Oana Dickinson

Modulation of the autonomic nervous system assessed through heart rate variability by a mindfulness based stress reduction program

Heart rate variability (HRV) is an established method to evaluate cardiac sympatho-vagal balance [1]. Reduced HRV is an adverse prognostic marker for fatal arrhythmias in myocardial infarction and heart failure patients [2,3]. Mindfulness based stress reduction (MBSR) is a well-delineated 8-week meditation program that has a standardized technique [4]. Certain meditation practices have been shown to positively influence HRV [5,6], but the effects of MBSR on HRV have not been established. Twenty two healthy volunteerswere recruited fromparticipants of a MBSR program. After excluding for followup loss and ECG artifact, final study population was 18 subjects (44% men, mean age 52.7 ± 11.8 years, mean BMI 24.0 ± 3.9 kg/m). The study protocol was approved by the University of Minnesota Institutional Review Board, and written informed consent (in accordancewith theHelsinki Declaration) was obtained. Volunteers were reimbursed US

Syncope: Classification and risk stratification

50 per visit to cover travel costs. MBSR consists of an 8-week intervention with weekly classes that last 2–3 h, and daily home practice is encouraged [7].

Atrial fibrillation and heart failure: intersecting populations, morbidities, and mortality.

BACKGROUND Syncope is one of the most common reasons for emergency department and urgent care clinic visits. The management of syncope continues to be a challenging problem for front-line providers inasmuch as there are a multitude of possible causes for syncope ranging from relatively benign conditions to potentially life-threatening ones. In any event, it is important to identify those syncope patients who are at immediate risk of life-threatening events; these individuals require prompt hospitalization and thorough evaluation. Conversely, it is equally important to avoid unnecessary hospitalization of low-risk patients since unneeded hospital care adds to the healthcare cost burden. RESULTS Historically, front-line providers have taken a conservative approach with admission rates as high as 30-50% among syncope patients. A number of studies evaluating both the short- and long-term risk of adverse events in patients with syncope have focused on development of risk-stratification guidelines to assist providers in making a confident and well-informed choice between hospitalization and out-patient referral. In this regard, a much needed consensus on optimal decision-making process has not been developed to date. However, knowledge from various available risk-stratification studies can be helpful. CONCLUSION This review summarizes the findings of various risk-stratification studies and points out key differences between them. While, the existing risk-stratification methods cannot replace critical assessment by an experienced physician, they do provide valuable guidance. In addition, the various risk-assessment schemes highlight the need for careful initial clinical assessment of syncope patients, selective testing, and being mindful of the short- and long-term risks.

Risk Stratification of Patients Presenting with Transient Loss of Consciousness

Heart failure (HF) and atrial fibrillation (AF) are the only two cardiovascular disorders that continue to increase in magnitude in the United States. The purpose of this brief overview is to provide a description of these two cardiovascular epidemics of HF and AF as they interact, and to provide additional information regarding the emerging influence of genetics and environment in the development of AF in the HF setting. These two modern epidemics are highly interactive and highly age-dependent. The development of new AF in a patient with either HF with preserved ejection fraction or HF with reduced ejection fraction possesses challenging management issues for practicing physicians. Control of heart rate is always prudent though still not precisely defined. The need to restore normal sinus rhythm is highly patient-dependent and strategies will vary. Elderly patients derive the most benefit from anticoagulation, but are also more prone to falls and bleeding complications. Today, we know much more about AF and HF and how they interact. The extent of AF/HF challenge is now widely recognized. It is inevitable that as people age, they will develop structural and functional changes in the cardiovascular system, some of which will predispose to the development of HF and AF. Not every case of HF or AF is preventable. Nevertheless, it is only throughout careful observations and further studies that we will be able to better manage these two Goliaths.

CARDIAC TAMPONADE, PERICARDITIS, ACUTE SYSTOLIC HEART FAILURE AND ELEVATED TROPONIN DUE TO ACUTE EOSINOPHILLIC MYOCARDITIS

Important goals in the initial evaluation of patients with transient loss of consciousness include determining whether the episode was syncope and choosing the venue for subsequent care. Patients who have high short-term risk of adverse outcomes need prompt hospitalization for diagnosis and/or treatment, whereas others may be safely referred for outpatient evaluation. This article summarizes the most important available risk assessment studies and points out key differences among the existing recommendations. Current risk stratification methods cannot replace critical assessment by an experienced physician, but they do provide much needed guidance and offer direction for future risk stratification consensus development.

Isolated left ventricular non-compaction cardiomyopathy associated with polymorphous ventricular tachycardia mimicking torsades de pointes

Eosinophilic myocarditis is a major cause of morbidity and mortality among patients with hypereosinophilic syndromes (HES), which are marked by overproduction of eosinophils (≥1,500/uL), causing damage to multiple organs. It is rare, with estimated prevalence of 0.36-6.3 per 100,000. 52-year-old

Vasodepressor Cough Syncope Masked by Sleep Apnea-Induced Asystole

Left ventricular non‐compaction (LVNC) cardiomyopathy is a rare congenital disorder, classified by the American Heart Association as a primary genetic cardiomyopathy and characterized by multiple trabeculations within the left ventricle. LVNC cardiomyopathy has been associated with 3 major clinical manifestations: heart failure, atrial and ventricular arrhythmias and thromboembolic events, including stroke. In this case report, we describe a female patient with apparently isolated LVNC in whom pause‐dependent polymorphic ventricular tachycardia suggesting torsades de pointes occurred in the presence of a normal QT interval.

Haematological, neurological and electrocardiographic findings in secondary hypothermia

Vasodepressor Cough Syncope.  Cough syncope is classified among the neural‐reflex “situational” faints, but whether the clinical consequences in affected individuals result from reflex triggered bradyarrhythmia or vasodepressor‐induced hypotension, or both, is often unknown. In this report we describe findings in a patient with a clinical history consistent with cough syncope, and in whom documented multiple asystolic spells were at first believed to be responsible for symptoms. However, pacemaker therapy initiated at an outside facility failed to suppress symptoms, and subsequent referral for more detailed autonomic study revealed the asystole to be due to sleep apnea, whereas cough‐induced vasodepressor hypotension was the basis of syncope in this individual; the latter provided a pathophysiologic target for prevention of recurring symptoms. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1024‐1027, September 2012)

Cardiac pauses in competitive athletes: a systematic review examining the basis of current practice recommendations.

The association between secondary hypothermia and pancytopaenia is uncommon. A young woman presented with chronic hypothermia (28.8–34.6°C) secondary to surgical hypothalamic injury postcraniopharyingioma resection as a child. Associated findings included pancytopaenia (haemoglobin 8.1 g/dl, leucocytes 3500/mm3, platelets 63 000/mm3), ataxia, upper motor neuron signs, decreased level of consciousness and new ECG changes. An extensive evaluation failed to reveal any cause of pancytopaenia other than chronic hypothermia. The haematological and neurological changes improved after active rewarming.