Thermogenic supplement use does not alter characteristics of sudden death in the young.

BACKGROUND: To evaluate supplement use, most notably ephedra, which has been temporally associated with sudden death. Animal models suggest increased myocardial irritability may predispose to primary arrhythmic death. METHODS: Clinical, pathological, and investigative records from the Office of the Armed Forces Medical Examiner's Cardiovascular Death Registry were reviewed. Forty-eight cases of those with known supplement use were compared to 144 age-, gender-, and socioeconomic-matched controls in a 1:3 case:control manner. RESULTS: Of the 48 sudden deaths temporally associated with supplement use, the mean age was 34.2 ± 10.0 years and predominantly male (n = 44, 91.7%). The underlying cause of death was fatal atherosclerotic coronary disease in 18 (37.5%), sudden unexplained death in 16 (33.3%), and hypertrophic cardiomyopathy in six (12.5%). Compared with controls, there were no statistically significant differences in adjudicated cause of death. On autopsy, there were no differences in cardiac mass, ventricular wall thickness, or presence of atherosclerosis in those known to be taking identified supplements compared to a control population. In the subject ≥35 years, and known to be taking supplements, there was a significant increase in causality of death as due to sudden unexplained death (relative risk = 5.1 [95% confidence interval, 1.4-18.7]). CONCLUSIONS: Active surveillance of mortality in an autopsy-derived series of young adults finds atherosclerotic coronary disease and idiopathic sudden death are common etiologies of death when taking supplements, but no cardiac structural or histologic mechanism to suggest different pathologic process than a matched control population.

Management of central venous gradient using excimer laser lead extraction of chronic indwelling pacemaker leads in the setting of ipsilateral arteriovenous fistula.

Device therapy is becoming common in those patients with renal insufficiency. Coexisting need for arteriovenous (AV) fistula placement is often contemplated relative to device placement. We describe the excimer laser lead extraction of a malfunctioning chronic atrial pacemaker lead ipsilateral to an AV fistula.

Differential manifestation of cardiovascular complaints as a function of utilization of ergogenic supplements.

INTRODUCTION: The rate of use of dietary supplements among young adults is significant. While the military makes significant restrictions on the use of certain pharmacologic drugs and actively tests for illegal drugs in a deployed environment, there is a near-unlimited supply of body-enhancing supplements available at military exchanges to deployed personnel. By emphasizing physical performance and providing these for purchase, the military leadership, perhaps unknowingly, endorses the use of these products. Cardiovascular symptoms represent one of the leading nontraumatic causes of aeromedical evacuation from a combat zone. Whether the use of supplements is associated with a differential presentation to cardiovascular complaint is unknown. METHODS: Retrospective review using the US Department of Defense Military Health System data, we identified patients evaluated for cardiovascular complaints of syncope or palpitations while deployed to Iraq and Afghanistan. RESULTS: There were 905 US military personnel who presented with complaint of syncope or palpitations (mean age 31 +/- 10 years, 77% male). There were 83 (9.2%) who self-reported taking an ergogenic supplement. The incidence of reported use of supplements among males was 10.8%, which was significantly higher than its use among females at 3.8% (P = 0.001). In those >30 years, those on supplements had a higher resting pulse (90 +/- 28 vs 79 +/- 24 beats/min, P = 0.032), and the incidence of resting tachycardia was three-fold higher (35.0% vs 11.4%, P = 0.008). Supplement use was seen in 12.3% of those who presented with palpitations, which was significantly higher than those who presented without palpitations (7.8%, P = 0.043). In those taking supplements, symptoms were more likely during exertion (26.5% vs 15.0%, P < 0.001), and immediately postexertional (13.2% vs 4.6%, P < 0.001). An electrocardiogram was suggestive of diagnosis in 103 (16.3%), while head computed tomography, treadmill, and echocardiogram had no diagnostic utility in this patient population. DISCUSSION: In a healthy population serving within a combat zone, there exists a differential expression of disease in those taking supplements. Further study of a prospective nature to determine the impact of supplement use in this environment may allow for a more refined policy toward use and medical evaluation.

The cardiovascular patient's perceptions of complementary and alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among patients with cardiovascular disorders and is generally underrecognized by physicians. The attitudes of these patients regarding these therapies and their perceptions of safety and efficacy have not been well defined. METHODS: A written survey was received from a cohort of outpatients seen at a large outpatient cardiovascular clinic in Texas. Over 75% of patients responded, with more than 90% of returned surveys adequate for analysis. RESULTS: Of the 210 respondents 113 admitted to CAM use, with Vitamins E and C being the most frequently utilized agents. Women were significantly more likely to take CAM than men (69 vs. 46%, p = 0.002), particularly those taking hormone replacement therapy. Over half of patients surveyed stated their cardiologist was unaware of their use of CAM. Only 15% of patients felt that CAM was more efficacious than their traditional medications, but almost half felt it was significantly safer. A similar number were unaware of any interactions between CAM and their other medications. CONCLUSIONS: Use of CAM is common in cardiology outpatients, and many patients remain unaware of potential health risks. Physicians should routinely question patients about use of CAM and attempt to educate users regarding potential health risks.