Dietary Recommendations for Familial Hypercholesterolaemia: an Evidence-Free Zone.

We have evaluated dietary recommendations for people diagnosed with familial hypercholesterolaemia (FH), a genetic condition in which increased low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk for coronary heart disease (CHD). Recommendations for FH individuals have emphasised a low saturated fat, low cholesterol diet to reduce their LDL-C levels. The basis of this recommendation is the 'diet-heart hypothesis', which postulates that consumption of food rich in saturated fat increases serum cholesterol levels, which increases risk of CHD. We have challenged the rationale for FH dietary recommendations based on the absence of support for the diet-heart hypothesis, and the lack of evidence that a low saturated fat, low cholesterol diet reduces coronary events in FH individuals. As an alternative approach, we have summarised research which has shown that the subset of FH individuals that develop CHD exhibit risk factors associated with an insulin-resistant phenotype (elevated triglycerides, blood glucose, haemoglobin A1c (HbA1c), obesity, hyperinsulinaemia, high-sensitivity C reactive protein, hypertension) or increased susceptibility to develop coagulopathy. The insulin-resistant phenotype, also referred to as the metabolic syndrome, manifests as carbohydrate intolerance, which is most effectively managed by a low carbohydrate diet (LCD). Therefore, we propose that FH individuals with signs of insulin resistance should be made aware of the benefits of an LCD. Our assessment of the literature provides the rationale for clinical trials to be conducted to determine if an LCD would prove to be effective in reducing the incidence of coronary events in FH individuals which exhibit an insulin-resistant phenotype or hypercoagulation risk.

Novel Behavior of the 2019 Novel Coronavirus With Invasion of the Cardiac Conduction System in the Young.

We report the case of a 35-year-old man (an oil engineer) referred as a coronavirus disease-2019 (COVID-19) case with heart block and a four-day history of headache and fever. The patient was hemodynamically stable with normal respiratory effort and oxygen saturation. Three consecutive COVID-19 tests were positive since admission. Comprehensive clinical assessment investigations were performed. Apart from mild acute phase reactants elevation, all results were within reference limits. He had no leukocytosis and normal cardiac enzymes, chest x-ray findings, echocardiography findings, and healthy coronary arteries. The patient had a fever and electrocardiographic evidence of sinus node dysfunction associated with Mobitz type 2 atrioventricular block that progressed to complete heart block. This was a unique presentation of COVID-19 in a young, otherwise healthy man with the sole manifestation confined to the cardiac conduction system and the absence of respiratory involvement, hypoxemia, and acidosis.

Biventricular Outflow Obstruction Associated With Atrioventricular Septal Defects and Patent Ductus Arteriosus: An Extremely Rare Combination.

We present an extremely rare combination of biventricular outflow obstruction associated with atrioventricular septal defects and patent ductus arteriosus (PDA). Almost all the other published cases, including ours, were associated with other congenital cardiac lesions other than biventricular outflow obstruction. Most cases ended with poor outcomes. Our patient was a 55-day-old term female infant. She was managed by successful aortic balloon valvuloplasty with successful early outcome.

The new European guidelines for prevention of cardiovascular disease are misleading.

Introduction: The European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) have recently published three major revisions of their guidelines for the management of chronic heart disease, blood lipids, and diabetes. Areas covered: We have scrutinized these guidelines in detail and found that the authors have ignored many studies that are in conflict with their conclusions and recommendations. Expert commentary: The authors of the guidelines have ignored that LDL-cholesterol (LDL-C) of patients with acute myocardial infarction is lower than normal; that high cholesterol is not a risk factor for diabetics; that the degree of coronary artery calcification is not associated with LDL-C; and that 27 follow-up studies have shown that people with high total cholesterol or LDL-C live just as long or longer than people with low cholesterol. They have also ignored the lack of exposure-response in the statin trials; that several of these trials have been unable to lower CVD or total mortality; that no statin trial has succeeded with lowering mortality in women, elderly people, or diabetics; and that cholesterol-lowering with statins has been associated with many serious side effects.

Long-Term Study of Heart Rate Variability Responses to Changes in the Solar and Geomagnetic Environment.

This long-term study examined relationships between solar and magnetic factors and the time course and lags of autonomic nervous system (ANS) responses to changes in solar and geomagnetic activity. Heart rate variability (HRV) was recorded for 72 consecutive hours each week over a five-month period in 16 participants in order to examine ANS responses during normal background environmental periods. HRV measures were correlated with solar and geomagnetic variables using multivariate linear regression analysis with Bonferroni corrections for multiple comparisons after removing circadian influences from both datasets. Overall, the study confirms that daily ANS activity responds to changes in geomagnetic and solar activity during periods of normal undisturbed activity and it is initiated at different times after the changes in the various environmental factors and persist over varying time periods. Increase in solar wind intensity was correlated with increases in heart rate, which we interpret as a biological stress response. Increase in cosmic rays, solar radio flux, and Schumann resonance power was all associated with increased HRV and parasympathetic activity. The findings support the hypothesis that energetic environmental phenomena affect psychophysical processes that can affect people in different ways depending on their sensitivity, health status and capacity for self-regulation.

Identification of a Group's Physiological Synchronization with Earth's Magnetic Field.

A new analysis technique for the evaluation of the degree of synchronization between the physiological state of a group of people and changes in the Earth's magnetic field based on their cardiac inter-beat intervals was developed and validated. The new analysis method was then used to identify clusters of similar synchronization patterns in a group of 20 individuals over a two-week period. The algorithm for the identification of slow wave dynamics for every person was constructed in order to determine meaningful interrelationships between the participants and the local magnetic field data. The results support the hypothesis that the slow wave rhythms in heart rate variability can synchronize with changes in local magnetic field data, and that the degree of synchronization is affected by the quality of interpersonal relationships.

Synchronization of Human Autonomic Nervous System Rhythms with Geomagnetic Activity in Human Subjects.

A coupling between geomagnetic activity and the human nervous system's function was identified by virtue of continuous monitoring of heart rate variability (HRV) and the time-varying geomagnetic field over a 31-day period in a group of 10 individuals who went about their normal day-to-day lives. A time series correlation analysis identified a response of the group's autonomic nervous systems to various dynamic changes in the solar, cosmic ray, and ambient magnetic field. Correlation coefficients and p values were calculated between the HRV variables and environmental measures during three distinct time periods of environmental activity. There were significant correlations between the group's HRV and solar wind speed, Kp, Ap, solar radio flux, cosmic ray counts, Schumann resonance power, and the total variations in the magnetic field. In addition, the time series data were time synchronized and normalized, after which all circadian rhythms were removed. It was found that the participants' HRV rhythms synchronized across the 31-day period at a period of approximately 2.5 days, even though all participants were in separate locations. Overall, this suggests that daily autonomic nervous system activity not only responds to changes in solar and geomagnetic activity, but is synchronized with the time-varying magnetic fields associated with geomagnetic field-line resonances and Schumann resonances.

New approach for visualization of relationships between RR and JT intervals.

This paper presents the concept of perfect matrices of Lagrange differences which are used to analyze relationships between RR and JT intervals during the bicycle ergometry exercise. The concept of the perfect matrix of Lagrange differences, its parameters, the construction of the load function and the corresponding optimization problem, the introduction of internal and external smoothing, embedding of the scalar parameter time series into the phase plane-all these computational techniques allow visualization of complex dynamical processes taking place in the cardiovascular system during the load and the recovery processes. Detailed analysis is performed with one person's RR and JT records only-but the presented techniques open new possibilities for novel interpretation of the dynamics of the cardiovascular system.

Coherence: a novel nonpharmacological modality for lowering blood pressure in hypertensive patients.

This study examined the efficacy of teaching emotional self-regulation techniques supported by heart rhythm coherence training (emWave Personal Stress Reliever) as a means to quickly lower blood pressure (BP) in patients diagnosed with hypertension. Previous studies have demonstrated systemic reductions in BP in both high stress populations and patients diagnosed with hypertension using this approach, but to the best of our knowledge, an investigation of their ability to produce immediate reductions in BP had not been published in the medical literature. The study was a randomized controlled design with 62 hypertensive participants who were divided into three groups. Group 1 was taking hypertensive medication, was taught self-regulation technique, and used heart rate variability coherence (HRVC) training devices. Group 2 was not yet taking medication and was trained in the same intervention. Group 3 was taking hypertensive medication but did not receive the intervention and was instructed to relax between the BP assessments. An analysis of covariates was conducted to compare the effectiveness of three different interventions on reducing the participants' BP. The use of the self-regulation technique and the HRVC-monitoring device was associated with a significantly greater reduction in mean arterial pressure in the two groups who used the intervention as compared with the relaxation-plus-medication group. Additionally, the group not taking medication that used the intervention also had a significantly greater reduction in systolic BP than the relaxation- plus-medication group. These results suggest that self-regulation techniques that incorporate the intentional generation of positive emotions to facilitate a shift into the psychophysiological coherence state are an effective approach to lowering BP. This approach to reducing BP should be considered a simple and effective approach that can easily be taught to patients to quickly lower their BP in stressful situations. The technique should be especially useful when hypertensive patients are experiencing stressful emotions or reactions to stressors. It is possible that the BP reductions associated with the use of the technique leads to a change in the physiological set-point for homeostatic regulation of BP. Further studies should examine if large scale implementations of such heart-based coherence techniques could have a significant impact on reducing risk of mortality and morbidity in hypertensive patients.

Este estudio examinó la eficacia de enseñar las técnicas de auto-regulación emocional, apoyadas por el entrenamiento de la coherencia de ritmos del corazón (emWave Personal Stress Reliever), como medio para reducir con rapidez la presión arterial (PA) en pacientes diagnosticados con hipertensión. Los estudios previos han demostrado reducciones sistémicas de la PA tanto en poblaciones con alto estrés como en pacientes diagnosticados con hipertensión, después de usar este enfoque pero no se ha investigado todavía la capacidad de causar reducciones inmediatas de la PA.El estudio se llevó a cabo con 62 participantes hipertensos mediante un diseño controlado aleatorizado, que los dividió en tres grupos. El grupo 1 estaba tomando medicación para la hipertensión, se le enseñó la técnica de auto-regulación y utilizó aparatos de entrenamiento de coherencia de la variabilidad de la frecuencia cardiaca (heart rate variability coherence, HRVC). El grupo 2 no tomaba todavía ninguna medicación y se entrenó en el mismo procedimiento. El grupo 3 estaba tomando medicación para la hipertensión, pero no recibió la intervención y se le enseñó a relajarse entre las evaluaciones de la PA.Se realizó un análisis de covarianza para comparar la eficacia de los tres tipos distintos de intervención para reducir la PA de los participantes. El uso de la técnica de auto-regulación y del aparato de control de la HRVC se asoció a una reducción significativamente mayor de la media de la presión arterial en los dos grupos que utilizaron la intervención, en comparación con el grupo con la medicación y la relajación. Además, el grupo que no tomaba medicación, pero que utilizó la intervención, mostró también una reducción significativamente mayor en la PA sistólica que el grupo con la medicación y la relajación.Estos resultados sugieren que las técnicas de auto-regulación, que incorporan la generación intencional de emociones positivas para facilitar un cambio hacia el estado de coherencia psicofisiológico son un enfoque eficaz para reducir la PA. Este enfoque para reducir la PA se debe considerar un planteamiento simple y eficaz, que puede enseñarse fácilmente a los pacientes, para reducir rápidamente su PA en situaciones de estrés. Esta técnica debería ser útil especialmente en los casos en los que los pacientes hipertensos sufren emociones estresantes o reacciones ante situaciones de estrés. Es posible que las reducciones de la PA, asociadas al uso de la técnica, causen un cambio en el punto fisiológico establecido, que controla la regulación homeostática de la PA. Los estudios adicionales deberían examinar si las implementaciones a gran escala de dichas técnicas de coherencia basadas en el ritmo cardíaco podrían tener un impacto significativo en la reducción del riesgo de mortalidad y morbilidad en los pacientes hipertensos.

Laryngotracheoesophageal cleft type 3 and double outlet right ventricle: unique combination.

The laryngotracheoesophageal cleft is marked by the absence of the anatomic separation of the esophagus and the larynx. The cleft functionally can be restricted to involve the interarytenoid musculature (type 1), cricoid involvement (type 2), the proximal laryngotracheoesophagus (type 3), or missing of the whole tracheoesophageal septum (type 4). Association with significant congenital heart disease is uncommon. In this report, we are presenting a 2-week-old preterm girl presented with frequent aspiration pneumonitis, cyanosis, and heart murmur. Mechanical ventilation was extremely difficult because of endotracheal tube air leak and excessive secretions. Endoscopic evaluation revealed type 3 laryngotracheoesophageal cleft. Echocardiogram revealed double outlet right ventricle with subpulmonic ventricular septal defect. Such unique combination with severe airway disease and complex congenital heart disease was thought to constitute very high morbimortality if intervention is contemplated. It was elected to proceed with compassionate care.

Noninvasive diagnosis of coronary artery fistula after cardiac surgery.

A 5-year-old boy underwent ventricular septal defect closure as well as resection of the muscle bundle of a double-chamber right ventricle and a subaortic membrane. Five days after surgery, echocardiography revealed a left anterior descending artery fistula with 2 sites of entry to the right ventricle. The child was asymptomatic with no murmurs. Echocardiography is an excellent tool for detecting such silent clinical lesions.