Atherogenic dyslipidaemias beyond LDL

Atherosclerotic vascular disease is a major healthcare burden in developed countries and has increased markedly in developing countries. Epidemiologic findings, diagnostic investigations and interventional studies are summarised in guidelines for current management of dyslipidaemia. The guidelines for managing dyslipidaemia in South Africa is a good foundation but additional considerations can further refine diagnosis and risk assessment in an individual. The purpose of this document is to advise additional tests as a clinician who also performed laboratory investigations for a lipid clinic at a teaching hospital.

Management of no-reflow phenomenon in the catheterisation laboratory

No-reflow is defined as failure to achieve normal perfusion at myocardial level. That is thrombolysis in myocardial infarction flow grade ≤ II or myocardial blush grade 0 or 1, despite opening an occluded epicardial coronary vessel in the setting of percutaneous coronary interventions (PCI), excluding the presence of dissection, underlying significant stenosis, thrombus and/or coronary spasm. It is assessed angiographically using thrombolysis in myocardial infarction (TIMI) flow grading (Table 1), myocardial blush grading (MBG), Table 2 and/or corrected (TIMI) frame count (cTFC). It is a common and frequent complication during percutaneous interventions in degenerative venous grafts, rotational atherectomy of native coronary arteries and during PCI in ST elevation myocardial infarctions (STEMI). In the literature the estimated frequency of no-reflow phenomenon vary, is ranging between 5-60%. Its prevalence in acute coronary syndrome is reported to be around 32%.

South African law and how it affects you – a guide for healthcare practitioners

Readers will be well aware that medicine can be divided into specialties and subspecialties. Like medicine, the law can be similarly divided, and further sub-divided, into specific and well-defined fields. Despite this similarity, many healthcare practitioners (HCPs) find the alien legal landscape to be intricate and confusing. Thankfully, involvement with the law remains mostly on the periphery of HCP’s daily clinical obligations, at arm’s length to patient care and mostly unrelated to their associated practice commitments. There will however, unfortunately, be occasions when a HCP is implicated in a medicolegal matter. At that point the HCP becomes personally embroiled in the legal system, be that as a respondent to a complaint, a defendant in a civil claim or even as an accused in a criminal trial. As the legal issues suddenly become more intimate and pressing, a HCP, who might already feel somewhat anxious, concerned, and uncertain, may find that they have no alternative but to urgently familiarise themselves with an unknown legal landscape. Attempts to navigate this seemingly complex and unchartered terrain often results in further distress and discomfort.


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Heart Matters Vol 13 No 2 - June 2022

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