Prevalence of Erectile Dysfunction in Atrial Fibrillation Patients: A Cross-Sectional, Epidemiological Study.

BACKGROUND: Sexual dysfunctions, especially erectile dysfunction (ED), are a major problem in cardiovascular patients. They are caused by cardiovascular risk factors including low-grade inflammation process, endothelial dysfunction, oxidative stress, and hemodynamic and vascular alterations. The same mechanisms are some of the main causes and/or consequences of atrial fibrillation (AF). To this day, literature provides no cross-sectional data on the prevalence of sexual dysfunction in AF. The study aimed to determine the prevalence of sexual dysfunction in consecutive, young male patients with AF. MATERIAL AND METHODS: A cross-sectional survey of adult male patients with a primary diagnosis of AF was conducted at University Cardiology Departments, during the period of July 2013 to July 2014. During the enrollment process, the study participants were either electively hospitalized with a primary diagnosis of AF, or had a scheduled outpatient visit. Sexual dysfunctions were assessed using the International Index of Erectile Function. RESULTS: A total of 129 consecutive AF patients (mean age 57.0 ± 11.8 years) were analyzed. Hypertension was present in 60.5%, diabetes in 22.5% of patients, 46.5% had dyslipidemia, 18.6% were current smokers, and 45.7% had a family history of cardiovascular disease. At least one kind of sexual dysfunction was found in 86.8% of patients. ED was present in 57.4% of patients, 44.2% of patients had orgasmic dysfunction, 69.0% had lowered sexual desire, 65.1% had lowered intercourse satisfaction, and 55.8% had lowered overall satisfaction. CONCLUSIONS: Sexual dysfunctions are highly prevalent in AF patients and are not only limited to ED, but also include dysfunction of orgasmic function, desire, or general satisfaction. In part, the presence of the sexual dysfunctions is probably caused by classical cardiovascular risk factors highly prevalent in AF patients, but the impact of AF itself cannot be underestimated.

Long QT interval in a patient after out-of-hospital cardiac arrest with hypocalcaemia, undergoing therapeutic hypothermia.

A 53-year-old woman was hospitalized after out-of-hospital cardiac arrest due to ventricular fibrillation. Initial electrocardioagram showed sinus rhythm of 117 beats per minute, 452 ms QTc interval, ST-segment depression up to 1 mm in V(2)-V(6), and ST-elevation in lead aVR. Patient was treated with primary coronary angioplasty and therapeutic hypothermia, during which QTc interval prolonged up to 616 ms and Osborn wave was seen in lead V(4), along with elevation of ST-segment in I, II, III, aVF, V(5) and V(6); negative T waves in I, II, aVL, aVF, and V(2)-V(6). Laboratory test results showed hypocalcaemia. After rewarming and ion correction QT abnormalities resolved.

[Sexual dysfunction in men in the first 9 months after myocardial infarction]. / Dysfunkcje seksualne u mezczyzn w ciagu pierwszych 9 miesiecy po przebytym zawale serca.

OBJECTIVES: The aim of the study is to assess the frequency of sexual dysfunction in men after myocardial infarction (MI). METHODS: 62 men were asked to fill IIEF 15 to assess sexual dysfunction 3 and 9 months after MI. RESULTS. Erectile dysfunction (ED), orgasmic dysfunction, decreased sexual desire, decreased intercourse satisfaction, decreased overall satisfaction were recognized respectively by: 61.3%, 24.2%, 62.9%, 71%, 54.8% of men 3 months after MI, and 51.6%, 17.7%, 58.1%, 77.4%, 59.7% of men 9 months after MI. Men with ED had higher serum CRP (5.8 vs. 3.8; p = 0.04) and creatinine (1 vs. 0.9; p = 0.04) levels in the peri-infarction period and higher serum BNP (47.4 vs. 24.6; p = 0.04) measured 3 months after MI than men without ED. They had also higher serum testosterone levels than men without ED (12.6 vs. 10.6; p = 0.03). Men with decreased sexual desire had significantly lower serum DHEAs (dehydroepiandrosterone sulfate) levels in the peri-infarction period than men with normal sexual desire (191.1 vs. 224.3; p = 0.044). Men with ED 9 months after MI had higher serum CRP levels in the peri-infarction period (7.5 vs. 4.6; p = 0.0371). Men with orgasmic dysfunction had lower left ventricular ejection fraction (EF) measured in the peri-infarction period (0.4 vs. 0.5; p = 0.0318). CONCLUSIONS: 1. Men with ED have higher serum CRP and creatinine levels in the peri-infarction period. 2. DHEAs level has an influence on sexual desire and on erectile function after MI. 3. BNP level in post-MI patients affects erectile function. 4. EF has an impact on orgasmic function.

Fuzzy Multi-Regional Fractional PID controller for Pressurized Water nuclear Reactor.

The paper presents the methodology for the synthesis of a Fuzzy Multi-Regional Fractional Order PID controller (FMR-FOPID) used to control the average thermal power of a PWR nuclear reactor in the load following mode. The controller utilizes a set of FOPID controllers and the fuzzy logic Takagi-Sugeno reasoning system. The proposed methodology is based on two optimization parts. The first part is devoted to finding the optimal parameters of local FOPID controllers and in the second part, the optimal membership functions of the fuzzy reasoning system are designed. During the controller designing and comparison phase, the two validated nodal models of a nuclear reactor are used, simplified model and extended model respectively. The proposed approach has been verified by computer simulations that confirm its effectiveness.

The effects of CD4 nadirs on vessel stiffness in HIV patients undergoing antiretroviral therapy.

BACKGROUND: There are many factors associated with human immunodeficiency virus (HIV) patients having a greater risk of cardiovascular diseases (CVD). HIV damages vessel endothelium through chronic inflammation, which, combined with dys-lipidaemia, arterial hypertension, and antiretroviral therapy leads to the progression of atherosclerotic changes. AIM: Our goal was to determine if a CD4 nadir along with immunological, inflammatory, biochemical, and metabolic mark-ers can be associated with higher vessel stiffness and therefore an increased risk of CVD in patients undergoing antiretroviral therapy for HIV. METHODS: Endothelial damage was evaluated in 20 patients (including four female) during successful antiretroviral therapy. We assessed the endothelial stiffness by recording the reactive hyperaemia of peripheral arteries using an Endo-PAT2000 (ITAMAR®) device. This device allowed us to measure the arterial tonometry and to determine the augmentation index for a pulse rate of 75/min (AI@75). We set the normal value for vessel stiffness at reactive hyperaemia index (RHI) > 1.67, as recommended by the manufacturer. Additionally, we recorded the length of antiretroviral therapy, number of CD4 lymphocytes, CD4 nadir, HIV viremia, and biochemical and immunologic results. Finally, we compared patients with normal and dysfunctional endothelium. RESULTS: The only parameter significantly differentiating between the group with and group without endothelium dysfunction was platelet count (p = 0.012). CONCLUSIONS: We were not able to confirm the significance of a CD4 nadir in the progression of endothelial stiffness in HIV patients. However, platelet values could be an important complementary marker for assessing the risk for CVD amongst HIV patients undergoing antiretroviral treatment.

Evaluation of endothelial function and arterial stiffness in HIV-infected patients: a pilot study.

BACKGROUND: In the era of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients is the same as that of the general population, resulting in increasing prevalence of cardiovascular disease in this patient group. AIM: To assess the prevalence of endothelial dysfunction in HIV-infected patients and to identify factors which affect endothelial function and arterial stiffness. METHODS: Thirty-seven adult HIV-infected patients, regardless of the fact and the type of cART, were enrolled into the study. In patient, reactive hyperaemia peripheral arterial tonometry assessment was performed using the Endo-PAT2000 device (ITAMAR®). This method allows evaluation of endothelial function ant arterial stiffness. RESULTS: Final analysis included 37 patients (median age 38 years, range 32-45 years), including 89.2% men. Endothelial dysfunction was found in 13 (35.1%) HIV-infected patients. We found no differences in demographic and clinical characteristics, laboratory data, and cardiovascular drug therapy between patients with or without endothelial dysfunction, except for platelet count which was higher in patients with endothelial dysfunction (174 [119-193] × 10³/mm3 vs. 222 [168-266] × 10³/mm³, p = 0.03). No demographic or clinical variables were identified as predictors of endothelial dysfunction in HIV-infected patients. In addition, no association was found between factors related to HIV infection, chronic drug therapy and the risk of endothelial dysfunction. Statistically significant correlations were found between arterial stiffness and age (rs = 0.53, p < 0.001), red blood cell count (rs = -0.39, p = 0.018), and platelet count (rs = 0.42, p = 0.009). CD4+ and CD8+ lymphocyte count and viral load were similar in patients with or without endothelial dysfunction. Arterial stiffness was significantly higher in patients with higher viral load (rs = -0.39, p = 0.0018) and in those with established AIDS (9.5 [1.0-16.0] vs. -5 [-10-5], p = 0.009). cART had no effect on endothelial dysfunction, while arterial stiffness was higher in patients treated with cART (10 [0-15] vs. -5 [-10-3], p = 0.014). CONCLUSIONS: Endothelial dysfunction is common in HIV-infected patients. In general, none of the analysed factors had an effect on endothelial function but cART had a negative effect on arterial stiffness.

Obstructive sleep apnoea in patients with atrial fibrillation: prevalence, determinants and clinical characteristics of patients in Polish population.

BACKGROUND: Obstructive sleep apnoea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause haemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in AF triggering and exacerbation. Coexistence of OSA and AF influences the course of both diseases, and therefore should be taken into consideration in patient management strategy planning. AIM: To assess the prevalence of OSA in Polish AF patients, and to describe the clinical characteristics of patients with concomitant OSA and AF. METHODS: We enrolled into the study 289 consecutive patients hospitalised in a tertiary, high-volume Cardiology Department with a primary diagnosis of AF. In addition to standard examination, all patients underwent an overnight sleep study to diagnose OSA, which was defined as apnoea-hypopnoea index (AHI) ≥ 5 per hour. RESULTS: After applying exclusion criteria, the final analysis covered 266 patients (65.0% male, mean age 57.6 ± 10.1 years). OSA was present in 121 (45.49%) patients. Patients with OSA were older (59.6 ± 8.0 vs. 56.0 ± 11.4 years; p = 0.02), had higher body mass index (BMI; 30.9 ± 5.4 vs. 28.7 ± 4.4 kg/m²; p < 0.01) larger neck size (41.2 ± 3.8 vs. 39.3 ± 3.3 cm; p = 0.0001) and waist circumference (108.5 ± 13.1 vs. 107.7 ± 85.4 cm; p < 0.0001) than patients without OSA. There were no significant differences between the groups in terms of systolic and diastolic blood pressure or history of comorbidities (p > 0.05). OSA patients were less likely than non-OSA patients to have paroxysmal AF (62.0% vs. 75.9%; p = 0.02). Dividing newly diagnosed OSA patients according to the disease severity showed that mild OSA (AHI ≥ 5/h and < 15/h) was present in 27.82% of the study population, moderate OSA (AHI ≤ 15/h and ≥ 30/h) in 13.16% of patients, and severe OSA (> 30/h) in 4.51% of patients. No significant differences in terms of comorbidities and anthropometric features were seen between mild and moderate, between moderate and severe, and between mild and severe OSA. CONCLUSIONS: OSA is highly prevalent in patients with AF in the Polish population, and affects approximately half of the patients. OSA patients are more likely to be older, have higher BMI, and greater waist and neck circumference. Persistent AF is the most common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.

Clinical characteristics, aetiology and occurrence of type 2 acute myocardial infarction.

BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide. One of the most important diseases in this group is myocardial infarction (MI). According to the universal definition developed by the European Society of Cardiology (ESC), MI is divided into five main types based on its cause. Type 2 MI is secondary to ischaemia due to either increased demand or decreased supply of oxygen (for example due to coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension). AIM: To assess the occurrence and aetiology of type 2 acute MI (AMI), and to describe the clinical characteristics and prognosis of study patients. METHODS: Into a retrospective study, we enrolled 2,882 patients in the Cardiology Department with an initial diagnosis of AMI between 2009 and 2012. Diagnosis of AMI was made based on ESC criteria. In all patients, coronary angiography was performed in order to exclude haemodynamically significant coronary lesions. RESULTS: Among 2,882 patients hospitalised in the described time period, 58 (2%) patients were diagnosed with type 2 AMI.The mean age of the study group was 67.3 ± 13.2 years; and the majority of the study group, 60.3%, were women. Out of them, 23 (39.6%) patients experienced AMI due to coronary artery spasm, 15 (25.9%) due to arrhythmias, 11 (19%) due to severe anaemia, and nine (15.5%) due to hypertension, without significant coronary artery disease. 42 (72.4%) patients, were diagnosed as non-ST-segment elevation MI, 14 (24.1%) as ST-segment elevation MI, and two (3.5%) as AMI in the presence of ventricular paced rhythm. History of classical cardiovascular risk factors including hypertension, diabetes, dyslipidaemia, family history of heart diseases, and smoking was reported in 42 (72.4%), 14 (24.1%), 23 (39.7%), 24 (41.4%), and 16 (27.6%) cases, respectively. All-cause 30-day mortality rate was 5.2%, and six-month was 6.9%. CONCLUSIONS: Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation MI. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading cause of AMI was coronary artery spasm.

Obstructive sleep apnea, atrial fibrillation, and erectile dysfunction: are they only coexisting conditions or a new clinical syndrome? The concept of the OSAFED syndrome.

Patients rarely suffer from only 1 disease. Most of them have several conditions with common risk factors and etiology, and which often increase the severity of each other. The phenotypes linked to 1 condition are often linked to many others. We describe 3 patients with obstructive sleep apnea (OSA), atrial fibrillation (AF), and erectile dysfunction (ED), all of which are highly prevalent in the general population. OSA is one of the most common sleep disorders, affecting approximately 24% of men and 9% of women between 30 and 60 years of age. AF is one of the most common arrhythmias, present in approximately 2% of the population, and erectile dysfunction can be found in 18% to 40% of the male population older than 20 years. The presence of these 3 conditions in the same patient may be not only a coincidence but rather a new clinical syndrome. We present data which allow one to consider OSA, AF, and ED as parts of a clinical syndrome: OSAFED (obstructive sleep apnea, atrial fibrillation, and erectile dysfunction), with a larger effect on the cardiovascular risk profile than those 3 conditions taken alone. Introducing the OSAFED acronym into everyday clinical practice would have the tremendous advantage of reminding health care workers to screen every patient with either OSA, AF, or ED for the remaining 2 diseases. This would result in an early diagnosis and break the vicious circle of mutual disease exacerbation.

The prevalence of sexual dysfunction before myocardial infarction in population of Polish men: a retrospective pilot study.

BACKGROUND AND AIM: To assess the frequency of sexual dysfunction in men before myocardial infarction (MI). METHODS: Sixty-two men with cardiovascular disease risk factors who were admitted to the hospital because of a first MI, were asked to fill the IIEF-15 questionnaire to assess sexual dysfunction before MI. RESULTS: Erectile dysfunction (ED), decreased orgasmic function, decreased sexual desire, decreased intercourse satisfaction, and decreased overall satisfaction were reported by 51.6%, 14.5%, 50%, 69.4%, and 48.4% of men, respectively. Men with ED had significantly higher serum C-reactive protein (CRP) levels than men without ED (5.8 mg/L, 95% confidence interval [CI] 8.3-21.7) vs. 4.6 mg/L, 95% CI 3.0-11.3; p = 0.01). Men with decreased orgasmic function had significantly higher serum triglyceride levels (259.5 mg/dL, 95% CI 176.9-362.1 vs. 150 mg/dL, 95% CI 146.8-187.4; p = 0.01), and men with normal sexual desire had significantly higher serum high-density lipoprotein (HDL) cholesterol levels than men with decreased sexual desire (41 mg/dL, 95% CI 39.9-47.8 vs. 36 mg/dL, 95% CI 34.1-40.5; p = 0.01). Men with decreased sexual desire had significantly higher serum CRP levels (7 mg/L, 95% CI 7.7-21.4 vs. 5 mg/L, 95% CI 3.6-12.1; p = 0.03). CONCLUSIONS: 1. ED was present in more than half of men before MI and it may be the first symptom of coronary artery disease. 2. Men with ED and decreased sexual desire have higher serum CRP levels in the acute peri-infarction period. 3. Serum triglyceride level is a factor that significantly affects orgasmic function, and serum HDL cholesterol level is a factor that significantly affects sexual desire.

[Cardiac tamponade as the initial symptom of lung cancer]. / Tamponada serca pierwszym objawem raka pluca.

We report a case of a 55 year-old woman in whom cardiac tamponade was first symptom of lung cancer. The pericardium is involved in about 12% of patients with malignant disease. Cardiac tamponade is life-threatening situation. In our case diagnosis was made on clinical symptoms and echocardiography. Only urgent pericardiocentesis performed under echocardiograhic guidance can save patient's life. In described case final diagnosis was made on histological examination. We should take into the consideration lung cancer in differentiation causes of cardiac tamponade.