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Abstract
The results are reported of a clinicopathologic investigation into three problems
of cardiac disease in the South African Bantu: (1) the incidence of coronary atherosclerosis
in the Bantu; (2) the effect of any such coronary atherosclerosis on the myocardium
of the Bantu; (3) the problem of the large number of Bantu patients with cardiac disease
reported as suffering from clinically unidentified heart disease, i.e., the so-called
“cryptogenic” group of cardiac patients.
The material consisted of 206 consecutive cardiac patients admitted to the Edendale
Hospital medical wards over a six-month period, and of 513 necropsies specially investigated
of a total of 1,048 autopsies performed at Edendale Hospital from June 1957 to June
1958.
The postmortem material showed that coronary atherosclerosis does occur in the Bantu
and is sometimes found in severe degree. The clinical findings were in agreement,
e.g., the presence of myocardial ischemia in the cardiac patients was shown by the
finding that angina pectoris was a not uncommon presenting symptom.
In the postmortem and clinical series the incidence of proved frank myocardial infarction
in the Bantu was about 1.4 per cent, an incidence higher than that reported by other
workers but much lower than that in European patients.
Histopathological examination of the autopsied hearts showed patchy fibrosis was a
common finding in the myocardium of the Bantu dying of heart discase. There was a
close relationship between the incidence and severity of patchy fibrosis and coronary
atherosclerosis. The hearts of Bantu patients with cardiac disease suffering from
occlusive disease of the coronary arteries and/or the ostia do not commonly present
with gross frank myocardial infarction but rather with minute infarcts. A suggested
explanation is advanced to account for this difference between Bantu and European
patients suffering from coronary heart disease.
It is suggested that the so-called “cryptogenic” group of Bantu cardiac patients consists
largely of undiagnosed examples of well recognized causes of heart disease, notably
coronary heart disease, decompensated hypertension and pericardial disease.
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© 1960 Published by Elsevier Inc.
