Charles Kyriakakis

Tuberculous pericarditis : challenges and controversies in the modern era

Tuberculous pericarditis (TBP) continues to wreak havoc across Sub-Saharan Africa (SSA). Despite more than 5 decades of treatment and research into TBP, we are not much closer to alleviating the suffering and mortality associated with this extrapulmonary manifestation of tuberculosis (TB). In the era of modern cardiology, diseases of the pericardium do not receive the same amount of research attention and investment as what diseases of lifestyle do. Interventional techniques for their diagnosis and management do not extend much further than pericardiocentesis with appropriate laboratory investigations. They also do not provide the potential for the development and use of consumable equipment, or that of expensive drugs and, consequently, fi nancial investment into their research and development is not forthcoming. Diseases of the pericardium do, however, remain important within the discipline that we practice and TBP in particular deserves our continuous efforts and attention. It is unfortunate to acknowledge that we have not made much of an impact on this ancient foe over the last 50 odd years. Despite the World Health Organisation (WHO) declaring TB a global emergency in 1993, more than 20 years later we are not much better off. In 2013 an estimated 9 million people developed the disease and 1.5 million died from it.(1) TBP is predominantly a disease of SSA and it requires a solution from the very region which it torments.

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Cardiac tamponade due to hypothyroidism: a case cluster report

This study reports on three patients who were seen at Tygerberg Hospital within a short period of six months, with a new diagnosis of biochemically severe primary hypothyroidism. Pericardial effusion was suspected on clinical and X-ray findings and confirmed with echocardiography in all cases. All had evidence of pericardial tamponade based on echocardiographic criteria. Pericardiocentesis was performed on all patients and other causes of pericardial effusions were excluded. Although infrequently described, hypothyroidism needs to be considered in patients presenting with unexplained large pericardial effusions and cardiac tamponade.

Persistant left superior vena cava – the value of an agitated saline contrast study

A persistant left superior vena cava (PLSVC) draining to the coronary sinus (CS) is the most common venous anomaly of the thorax, affecting approximately 0.5% - 2% of the general population, and is present in up to 10% of patients with other congenital cardiac anomalies.(1) The embryological development of the thoracic venous system is complex and subject to significant variation. Usually, most of the left cardinal system involutes, leaving only the coronary sinus, which drains the cardiac veins, and the ligament of Marshall (a remnant of the left superior vena cava).(2) The presence of a PLSVC is usually an incidental finding at either echocardiography, cardiac catheterisation or device implantation.(1) The typical echocardiographic findings are that of a dilated CS, which can be appreciated on the parasternal long axis view, the parasternal short axis at mitral valve level, the apical 2 chamber view and a modified apical four chamber view scanning down to visualise the CS (Figure 1). A contrast study with agitated saline (“bubble study”) done via the left brachial vein will demonstrate the dilated CS draining into the right atrium (Figure 2).