomas, so as to avoid its fatal outcome (AU)

Sudden death in athletes in Trinidad and Tobago

Sudden death related to exercise activity is a well-recognised clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last four years, we have had six proven cases of sudden death in athletics. The cause varied from congenital to acquired pathology of the heart, and there was one case of heat stroke. From this study, we were able to analyse some of the risk factors and, from a review of the literature, we are able to determine (1) the feasibility of a screening programme, and (2) the design of such a programme as would be suitable for our environment. (AU)

Beliefs about heart disease prevention among Jamaican service club members

A knowledge survey on heart disease prevention or heart health was administered to 320 male and female Jamaican service club members. Respondents demonstrated moderate-to-high awareness of heart health in general (88 percent) but substantially less awareness of healthy heart nutrition (48.0 percent). Those respondents who demonstrated significantly higher awareness of heart health tended to be normotensive and non-smokers; self-described overweight and university-educated respondents. Those respondents who demonstrated significantly higher awareness of the relationship between diet and heart disease prevention tended to be male, university-educated, and affiliated to Rotary or Kiwanis (compared to the Lions Club). Due to the absence of existing data and awareness of weight loss strategies among Caribbean people, these data are particularly interesting. Approximately 43.6 percent of male and 56.7 percent of female respondents had attenpted to lose weight in the 6-month period prior to the survey. These weight loss attempts coexisted with moderately high levels of awareness of the best strategies for weight loss. Female respondents (56.7 percent) and recent dieters (73.8 percent) were significantly more likely to identify both strategies than male respondents (47.3 percent); and those who had never attempted to lose weight (26.2 percent). The data suggests that the existing knowledge gaps about heart disease prevention among privileged Jamaican are apparent in two areas; (1) the relationship between diet and heart disease; and (2) practical strategies for permanent weight loss which encourage individuals to translate knowledge into healthful behaviour. (AU)

A new cardiology service for Antigua and Barbuda

Antigua, which occupies a central position in the north-eastern Caribbean, was the site of a new Cardiac Centre, based at the Government Hospital. Together with the smaller surrounding islands, a population of a quarter of a million/persons was thus offered cardiac care with great savings in total cost and travelling. The new cardiac clinic enrolled 78 patients, and provided a base for surgery assessment, pacemaker follow-up, and teaching. Two new echocardiography service benefited 127 patients, of whom 9 subsequently underwent open-heart surgery. Two new avenues for surgery were formed. A new permanent pacemaker implantation service resulted in 3 implants, and temporary pacemaker therapy became operational. These services ceased in late 1989 (AU)

Infective endocarditis at the University Hospital of the West Indies: a postmortem evaluation

Thirty cases of infective endocarditis identified in the autopsy service of the University hospital over a 10-year period are reviewed. The mean age of the patients was 30.6 years, and 70 percent were below the age of 40 years. Sixty per cent of the cases had previous heart disease was the most commonly affected, and there were only 2 cases of right-sided endocarditis. Evidence of systemic embolization was present in 83 percent of the patients. The results of this study are compared with others from both developed and under-developed countries (AU)