Recurrent sudden cardiac death secondary to anomalous right coronary artery: Insights into prevalence and management.

A 32-year-old woman presented after ventricular fibrillation arrest requiring three defibrillations. The episode coincided with an upper respiratory infection and physical exertion. Eight years prior, she survived another cardiac arrest of unknown cause during childbirth. This time, imaging revealed an anomalous right coronary artery connecting to the left coronary cusp, with a small, slit-like osteal orifice coursing between the aorta and pulmonary artery. Surgical exploration revealed an intramural segment of the right coronary artery, which was surgically unroofed with improvement in cardiac function. An implantable cardioverter-defibrillator was implanted for secondary prevention of sudden cardiac death. Surgery is recommended for malignant anomalous coronary arteries, with a very low risk of recurrence of arrhythmia and sudden cardiac death after surgery. However, with growing evidence for persistent risk of arrhythmia and sudden cardiac death even after surgical correction of the anomalous coronary arteries, more experts choose to take secondary prevention measures as a component of initial management.

Outcomes in Takotsubo Syndrome Following Left Ventricular Ejection Fraction Improvement.

Takotsubo syndrome (TTS) is evaluated by monitoring of left ventricular (LV) ejection fraction (LVEF); however, there are limited data to correlate echocardiographic findings with long-term outcomes. This study assessed clinical outcomes in patients with TTS and their association with echocardiographic parameters. Echocardiographic parameters at the time of diagnosis and on first follow-up were collected for 115 consecutive patients (58.5 ± 15.2 years, 74.8% women) diagnosed with TTS. The primary clinical end points were all-cause mortality and time to first readmission. Cox proportional hazard analysis was used to assess the association between echocardiographic parameters and clinical end points. Mean baseline LVEF and global longitudinal strain (GLS) were 37.1 ± 10.7% and -8.5 ± 3.4%, respectively. On follow-up echocardiogram at median of 14 days, LVEF and GLS improved to 58.7 ± 9.3% and -14.2 ± 4.0%, respectively. Most patients (83%) experienced normalization of LVEF (>50%), whereas only 20% had normalization of LV-GLS (<-18%). A total of 99 patients had clinical follow-up after the second echocardiogram with a median follow-up time of 1.3 years. Estimated Kaplan-Meier survival at 2 years was 80% (95% confidence interval 69% to 88%), and median time to readmission was 226 days. There was no significant association between any of the echocardiographic parameters (including LV end-diastolic diameter and baseline, follow-up, and differential LVEF and GLS) and our clinical end points. Zero deaths and only 10.4% of first readmissions were from cardiovascular causes. This suggests that although cardiology follow-up with repeat imaging is important after TTS, additional follow-up with noncardiology specialists is essential to improve outcomes.

Sleep Apnea Screening Practices During Department of Transportation Medical Examinations.

OBJECTIVE: The aim of this study was to examine the practices of Michigan Occupational and Environmental Medicine Association (MOEMA) members regarding screening for sleep apnea during required driver medical examinations. METHODS: A 13-question survey on sleep apnea screening practices was emailed to the MOEMA member. Nonresponders received additional E-mails and calls. RESULTS: The survey response rate was 66%. Fifty-five percent of respondents performed driver examinations and 94% screened for sleep apnea. Variations in practice included differences in how many risk factors were used to determine the need for polysomnography, 13% never ordered polysomnography and 42% never denied medical certification because of sleep apnea. CONCLUSION: Although there was significant consensus that sleep apnea screening was important, there was a large variation in the indication for and frequency in which sleep studies were ordered and drivers were denied approval because of concern about sleep apnea.