Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case-control study.

AIMS: Anxiety is an emotion, which stimulates sympathetic nervous outflow potentially facilitating vasovagal reflex syncope (VVS) but reports on anxiety levels in patients with VVS are sparse. METHODS AND RESULTS: We studied anxiety levels in young women (21-40 years) referred for unexplained transient loss of consciousness (TLOC), and age-matched female controls with or without past history of TLOC (≈probable VVS). Referred patients underwent head-up tilt (HUT) according to current ESC Guidelines. State and Trait Anxiety Inventory questionnaire evaluated anxiety levels plus a questionnaire explored risk factors for cardiovascular disease (CVD). Sixty-five of 91 women were diagnosed with VVS on HUT. Among 549 controls, 223 (40.6%) reported at least one episode of TLOC. State-anxiety level in patients with VVS undergoing HUT (42.4 ± 9.3) was higher compared with both controls with (38.3 ± 10.2; P < 0.01) and without past TLOC history (35.9 ± 9.8; P < 0.001). Trait anxiety in patients with VVS (42.7 ± 8.4), and controls with TLOC history (42.4 ± 8.4) was higher compared with controls without TLOC history (39.7 ± 8.5; P < 0.01). In the logistic regression using controls without TLOC as reference, both VVS diagnosis and past history of TLOC were associated with family history of CVD [odds ratio (OR) 2.4, 95% confidence interval (CI), 1.3-4.4; P = 0.007, and 2.3, 1.4-3.6; P = 0.001, respectively], and this association was independent of anxiety level. CONCLUSIONS: Trait anxiety and family history of CVD are increased in both young women with VVS and controls with history of TLOC. However, the height of anxiety level does not explain CVD heredity and other mechanisms may link syncope with CVD.

Effect of short-term rapid ventricular pacing followed by pacing interruption on arterial blood pressure in healthy pigs and pigs with tachycardiomyopathy.

Ventricular tachycardia may lead to haemodynamic deterioration and, in the case of long term persistence, is associated with the development of tachycardiomyopathy. The effect of ventricular tachycardia on haemodynamics in individuals with tachycardiomyopathy, but being in sinus rhythm has not been studied. Rapid ventricular pacing is a model of ventricular tachycardia. The aim of this study was to determine the effect of rapid ventricular pacing on blood pressure in healthy animals and those with tachycardiomyopathy. A total of 66 animals were studied: 32 in the control group and 34 in the study group. The results of two groups of examinations were compared: the first performed in healthy animals (133 examinations) and the second performed in animals paced for at least one month (77 examinations). Blood pressure measurements were taken during chronic pacing--20 min after onset of general anaesthesia, in baseline conditions (20 min after pacing cessation or 20 min after onset of general anaesthesia in healthy animals) and immediately after short-term rapid pacing. In baseline conditions significantly higher systolic and diastolic blood pressure was found in healthy animals than in those with tachycardiomyopathy. During an event of rapid ventricular pacing, a significant decrease in systolic and diastolic blood pressure was found in both groups of animals. In the group of chronically paced animals the blood pressure was lower just after restarting ventricular pacing than during chronic pacing. Cardiovascular adaptation to ventricular tachycardia develops with the length of its duration. Relapse of ventricular tachycardia leads to a blood pressure decrease more pronounced than during chronic ventricular pacing.

P-wave duration and interatrial conduction abnormalities in paroxysmal and persistent typical atrial flutter.

Functional and structural changes, the enlargement of the right atrium is the background for the development of typical atrial flutter (AFL). These changes in ECG are manifested in the morphology of the initial part of the P-wave. The aim of the study was to assess the duration and morphology of the P-wave in patients with paroxysmal and persistent AFL. The study population consisted of 131 patients with AFL, 38 women and 93 men aged 66 years (60-72), divided in 62 patients with paroxysmal and 69 with persistent AFL. P-wave duration was measured with an electrophysiological system in all leads at a paper speed of 200 mm/s. The groups did differ in terms of gender (38/24 vs. 55/14, (M/F), p=0.033). Patients with persistent AF had a longer P-wave duration - 175±26.3 ms vs. 159±22.6 ms, p=0.01, and higher creatinine concentration - 1.2±0.60 mg/dl vs. 1.08±0.68 mg/dl, p=0.007. The presence and severity of interatrial conduction block (I-none, II-partial, III-total) was related to age of the patients (60.3±12.1 vs. 64.7±-8.3 vs. 68.9±9.5 years, respectively). Patients with persistent AFL show a longer P-wave compared to paroxysmal AFL, regardless of comorbidities and antiarrhythmic drugs. The arrhythmia-related longer P-wave duration should encourage the clinicians to restore sinus rhythm earlier in order to more effectively maintain it over the long term.

Quality of life of patients with pulmonary arterial hypertension: a meta-analysis.

OBJECTIVE: Pulmonary arterial hypertension (PAH) is a rare condition, with an incidence of 15-50 cases per million annually. Available studies demonstrate that despite the longer survival of PAH patients, their quality of life (QoL) deteriorates as the condition progresses. Consequently, the goals of PAH therapy have expanded from increasing survival to improving health-related quality of life. The objective of this systematic review and meta-analysis was to summarize the available evidence about the level of QoL in patients with PAH. MATERIALS AND METHODS: A systematic search was performed using the Cochrane guidelines for conducting meta-analysis following the PRISMA statement. The meta-analysis includes findings from 11 studies evaluating the QoL of PAH patients at baseline and at follow-up (12 weeks) using the Short Form (36) Health Survey (SF-36), the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). RESULTS: The mean physical component score (SF-36) for the group was 37.2 points (95% CI: 33.24-41.16) and the heterogeneity coefficient was I²=97.71% (p < 0.001). The mean mental component score (SF-36) was 46.38 (95% CI: 44.21-48.56) and the heterogeneity coefficient was I²=87.92% (p < 0.001). The result indicates improved QoL 12 weeks after the intervention, though three papers did not fully confirm this. The greatest improvement in QoL was found in patients treated with bosentan and iloprost and the smallest improvement in QoL was found in patients treated with epoprostenol sodium. The heterogeneity coefficient was I²=91.36%, p < 0.001 for CAMPHOR and I²=97.65%, p < 0.001 for MLHFQ. CONCLUSIONS: PAH patients tend to have a poor QoL, mainly in the physical functioning domain, less so in the psychological functioning domain. QoL may be improved by therapeutic interventions, mainly pharmaceutical ones. Patients with PAH also tend to suffer from depression, anxiety, stress, or sleep disorders. All these factors are significantly correlated with poorer QoL.

[The risk of direct current countershock]. / Ryzyko kardiowersji elektrycznej.

Direct current cardioversion (DCC) is a procedure commonly used to restore the sinus rhythm in patients with supraventricular and ventricular arrhythmias. Its safety, regarding the use of electric current, is still a matter of controversy and debate. The patients with atrial fibrillation/flutter, supraventricular or ventricular tachycardia represent a broad spectrum of clinical conditions and it is difficult to draw the conclusions. The high success rate of DCC in restoring the sinus rhythm, may be partly responsible for enhancing and revealing proarrhythmic properties of antiarrhythmic drugs. The deaths described as a complications of DCC were mainly due to the proarrhythmia and less common to the progression of the pathologic process. The embolic, arrhythmic and anesthetic complications of DCC can be prevented if the known recommendations of performing the DCC are followed. The authors review critically the literature data about the complications of the procedure and come to the conclusion of safety of DCC.

[Idioventricular rhythm in patients with acute myocardial infarction: an indicator of perfusion or ischemic symptom]. / Rytm idiowentrykularny u chorych na swiezy zawal miesnia serca--wskaznik reperfuzji czy objaw niedokrwienia.

Episodes of idioventricular rhythm occur frequently during the first hours of myocardial infarction. In patients receiving thrombolytic therapy, idioventricular rhythms may be an indicator of successful reperfusion--called "reperfusion arrhythmia". The aim of our study was to assess an incidence of idioventricular rhythm and other ventricular arrhythmias and their relations to thrombolytic therapy and reperfusion in a relatively large group of patients with acute myocardial infarction (AMI). The study included 100 patients with AMI, divided into three groups: with anterior, inferior and inferior with right ventricle infarction. Sixty six patients were treated with thrombolysis. 24-hour Holter recordings were obtained in every patient and reperfusion was assessed clinically. Episodes of idioventricular rhythm and other ventricular arrhythmias were more frequent in the thrombolytic group but not in patients with clinically established reperfusion. The main conclusion from our study is, that accelerated idioventricular rhythm is not specific for reperfusion but rather for myocardial ischaemia. The higher incidence of the ventricular arrhythmias in the thrombolytic group partially depends of their earlier hospitalization, and time-dependent inclusion into treated group.

[Studies on the relationship between beta-adrenergic receptor density on cell wall lymphocytes, total serum catecholamine level and heart rate in patients with hyperthyroidism]. / Badanie zaleznosci miedzy gestoscia receptorów beta-adrenergicznych na blonach komórkowych limfocytów i stezeniem amin katecholowych w surowicy a czestoscia serca u chorych na nadczynnosc tarczycy.

Hyperthyreosis mimics the hyperadrenergic state and its symptoms were though to be dependent on increased level of catecholamines. Another reason for the symptoms could be the increased density or affinity of beta-adrenergic receptors to catecholamines. The aim of the study was to examine the elements of sympathetic nervous system, thyroid hormones level and their influence on heart rate control in patients with hyperthyreosis. The study was carried out in 18 women, mean age 48.9 +/- 8.7 yrs and 6 men, mean age 54.2 +/- 8.7 yrs. The control group consisted of 30 healthy persons matched for age and sex. We examined the density of beta-adrenergic receptors using radioligand labelling method with 125I-cyanopindolol, serum total catecholamines level with radioenzymatic assay kit, the levels of free thyroid hormones using radioimmunoassays and thyreotropine level with immunoradiometric assay. Maximal, minimal and mean heart rate were studied using Holter monitoring system. The density of beta-adrenergic receptors in hyperthyreosis was 37.3 +/- 21.7 vs 37.2 +/- 18.1 fmol/mg in the control group (p = NS). Total catecholamines level was significantly decreased in hyperthyreosis group: 1.5 +/- 0.89 vs 1.9 +/- 0.73 pmol/ml (p < 0.05). There was significantly higher minimal, maximal and mean heart rate in hyperthyreosis group (p < 0.0001, p < 0.0001 and p < 0.05 respectively). There was a weak inverse correlation between minimum heart rate and triiodothyronine level (r = -0.38, p < 0.05). An inverse correlation between triiodothyronine and catecholamines level (r = -0.49, p < 0.05) was observed. Beta-adrenergic receptors density is unchanged and catecholamines level is decreased in hyperthyreosis when compared to normal subjects. There is no correlation between minimal heart rate and adrenergic receptors density or catecholamines level in hyperthyreosis.

[Density of beta-adrenergic receptors and left ventricular mass in patients with primary essential hypertension]. / Gestosc receptorów beta-adrenergicznych a masa miesnia lewej komory serca u chorych na pierwotne nadcisnienie tetnicze.

UNLABELLED: Left ventricular hypertrophy (LVH) is one of the more important risk factors for sudden death. There are multiple factors for development of LVH in patients with hypertension. Sympathetic nervous system may play a key role causing afterload increase and neurohumoral mechanisms activation. The aim of the study was to determine beta-adrenergic receptors density and its relations to left ventricular mass in hypertensive subjects. The study was carried out in 63 patients (23 women and 40 men), mean age 43.3 +/- 11.6 yrs with primary hypertension: stage I--42 pts and stage II--21 pts. The control group consisted of 26 healthy persons matched for age and sex. We evaluated the density of beta-adrenergic receptors using 125I-cyanopindolol radioligand labeling method. Left ventricular dimensions were assessed by echocardiography (Hewlett-Packard 77010 CF) and left ventricular mass index (LVMI) was calculated. Systolic and diastolic blood pressure and LVMI was significantly higher in hypertension group 156.7 +/- 12.5 vs. 119.8 +/- 8.8 mmHg, p < 0.0001, 95.9/5.5 vs. 78.8 +/- 6.5 mmHg, p < 0.0001, 126.5 +/- 41.9 vs. 93.1 +/- 19.9 g/m2, p < 0.001 respectively. Beta-adrenergic receptors density was 40.7 +/- 29.9 fmol/ml in the hypertensive vs. 37.2 +/- 17.8 fmol/ml in control group (p = NS). There was no correlation between beta-adrenergic receptors density and LVMI. There was a statistically significant positive correlation between LVMI and systolic and diastolic blood pressure (r = 0.44, p < 0.05; r = 0.60, p < 0.01 respectively). CONCLUSIONS: 1. Beta-adrenergic receptors density was unchanged in patients with hypertension and did not correlate with LVMI. 2. A high positive correlation between blood pressure values and LVMI, but only in stage II hypertension was revealed.

[The effect of a single moderate physical exertion on serum leptin levels in patients with essential hypertension (preliminary results)]. / Wplyw jednorazowego umiarkowanego wysilku fizycznego na osoczowe stezenie leptyny u chorych na pierwotne nadcisnienie tetnicze (doniesienie wstepne).

Leptin is a product of the ob gene and is secreted by the adipose tissue. It takes part in regulation of nervous, cardiovascular, endocrine system and renal functions. The aim of this study was to assess the influence of short term moderate exercise on serum leptin levels in patients with arterial hypertension. The study group consisted of 34 patients with essential hypertension: 15 women (48.9 +/- 12.1 years old) and 19 men (43.5 +/- 14.6 years old). There were 7 patients with stage I of hypertension, 17 patients with stage II of hypertension and 10 patients with stage III of hypertension. The blood samples were taken before and after the exercise test. Serum leptin levels were assessed by radioimmunoassay. Serum leptin levels were significantly higher in women then in men. The logarithm of serum leptin levels after the exercise was significantly lower than before (0.8 +/- 0.4 and 0.9 +/- 0.5 respectively). The moderate, short term exercise decreases serum leptin levels in the hypertensive patients.