Patterns of disease in Africa continue to change. An urban lifestyle limits traditional physical exercise and favours obesity. Moreover, the increase in cardiovascular risk factors, such as smoking, diabetes and coronary disease, are seen throughout the continent. Rheumatic heart disease is still far too prevalent, particularly among the poor; thus, these predisposing factors exacerbate the epidemiological transition from communicable to non-communicable disease. Nevertheless, there have been enormous technological advances in the last 10–20 years. For example, accessing clinical information from a phone in this digital era is now possible. The technology to diagnose and treat cardiac disease has also become more available and affordable: oximeters now only cost a few dollars, and electrocardiograms (ECGs) can be rapidly performed and automatically interpreted using a reusable belt, limiting the use of consumables. A tablet computer that does not require maintenance (Opio & Kellett 2017b) and bedside echocardiography is now widely available. Beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are widespread and affordable.