Physiologic and pathophysiologic changes in the right heart in highly trained athletes.

Exercise causes changes in the heart in response to the hemodynamic demands of increased systemic and pulmonary requirements during exercise. Understanding these adaptations is of great importance, since they may overlap with those caused by pathological conditions. Initial descriptions of athlete's heart focused mainly on chronic adaptation of the left heart to training. In recent years, the substantial structural and functional adaptations of the right heart have been documented, highlighting the complex interplay with left heart. Moreover, there is evolving evidence of acute and chronic cardiac damage, mainly involving the right heart, which may predispose subjects to atrial and ventricular arrhythmias, configuring an exercise-induced cardiomyopathy. The aim of this article is to review the current knowledge on the physiologic and pathophysiologic changes in the right heart in highly trained athletes.

Sleep disorders in peritoneal and haemodialysis patients as assessed by a self-administered questionnaire.

Sleep disorders have been reported as a frequent problem in dialysis patients. However, only one paper has compared the prevalence and possible causes of this complication in peritoneal (PD) and haemodialysis (HD) patients. We surveyed 84 PD and 87 HD patients about disordered sleep using a self-administered questionnaire. Forty-nine percent of PD and 56% of HD patients reported problems sleeping. These problems were rated as severe by 29 PD and 22 HD patients. Type of disturbances involved delayed sleeping (13 PD and 32 HD, p < 0.005), interrupted sleep (32 PD and 44 HD) and early morning awakening (25 PD and 37 HD). The number of hours of sleep varied widely among patients: it was 5 and 21 minutes in PD patients with sleep disorders and 7 and 37 min in PD pts without such problems. No statistically significant relationship was evidenced between sleep disorders and age, sex, body weight, obesity, duration of dialysis, dialysis dose, self-assessed sadness, anxiety, worry, pain, pruritus, dyspnoea, restless leg syndrome, use of cigarettes, caffeine, or sleeping pills. In conclusion, sleep disorders are a frequent problem in both PD and HD patients. Apparently the relationship with demographics, dialysis dose, lifestyle and personality traits is poor. The possible role of other causes should be investigated.

[Arg506 --> Gln mutation of coagulation factor V (factor V Leiden) and transient cerebral ischemia at a young age in 3 members of the same family]. / Mutazione Arg506 --> Gln del fattore V della coagulazione (fattore V Leiden) ed ischemia cerebrale transitoria in giovane età in tre membri della stessa famiglia.

The Arg506 --> Gln coagulation factor V mutation (factor V Leiden) is the most frequent inherited abnormality of blood coagulation which predisposes to venous thromboembolism. Its association with an increased risk of arterial thrombosis is uncertain. We describe 3 members of the same family (a woman and her 2 children) who were heterozygous for the Arg506 --> Gln mutation and who presented cerebral transient ischemic attacks (TIA) at a young age. The patients (with the exception of one smoker) had no risk factors for TIA and no abnormality of the coagulation system other than the Arg506 --> Gln mutation. The observation of the mutation and TIA in 3 members of the same family may suggest the hypothesis of an association between the mutation and arterial thrombosis. This hypothesis must be interpreted with caution, due to the absence of objective instrumental findings in patients with TIA and to the high prevalence of the Arg506 --> Gln mutation in the general population.