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Discipline of Cardiology

About the Discipline

The objectives of the department are to provide, within the constraints of the health system of the province and the country, an effective consultative and diagnostic service for adult and paediatric patients with cardiac disease.

The cardiac unit is based at Inkosi Albert Luthuli Central Hospital (IALCH). This unit serves not only the eThekwini functional region but all the hospitals, practitioners, and specialists in the province of KwaZulu-Natal and parts of the Eastern Cape. The population served exceeds 10 million.

Cardiac clinics are held on twice a week. An additional clinic is held for pacemaker follow-up patients. Approximately 10 new patients are booked into the clinic daily and are seen by a consultant cardiologist. Between 70 and 100 patients a day are seen at the follow-up clinic by medical officers and part-time specialists. For non-urgent cases there is a waiting list for outpatient referral.

Urgent cases and emergency cases are seen or admitted on the basis of telephonic consultations. The following categories of emergencies are usually admitted to the cardiology wards: complications of acute myocardial infarction; complicated cases of infective endocarditis; patients with unstable angina pectoris; patients with severe life-threatening arrhythmias; patients with life-threatening valvular problems; patients with life-threatening heart valve problems; patients with dissecting aneurysms. The coronary care unit at Addington and R K Khan Hospitals refer emergencies almost on a daily basis, and other emergencies from King

Vision

  • To provide, within the constraints of the health system of the province and the country, an effective consultative and diagnostic service for adult and paediatric patients with cardiac disease,
  • To promote teaching at all levels in the department in order to achieve service delivery  and ensure that stability is maintained within the department
  • To encourage career advancement for all levels of skilled staff in a way that research can be promoted effectively
  • To attract, in the first instance, local graduates to specialise in the cardiological sub disciplines, and in this way build a cadre of postgraduates in all areas of cardiology, paving the way for capacity in research.

Mission

The very nature of the acute presentation of cardiac illnesses necessitates earlier disease detection in order to prevent poor long term outcomes. The department espouses the principle that multiskilling of staff can effectively be used to provide service delivery in areas where there would otherwise be none.

It is the express mission of the department to increase knowledge in cardiology through a coordinated approach of CPD education, staff training and deployment, at all levels of skills development. Only in this way will it be possible to detect patients at an earlier stage in their illness and provide an effective consultative service.

Referal Criteria

Adults: Referral to Cardiac Clinic

Entry Criteria

  1. Referrals accepted only from specialists or level 2/3 hospitals. Referrals are not accepted from general practitioners.
  2. Confirmed clinic appointment with reference number.
  3. Letter from referring specialist/hospital.Rheumatic heart disease requiring surgery.
  4. Uncontrolled arrhythmias.
  5. Investigation of syncope ¡V after initial evaluation.
  6. 2nd or 3rd degree heart block.
  7. Ischaemic heart disease requiring diagnostic coronary angiography.
  8. Left ventricular dysfunction for assessment for biventricular pacing or temporary pacemaker.
  9. Initial post-operative follow-up.
  10. Post PTCA/stent/BMV follow-up.
  11. Selected pericardial/myocardial disease.

Exit Criteria

  1. Patients that do not have any cardiac problem beyond any reasonable doubt.
  2. Patients with minor problems unlikely to ever require further cardiac investigations and/or interventions.
  3. Certain post-operative patients after initial follow-up considered to be cured.
  4. Patients with prosthetic valves for routine follow-up for INR check and anticoagulation therapy.
  5. Patients with extremely complex cardiac conditions considered inoperable.
  6. Patients with stable angina not for surgery.
  7. Patients with angina with normal coronary arteries.
  8. Patients with angina with vessels suboptimal for grafting.
  9. Asymptomatic valvular heart disease not requiring surgery.

Admissions-Criteria

Adults: Criteria for Admission as an Inpatient

Entry Criteria

  1. All emergency admissions to initially be discussed with the consultant on call.
  2. Valvular heart disease requiring workup for cardiac surgery ¡V ill decompensated patient not improving on medical management.
  3. Congenital heart disease requiring workup for surgery.
  4. Patients requiring diagnostic cardiac catheterisation.
  5. Ischaemic Heart Disease ¡V post myocardial infarction in cardiogenic shock requiring intra aortic balloon pump or with post infarct angina ¡V emergency resuscitation.
  6. Ischaemic Heart Disease ¡V post myocardial infarction in catheter based interventions: PMV, Amplatzer, PTCA, IVUS, stent.
  7. Patients requiring permanent pacemaker implantation.
  8. Patient with acute myocardial infarction for planned PTCA ¡V to be confirmed telephonically with consultant.
  9. Uncontrolled arrhythmias requiring specialist supervised medical treatment or electrophysiological studies.
  10. Selected patients with pericardial, myocardial or endocardial disease requiring special investigations, e.g. hypertrophic obstructive cardiomyopathy (HOCM), arrhythmogenic right ventricular dysplasia for biopsy, infiltrative myocardial disease, constrictive pericarditis.
  11. Ill patients requiring stabilization.
  12. Transplant assessment workup.

Exit Criteria

  1. All planned investigations completed and a satisfactory diagnosis and management plan has been made, provided no immediate intervention or surgery anticipated.
  2. Selected patients requiring further specialist follow-up and intervention or surgery will be called back for Outpatient follow-up.
  3. Post catheterization/intervention/surgery patients in stable and satisfactory condition.
  4. Every patient discharged will be followed up by the referral hospital.

Cardiology has an established research interest in the following areas:  chronic diseases of lifestyle; cardiac failure in Black subjects; genetics aspects of coronary heart disease; cardiac disease in pregnancy; structural and functional aspects of hyper-tension; undergraduate education in cardiology.

The research productivity of the department is slowly, but steadily, improving.  Postgraduate students are required to submit a research protocol to the Head of Department in their final year of postgraduate training, after they have completed the Certification examination in cardiology.  In addition the department has a structured teaching programme including Journal Club, annual Cardiology Updates, outreach workshops and guest lectures, all of which are designed to encourage research within the discipline.  The research output of the department in the last 5 years includes two whole journal issues in FORUM, three chapters in books, two postgraduate theses and over 25 peer-reviewed articles, 25 critical reviews and 12 presentations at national meetings.

The department has also embarked on a strategy of actively promoting research amongst the young members of staff through an incentive-based approach.  All staff are encouraged to attend congresses to see what their peers are accomplishing with resources far less than ours.  This has enabled the registration of six masters and five PhD projects.

Department  Initiated Research

RESEARCH PROJECT and its Goals

Outcome

1)   Cardiac failure in valvular heart disease :

Early detection of ventricular decompensation will indicate the timing of surgery

 

Masters thesis: R Prakaschandra

2)   Genetics aspects of coronary heart disease:

The contribution of genetic factors and telomere function to coronary diseases

 

DP Naidoo ; N Ranjith ; S Khan

3)   Cardiac disease in pregnancy:

Markers of maternal disease will help reduce the unacceptable morbidity and mortality in pregnancy

 

 

Publications

4)   Structural and functional aspects of hypertension in pregnancy

  • Identifying changes that will enable better treatment of hypertension
  • Role of BNP in pregnancy – …. hypertension
  • Mitral stenosis in pregnancy

 

 

 

PhD Thesis : DK Desai completed and published

Masters Thesis: S Fayurs

Publication

5)   Undergraduate education in medicine

Improved learning methods at the bedside would foster deeper learning with retention and transference

 

 

Masters  Thesis: D P Naidoo

6)   Chronic Diseases of lifestyle

  • WHO funded Community project designed to establish the role of risk factors in the pathogenesis of the chronic diseases and introduce a community based intervention
  • Microalbuminuria and endothelial dysfunction

 

PhD Thesis: R Prakaschandra

M.Med: Y Duki

 

 

Publication

7)   Infective endocarditis and HIV

  • Disease pattern in HIV infected persons

 

Masters Thesis: S Nel

8)   Acute coronary syndrome

  • Acute coronary syndrome in black subjects
  • Echocardiography vs BNP as risk markers
  • Prevalence of Metabolic syndrome

 

 

M. Med: S Dela

Publication

Publication

9)   Clinical trials

  • Role of placebo in clinical trials
  • Contract research

 

Publication

Funding for academic research

 

10)               Technology projects

  • Role of Exercise testing
  • Cardiac disease in the elderly
  • Haemodynamic changes in Balloon mitral valvuloplasty
  • Echocardiography vs BNP in acute coronary syndrome
  • Electrocardiography  as a marker of ventricular function
  • Echocardiographic study in hypertension
  • Hypertension in the elderly

 

 

Seven B Tech theses

The main focus of the department research has been in coronary heart disease, the pathogenesis of with a focus on genetics and on telomere function.

Researcher: Dr Tanya Maistry Designation: Committee Member at BREC Study: Genetic Contribution to the Risk for Metabolic Syndrome: An Investigation of Candidate Gene Polymorphisms related to Lipid and Carbohydrate Metabolism Summary: The study shows that Indian people living in Durban’s Phoenix area have a high risk of suffering from metabolic syndrome (MS). The metabolic syndrome is a group of risk factors – including abdominal obesity, elevated triglycerides, reduced high density lipoproteins cholesterol [HDL-C], elevated blood pressure, elevated blood glucose serum levels, insulin resistance and obesity – which increases the risk for heart disease and other health problems, such as diabetes and strokes. The term ‘metabolic’ refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase ‘the chance of developing a disease’. MS risk could lie in its components rather than in MS as an entity. ‘Data obtained in this study may allow for the implementation and development of medical interventions that could counteract susceptibility to the MS, thereby reducing the risk for cardiovascular disease.’ The main objective of the study was to determine genetic patterns that may be associated with the MS. The data obtained resulted in two findings related to epidemiology and genetics.   In epidemiology, results demonstrated that South African Indians from the Phoenix community present with an increased risk for the MS. Age, gender and clustering of the metabolic components influenced the results. IR was also observed to be the driving factor for MS pathogenesis with age, gender, clustering patterns and physical activity serving as key contributing factors. In genetics, results demonstrated the adiponectin 45T>G and the human paraoxonase 1 192Arg/Gln polymorphisms to be genetic markers that may assist in identifying participants who are susceptible to hypocholesterolemia (in males with the MS and with IR) and hypertension (in males with the MS), respectively. The lipoprotein lipase HinfI and human paraoxonase 1 192Arg/Gln polymorphisms associated with IR may also serve as genetic markers that may assist in identifying males with MS who are susceptible to hypertension. Gene-environmental associations exerted a degree of protection against the risk for the MS and IR.’

  1. South African Heart Association
  2. South African Hypertension Society

Staff

HOSPITAL: IALCH

 

Consultants

NameEmailContact Number
Dr S. KhanSajidah.Khan@ialch.co.za0312401524
Dr S BikitaSolomon.Bikita@ialch.co.za0312401421
Dr S NadarSandhiran.Nadar@ialch.co.za0312401421
Dr D.R NaidooDarrin.Naidoo@ialch.co.za0312401421

Medical Officers

NameEmailContact Number
Dr T MawThynnMaw@ialch.co.za0312401421
Dr. T ManilallTrishka.Manilall@ialch.co.za0312401421
Dr Yusuf KhatibYusuf.Khatib@ialch.co.za0312401421
Dr T MannaruTheleshni.Mannaru@ialch.co.za0312401421
Dr A BewanaAkho.bewana@gmail.com0312401421
Dr N HariparsadNirvam.Haripasard@ialch.co.za0312401421

Technologists

NameEmailContact Number
Nonhlanhla A ChilizaNonhlanhlaChi@ialch.co.za0312401436
Annurupa BhagwandinAnnurupaBha@ialch.co.za0312401426
Shaaista Sher AllyShaaistaShe@ialch.co.za0312401426
Sithembile DlomoSithembileDlo@ialch.co.za0312401426

Administrative Staff

Ms Z Ntuli

Ms C.D Pitt

Ms Z.C Ndlala

Mr N.J Mbiza

Contact Details

Name Position Telephone Email Address
Dr Sajhida Khan Head of Department 031 240 1524 Sajidah.Khan@ialch.co.za
Mr Ndibulele Mbiza Administrator 031 260 4282 /
031 240 2207
MbizaN@ukzn.ac.za

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