Chronotropic incompetence to exercise in anorexia nervosa patients during the body-weight recovery phase as an index of insufficient treatment.

Resting bradycardia is an important symptom for early diagnosis of anorexia nervosa (AN) during weight loss, and it improves with body-weight recovery. However, chronotropic incompetence (CI) in exercise is observed in some patients with AN despite amelioration of resting bradycardia in the recovery phase. We examined the relationship between CI in exercise and other parameters in patients with AN during the recovery phase. Ninety-two girls with AN (aged 13-20 years, median 15 years) performed cardiopulmonary exercise tolerance tests with a bicycle ergometer in the post-treatment recovery phase. Subjects with a peak-heart rate (HR) of < 160 beats/min (bpm) on subjective maximum loading were assigned to the CI+ group (n = 7), and those with a peak-HR of ≥ 160 bpm were assigned to the CI- group (n = 85). The peak-oxygen uptake (VO2) of both groups was below the normal range. Although there was no difference in peak-VO2 between these groups, both the resting-HR and ΔHR (peak-HR - resting-HR) were significantly lower in the CI+ group than in the CI- group (82 ± 8 vs. 93 ± 16 bpm, respectively; 72 ± 14 vs. 89 ± 13 bpm, respectively), suggesting lower exercise tolerance in patients with CI during the recovery phase of AN. Interestingly, the ΔVO2/ΔHR value was higher in the CI+ group than in the CI- group (0.31 ± 0.13 vs. 0.26 ± 0.06, respectively), suggesting excessive stroke volume for maintaining the cardiac output in patients with CI during their recovery phase. These data suggest that CI could be an index of insufficient recovery of AN and utilized for ideal exercise treatments of patients with AN during the recovery phase.

Implante de desfibrilador subcutáneo S-ICDTM: experiencia inicial en un centro español / Implantation of the subcutaneous implantable defibrillator S-ICDTM: initial experience in a single spanish center

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Improvised transvenous cardiac pacing during Operation Enduring Freedom.

We report a case of combat cardiology at a military medical facility in Afghanistan. The patient had a high-degree heart block following inferior ST-elevation myocardial infarction requiring cardiac pacing. Transcutaneous pacing failed, leading to asystolic arrest during critical care air transport. An available transvenous pacing wire was soldered to leads from transcutaneous pacing pads allowing effective in-flight cardiac pacing until definitive therapy was available. This case demonstrates use of available resources under austere conditions, has the potential to inform physicians in similar circumstance, and addresses an area of need at military medical facilities.

[Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery]. / Traumatisch ruggenmergletsel en cardiovasculaire complicaties door neurogene shock: een mogelijke bedreiging voor het functionele herstel.

Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

[Drug bradyarrhythmias as a cause of hospital admission. Study of 83 cases]. / Bradiarritmias secundarias a fármacos como causa de ingreso hospitalario. Estudio de 83 casos.

BACKGROUND AND OBJECTIVE: The frequency and circumstances associated with drugs-induced bradiarrhythmia (DB) causing hospital admission are little known. PATIENTS AND METHOD: Retrospective analyses of DB in Cardiology (CD) and Internal Medicine (IMD) Departments of a 3rd level hospital over two consecutive years. RESULTS: We detected 83 cases (mean age: 72.68, 75.9% women). Most frequent DB was slow atrial fibrillation (55.4%). DB were due to the use of one drug in 41 cases and to an association in 42 cases. Most frequently involved drug was digoxine (62.7%). DB were due to the use of one drug in 41 cases and to an association in 42 cases. Most frequently involved drug was digoxine (62.7%), which was commonly associated with another drug (69.3%). Most frequent pharmacological associations were negative chronotropic drugs (57.1%) followed by their association with a diuretic and/or an angiotensin converting enzyme inhibitor (42.8%), causing renal failure and/or potassium imbalance. CONCLUSIONS: Drugs-induced bradiarrhythmia is a frequent cause of hospital admission in aged people, especially women, and is frequently due to drugs associations and/or renal failure.

[Ways of decreasing lethality in various forms of bradyarrhythmia]. / Puti snizheniia letal'nosti pri razlichnykh formakh bradiaritmii.

Hospital mortality analysis in patients with different kinds of bradyarrhythmias after electrocardiopacemaker implantation operation performance was conducted. Significant haemodynamics improvement did not occur, if the patients had the pronounced coronary atherosclerosis. It was concluded that combined surgical correction of this pathology is needed.