Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors.

AIMS: The aim of our study was to evaluate the prevalence and clinical predictors of cardioinhibitory (CI) responses with asystole at the nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) in patients with a history of syncope admitted to a tertiary referral syncope unit. METHODS: We retrospectively evaluated all consecutive patients who underwent NTG-potentiated HUTT for suspected reflex syncope at our institution from March 1 2017 to May 1 2020. The prevalence of HUTT-induced CI syncope was assessed. Univariate and multivariate analyses were performed to test the association of asystolic response to HUTT with a set of clinical covariates. RESULTS: We enrolled 1285 patients (45 ± 19.1 years; 49.6% male); 368 (28.6%) showed HUTT-induced CI response with asystole. A multivariate analysis revealed that the following factors were independently associated with HUTT-induced CI syncope: male sex (OR 1.48; ConInt 1.14-1.92; P = 0.003), smoking (OR 2.22; ConInt 1.56-3.115; P < 0.001), traumatic syncope (OR: 2.81; ConInt 1.79-4.42; P < 0.001), situational syncope (OR 0.45; ConInt 0.27-0.73; P = 0.002), and the use of diuretics (OR 9.94; ConInt 3.83-25.76; P < 0.001). CONCLUSIONS: The cardioinhibitory syncope with asystole induced by NTG-potentiated HUTT is more frequent than previously reported. The male gender, smoking habit, history of traumatic syncope, and use of diuretics were independent predictors of HUTT-induced CI responses. Conversely, the history of situational syncope seems to reduce this probability.

Arrhythmias and Sudden Cardiac Death in Beta-Thalassemia Major Patients: Noninvasive Diagnostic Tools and Early Markers.

Beta-thalassemias are a group of inherited, autosomal recessive diseases, characterized by reduced or absent synthesis of beta-globin chains of the hemoglobin tetramer, resulting in variable phenotypes, ranging from clinically asymptomatic individuals to severe anemia. Three main forms have been described: heterozygotes, homozygotes ß+, and homozygotes ß°. Beta-thalassemia major (ß-TM), the most serious form, is characterized by an absent synthesis of globin chains that are essential for hemoglobin formation, causing chronic hemolytic anemia. Cardiac complications represent a leading cause of mortality in ß-TM patients, although an important and progressive increase of life expectancy has been demonstrated after the introduction of chelating therapies. Iron overload is the primary factor of cardiac damage resulting in thalassemic cardiomyopathy, in which diastolic dysfunction usually happens before systolic impairment and overt heart failure (HF). Although iron-induced cardiomyopathy is slowly progressive and it usually takes several decades for clinical and laboratory features of cardiac dysfunction to manifest, arrhythmias or sudden death may be present without signs of cardiac disease and only if myocardial siderosis is present. Careful analysis of electrocardiograms and other diagnostic tools may help in early identification of high-risk ß-TM patients for arrhythmias and sudden cardiac death.

Honor, brotherhood, and the corporate ethos of London's Barber-Surgeons' Company, 1570-1640.

As the largest and most civically active body of medical practitioners in the late Tudor and early Stuart period, surgeons played a vital role in London's urban landscape, but remained precariously vulnerable to abasement due to the regular contact with death and disease necessitated by their work. Based on an analysis of guild records, printed surgical manuals, and conduct literature, this study explores the emergent corporate ethos of London's Barber-Surgeons' Company and addresses the identity formation of surgeons in the late-sixteenth and early-seventeenth centuries. By implementing codes of conduct and uniform standards of practice, punishing transgressions of propriety, and developing legislation to limit the activities of unlicensed and foreign practitioners, Company officers ardently sought social and occupational legitimacy within a milieu characterized by a tremendous emphasis on status and hierarchy. Rooted in methodology drawn from the social history of medicine and cultural anthropology, this study argues that in response to the persistent stigma associated with their work and London's increasingly prevalent culture of credit, surgeons, like other artisanal groups, sought to enhance their social legitimacy and occupational respectability by manipulating contemporary social rituals, reinforcing the honorable associations of their work, and preserving the veneer of brotherhood and camaraderie.