Maternal Deaths From Childbirth Still High

In a report titled “Progress for Children: A Report Card on Maternal Maternity” the United Nations Children’s Fund (UNICEF) states that the number of mothers who died during pregnancy or childbirth remain largely unchanged. Over 99% of the estmated 536,000 worldwide maternal deaths in 2005 occurred in developing countries - half of them in sub-Saharan Africa. “One of the critical bottlenecks has always been access to highly skilled health workers required to deliver emergency obstetrical care, particularly caesarian sections,” Peter Salama UNICEF’s chief of health, told a news briefing. The leading causes of maternal death include hemorrhaging, infections, blood pressure problems, complications of abortions, obstructed labor, and HIV/AIDS.
Read more and share your opinion.

Heart Attacks Dip Day After Daylight Savings Time Ends

After looking at 20 years of records, Swedish researchers found that the number of heart attacks decreased the Monday after daylight savings time ended, possibly due to the extra hour of sleep most people get. Typically, most heart attacks occur on Mondays due to the increased stress load and activity of the new week. The researchers also noted that the number of heart attacks increased throughout the week after “springing forward” an hour. This may be due to the persistence of sleep disturbance following the reduction of sleep time, which may add to the stress load of the work week.

Interventional cardiology

Interventional cardiology is a branch of the medical specialty of cardiology that deals specifically with the catheter based treatment of structural heart diseases.
A large number of procedures can be performed on the heart by catheterization. This most commonly involves the insertion of a sheath into the femoral artery (but, in practice, any large peripheral artery or vein) and cannulating the heart under X-ray visualization (most commonly
fluoroscopy, a real-time x-ray).
Procedures performed by specialists in interventional cardiology:
Angioplasty (PTCA, Percutaneous Transluminal Coronary Angioplasty) - for coronary atherosclerosis
Valvuloplasty - dilation of narrowed cardiac valves (usually mitral, aortic or pulmonary)
Procedures for congenital heart disease - insertion of occluders for ventricular or atrial septal defects, occlusion of patent ductus arteriosus, angioplasty of great vessels
Emergency angioplasty and stenting of occluded coronary vessels in the setting of acute myocardial infarction
Coronary Thrombectomy - a procedure performed to remove thrombus (blood clot) from blood vessels.[1]
Invasive procedures of the heart to treat arrhythmias are performed by specialists in clinical cardiac electrophysiology
Surgery of the heart is done by the specialty of cardiothoracic surgery. Some interventional cardiology procedures are only performed when there is cardiothoracic surgery expertise in the hospital, in case of complications.

Circadian Rhythm-Metabolism Link Discovered

Researchers at the University of California, Irvine have discovered a protein that senses energy usage in our cells. This protein, called SRT1, works in concert with a circadian rhythm protein called CLOCK to regulate our cells’ activities. When the balance between these proteins is disrupted, say by poor sleep or diet patterns, normal cell functions can become upset in the process. This discovery of a link between a protein involved in cell metabolism and one involved in circadian rhythms demonstrates how sleep disturbance can lead to metabolic problems such as obesity, diabetes, and even accelerated aging.

Common Vaginal Infection May Increase Likeliness of HIV Infection

Public health researchers have found that women who have bacterial vaginosis (BV), a common vaginal infection, may be more susceptible to contracting HIV. It is unclear what the nature of the relationship between the two sexually transmitted diseases is. One theory is that BV changes the environment of the vagina by depleting “healthy” bacteria that usually defend against infections. BV also decreases the acidity of the vaginal environment, which may allow the HIV virus to better survive and cause infection.

Toxic Chemicals Found In Detergents, Air Fresheners

Did you know that manufacturers are not required to list the ingredients used in laundry products and air fresheners sold in the US? A new study from the University of Washington analyzed the chemical contents of top-selling detergents and air fresheners and found staggering amounts of toxic and volatile compounds which were not listed on any of the product labels. For example, one popular plug-in air freshener contained more than 20 unlisted volatile organic compounds, seven of which are regulated as toxic or hazardous under US laws. “Fragrance chemicals are of particular interest because of the potential for involuntary exposure,” said study leader Anne Steinemann, a UW professor of civil and environmental engineering. Her previous studies have showed that 20% of the population reported adverse health effects from air fresheners, and 10% complained of adverse effects from laundry product scents vented to the outdoors. These complaints doubled among people with asthma. Professor Steinemann hopes her research will raise public awareness and reduce exposures to potentially hazardous chemicals. In the meantime she recommends the use of scent-free consumer products.

Trans Fat Labeling May Mislead

Trans fats are once again in the news after governor Arnold Schwarzenegger signed into law a ban on the use of trans fats by California restaurants. Trans fat is produced by the food industry to increase the shelf life of food products by making oil solid at room temperature. The problem with trans fats is that they have severe adverse effects on cholesterol levels which increases coronary heart disease risk. But, is selecting foods labeled as containing zero grams of trans fats enough to avoid it? As it turns out, trans fat does not have to be listed if the total fat in a food is less than 0.5 gram per serving (source: FDA). For now, the only reliable way of reducing your trans fat intake is to eat unprocessed foods or follow some of these practical tips from the FDA.

Tobacco Plants Make Cancer Vaccine

Stanford University researchers have successfully produced antibodies against a specific type of cancer called follicular B cell lymphoma. Antibodies are traditionally produced from animals, however, this was the first human study of an injectable vaccine produced by plants. Ironically, the antibodies were produced by tobacco plants. When injected into humans, these antibodies can trigger the immune system to target cancer cells that are specific to that patient’s tumor, thus allowing the body to better fight the cancer. The advantages of plant-produced antibodies include lower cost, faster production times, and individually tailored vaccines capable to targeting each patient’s specific cancer. More trials to evaluate this method is currently under way.

West Nile Virus Expected For Summer 2008

The US Centers for Disease Control and Prevention is expecting summer 2008 to bring the same epidemic of West Nile Virus (WNV) as the previous four years. WNV is caused by an organism called a flavivirus. Humans contract the disease after getting bitten by mosquitoes that get the disease from feeding on infected birds. Signs of infection can range from mild flu-like symptoms to severe muscle aches, meningitis, confusion, and even death. Since there is no effective treatment or vaccine for WNV at the moment, the best way to stop the disease is through prevention. Repellent sprays containing DEET or oil of lemon eucalyptus, among others, are recommended. As well, eliminating standing water where mosquitoes breed can help to control disease spread. Full CDC guidelines.

High Fructose Corn Syrup Plans Resurgence

Since its introduction high fructose corn syrup (HFCS) has been used as sweeteners in a multitude of processed foods. HFCS refers to corn syrups which have undergone enzymatic processing in order to increase their fructose content. In recent years HFCS has been blamed, in part, for America's rising rate of obesity. However, beginning this week, the Corn Refiners Association, a HFCS advocacy group, is launching a new ad and public-relations campaign to convince consumers of the safety of HFCS. Full story.

AMA Says Clinics And Tobacco Don't Mix

The American Medical Association has adopted its position on retail health clinics this week at their annual policy meeting in Chicago. While the AMA is not against retail clinics per say, they believe that clinics should not be located inside retail establishments which sell tobacco. This makes philosophical sense from a health perspective, but some wonder whether this is an attempt at slowing the rapid growth in number of such clinics. In a statement today, the Convenient Care Association, the retail clinic industry advocate group, says, "We do not understand how forcing retailers to choose between having an in-store clinic and selling tobacco products serves the broader goal of providing consumers with easier access to high-quality, affordable healthcare.” Full story.

The Big Breakfast Diet

In dieting, fads are a dime a dozen. However, a new study is showing that the "big breakfast diet" - eating a hearty breakfast followed by meals lower in calories and carbohydrates - keeps the pounds off better than strict low-carb diets. Researchers say the big breakfast diet was more effective at helping women lose weight over the study period because it controlled appetite and cravings for carbohydrate foods, which are rich in sugar and starch. As well, dieters who adhered to the big-breakfast diet consumed more fruit and therefore got more fiber and vitamins. "Only 5 per cent of low carbohydrate diets are successful after two years, and most of them do not address addictive eating impulses," said lead researcher Dr. Daniela Jakubowicz, who has been using the diet successfully with patients for over 15 years. Full story.

Rare Tuberculosis Strain Returning

Tuberculosis (TB) experts in Southern California have been keeping track of a rare strain of bacteria, Mycobacterium bovis, which causes TB when ingested. Mycobacterium bovis was largely eradicated in the US in the 1900s, but it's making a resurgence due to improperly prepared dairy products. “I wouldn’t want to characterize it as increasing in epidemic proportions. But it’s clearly being seen, and being seen in places where people drink unpasteurized milk and eat unpasteurized dairy products,” said Dr. Kathleen Moser, director of tuberculosis control programs for San Diego County. The problem stems from infected cattle in Mexico where M. bovis infects an estimated 17% of the herds. Cheeses made from infected milk can also spread the disease. Because this type of strain is spread largely by ingestion of the bacteria, human-to-human contact should be less of a concern than making sure that the dairy products you consume come from a reputable source. Full story.

Choosing Where To Live Based On Insurance Costs

There are many factors that dictate where we choose to live. But, have you considered the cost of health care when picking a future home? Medical insurance and health care costs differ tremendously from region to region. For example, the average annual premium for one type of Medicare supplement policy in 2007 ranged from $3,700 in New York to as little as $1,200 in Phoenix. Differences in costs are see among all aspects of health care - from home care workers to drug prices. Where to find more information? See insurance company websites or consumer sites such as ConsumerReports.org/health. Full story.

Cigarette Sales Drop May Not Mean Less Tobacco Use

Cigarette sales have dropped in recent years due to increased taxation and anti-smoking campaigns. However, recent data shows that sales of other types of tobacco such as snuff, roll-your-own tobacco, and small cigars have increased. The concern is that any public health gains made from smoking reduction may actually be offset by the increased use of these other tobacco types, which have not been the focus of public health efforts. Full story.

Diabetic Ulcer Gel Increases Cancer Mortality Risk

Diabetics who use becaplermin gel (marketed as Regranex) have a new warning to be aware of. The US Food and Drug Administration has issued a black box warning for this product due to safety concerns. A recent study found that those who have used more than 3 tubes of the gel have a 5-fold increase in the risk of dying from cancer, comopared to those who have never used the gel. Regranex is used to treat certain types of diabetic ulcers. Physicians are urged to report Regranex-related events to the FDA. As well, this message should be passed on to any diabetics you know. Full story.

Marijuana Potency Highest In 30 Years

According to the University of Mississippi's Potency Monitoring Project the average amount of THC, the psychoactive agent in marijuana, has increased to 9.6 percent - the highest since tracking started in 1975. The White House Office of National Drug Control Policy attributed the increases in marijuana potency to sophisticated growing techniques that drug traffickers are using in the United States and Canada. Chronic marijuana use has been linked to increased rates of anxiety, depression, suicidal ideation, and schizophrenia. Full story.

Silver Teeth Fillings Toxic To Fetuses and Children?

That is what the FDA is attempting to find out. Depending on the results of a study due to be completed in 2009, the FDA may warn against the use of silver fillings in women who plan to become pregnant, pregnant women, nursing mothers, and young children. The reason is that silver amalgam fillings contain half mercury and half a combination of other metals. Mercury has been shown to effect brain growth and result in cognitive and motor-skill development problems. However, the American Dental Association still feels the amalgam fillings, which have been used for over a hundred years, remain safe for patients based on many studies and scientific reviews conducted by both government and independent agencies. Full story.

St. John's Wort No Better Than Placebo For ADHD

The first placebo-controlled trial of St. John's wort in children and adolescents suggests that the herb has no additional benefit beyond that of a placebo in treating the symptoms of attention-deficit/hyperactivity disorder (ADHD). Up to 30% of children with ADHD either do not respond to medication, or suffer from side effects of ADHD medication. This is why many parents turn to alternative treatments like St. John's Wort. The study was published in the most recent Journal of the American Medical Association.
Full story.

Incentives Increase For Healthy Employees Amid Rising Health Care Costs

A survey of 225 major US employers revealed that more are offering formal health and wellness programs than ever. And incentives for employees to join and complete these programs have increased as well. The values for incentives averaged between $100 to $300 and were paid out in cash bonuses, gift cards, or a reduction in health care premiums. More than three-quarters of big U.S. employers offer formal health and wellness programs, which aim to prevent disease, while more than half have disease management programs. All this has been attributed, in part, to rising health care costs. Full story.

The Echocardiogram

The echo test and its uses
The echocardiogram is an extremely useful test for studying the heart’s anatomy. It is non-invasive and entirely safe, and when interpreted by well-trained cardiologists, is very accurate.
How is the echocardiogram performed?
The patient lies on a bed or examination table, and the echo technician places a transducer (a device that resembles a computer mouse) over the chest wall. The transducer is moved back and forth across the chest wall, collecting several “views” of the heart. A Vaseline-like gel is applied to the chest wall to aid in sliding the transducer back and forth. The test takes 30 – 60 minutes to complete.
How does the echocardiogram work?
The transducer placed on the chest sends sound waves toward the heart. Like the sonar on a submarine, the sound waves bounce off the cardiac structures (that is, they “echo” off the heart).The sound wave "echos" are collected by by the transducer.
These returning sound waves are computer-processed, and a two-dimensional image of the beating heart is produced on a television screen. By “aiming” the transducer, most of the important cardiac structures can be imaged by the echocardiogram.

What are some of the variations used with the echocardiogram?

Echocardiograms are sometimes used in conjunction with stress tests. An echo test is made at rest, and then with exercise, looking for changes in the function of the heart muscle when exercise is performed. Deterioration in muscle function during exercise can indicate coronary artery disease.
A Doppler microphone can be used during echocardiography to measure the velocity of blood flow in the heart. This information can be useful in assessing heart valve function.

What are the risks of having a catheterization or angiography?

Cardiac catheterization and angiography are relatively safe, but because they are invasive procedures involving the heart, several complications are possible. Nobody should have a cardiac catheterization unless there is a reasonable likelihood that the information gained from the procedure will be of significant benefit.

Minor complications of cardiac catheterization include minor bleeding at the site of catheter insertion, temporary heart rhythm disturbances caused by the catheter irritating the heart muscle, and temporary changes in the blood pressure.

More significant complications include perforation of the heart wall (causing a life-threatening condition called cardiac tamponade), sudden blockage of a coronary artery (leading to a heart attack), extensive bleeding, stroke, or an allergic reaction to the dye used in angiography.

What kinds of heart disease can catheterization and angiography help to evaluate?

Cardiac catheterization and angiography can reveal vital information about overall cardiac function, about the function of the individual cardiac chambers, about the cardiac valves (whether they are too narrow (stenosis) or too leaky (regurgitation)), congenital heart defects, and about the location and severity of blockages in the coronary arteries (the arteries that supply blood to the heart muscle). What are some of the variations used with catheterization and angiography? Cardiac catheterization is often used therapeutically, that is, to deliver treatment for various heart problems. Therapeutic catheterizations include procedures to dilate stenotic heart valves, procedures to close atrial septal defects (i.e., a hole in the wall separating the left and right atria), and of course, procedures to relieve blockages in the coronary arteries (angioplasty and stent placement).

How is a catheterization performed?

The patient is brought to the catheterization laboratory and placed on a special examination table. After local anesthesia is given, a catheter is inserted into blood vessels in the groin, arm, or neck. (The catheter is inserted either through a small incision, or by means of a needle-stick. Sometimes, catheters are inserted from more than one site.) The catheter is advanced through the blood vessels to the heart.

Once in the heart, the catheter can be maneuvered to various locations within the heart. By attaching the catheter to a pressure transducer, the pressures within various chambers of heart can be measured. Blood samples can be withdrawn from different locations in order to measure the amount of oxygen in the blood (unusual variations in blood oxygen can signal a "shunt," or abnormal blood flow within the heart, often caused by congenital heart defects.) Finally, by injecting dye through the catheter while a series of rapid x-ray images is recorded, "movies" can be made of the blood flowing through the cardiac chambers, or the through the blood vessels surrounding the heart - a procedure know as angiography (also called arteriography).

Once the procedure is completed, the catheter(s) are removed. Bleeding is controlled by placing pressure on the catheterization site for 30 - 60 minutes.

Heart caths - what you should know

Cardiac catheterization and angiography are tests in which catheters (hollow tubes) are placed into the heart in order to evaluate the anatomy and function of the heart and surrounding blood vessels. So much useful information can be obtained from these tests that they are performed in virtually all patients being considered for cardiac surgery or angioplasty.

The Common Heart Tests:

Cardiac catheterization and angiography
Echocardiography (echo)
Electrocardiogram (ECG or EKG)
Electrophysiology study (EP study)
Holter monitor and event recorder
MUGA scan
Stress testing
Thallium and sestamibi (Cardiolite) scans
Tilt Table Testing
Transesophageal echocardiography (TEE)
Ultrafast CT scan
Cardiac MRI

Heart

The heart is the pump station of the body and is responsible for circulating blood throughout the body. It is about the size of your clenched fist and sits in the chest cavity between two lungs. Its walls are made up of muscle that can squeeze or pump blood out every time that the organ "beats" or contracts. Fresh, oxygen-rich air is brought to the lungs through the trachea (pronounced tray-kee-ya) or windpipe every time that you take a breath. The lungs are responsible for delivering oxygen to the blood, and the heart circulates the blood to the lungs and different parts of the body.

The heart is divided into FOUR chambers or "rooms". You can compare it to a Duplex apartment that is made up of a right and a left unit, separated from each other by a partition wall known as a SEPTUM (pronounced sep-tum).
Each "duplex" is subdivided into an upper and a lower chamber. The upper chamber is known as an ATRIUM (pronounced ay-tree-yum) while the lower chamber is referred to as a VENTRICLE (pronounced ven-trickle). The right atrium (RA) sits on top of the right ventricle (RV) on the right side of the heart while the left atrium (LA) sits atop the left ventricle (LV) on the left.
The right side of the heart is responsible for sending blood to the lungs, where the red blood cells pick up fresh oxygen. This OXYGENATED blood is then returned to the left side of the heart. From here the oxygenated blood is transported to the whole body supplying the fuel that the body cells need to function. The blood cells of the body extract or removes oxygen from the blood. The oxygen-poor blood is returned to the right atrium, where the journey began. This round trip is known as the CIRCULATION of blood.

The figure shown above is a section of the heart, as viewed from the front. It demonstrates the four chambers. You will also notice that there is an opening between the right atrium (RA) and the right ventricle (RV). This is actually a valve known as the TRICUSPID (pronounced try-cus-pid) valve. It has three flexible thin parts, known as leaflets, that open and shut. The figure below shows the mitral and tricuspid valves, as seen from above, in the open and shut position.

When shut, the edge of the three leaflets touch each other to close the opening and prevent blood from leaving the RV and going back into the RA. Thus, the tricuspid valve serves as a trapdoor valve that allows blood to move only in one direction - from RA to RV. Similarly, the MITRAL valve (pronounced my-trull) allows blood to flow only from the left atrium to the left ventricle. Unlike the tricuspid valve, the mitral valve has only two leaflets.

In the top diagram, you will also notice thin thread like structures attached to the edges of the mitral and tricuspid valves. These chords or strings are known as chordae tendineae (do not even try to pronounce it. However, if you really must, it is chord-ee tend-in-ee). They connect the edges of the tricuspid and mitral valves to muscle bands or papillary (pronounced pap-pill-lurry) muscles. The papillary muscles shorten and lengthen during different phases of the cardiac cycle and keep the valve leaflets from flopping back into the atrium.

The chords are designed to control the movement of the valve leaflets similar to ropes attached to the sail of a boat. Like ropes, they allow the sail to bulge outwards in the direction of a wind but prevents them from helplessly flapping in the breeze. In other words, they provide the capability of a door jamb that allows a door to open and shut in a given direction and NOT beyond a certain point.

When the three leaflets of the tricuspid bulge upwards during contraction or emptying of the ventricles, their edges touch each other and close off backward flow to the right atrium. This important feature allows blood to flow through the heart in only ONE direction, and prevents it from leaking backwards when the valve is shut. The two leaflets of the mitral valve functions in a similar manner and allows flow of blood from the left atrium to the left ventricle, but closes and cuts off backward leakage into the left atrium when the left ventricle contracts and starts to empty.

Use of intraaortic balloon counter pulsation in a patient with tortuous aorta

The intraaortic balloon pulsation (IABP) catheter is commonly used to treat left ventricular failure. The abnormality of the descending thoracic and abdominal aorta is considered as a relative contraindication for its insertion. We present here a patient with acute myocardial infarction with a post-infarct ventricular septal defect who presented with left ventricular failure. During coronary angiography, tortuous abdominal aorta was noted and IABP catheter was inserted under fluoroscopic guidance to support the cardiovascular system. This case is reported to encourage discussion on the use of IABP catheters in patients with tortuous aorta and avoidance of events described.

Home blood pressure monitor can be great monitoring tool

People with high blood pressure should make monitoring their condition at home a routine, says a new statement from the American Heart Association.

The statement is issued in Hypertension: Journal of the American Heart Association and published in the June issue of the Journal of Cardiovascular Nursing.

The American Heart Association said monitoring blood pressure at home can be an effective way of tracking and treating hypertension.

It says that blood pressure checks at doctor's offices are vulnerable to normal fluctuations, caused by such things as anxiety. According to the association, previous research has shown that between 10 per cent and 20 per cent of people fall prey to the "white coat effect" in which their blood pressure, which is normal, suddenly spikes.

"It is also believed that some people with normal blood pressures in their doctors' offices have pressures that spike to potentially dangerous levels in other situations," said Thomas Pickering, director of the Center for Behavioral Cardiovascular Health at Columbia Presbyterian Medical Center in New York, in a statement.

Measuring blood pressure with an at-home monitor can provide a more accurate snapshot of a person's blood pressure — particularly among the elderly, diabetics, kidney patients and pregnant women, say the authors. And they believe the frequent readings can help doctors work with patients to treat their condition.

"Home blood pressure monitoring also gives patients the physiologic feedback they need to see regarding blood pressure," says Nancy Houston Miller, co-author and former president of the Preventive Cardiovascular Nurses Association.
"Rather than three to four office blood pressure checks per year, if they measure blood pressure at home in addition to following up with their health-care provider, patients are likely to achieve goals more quickly and be confident that medicines are working for them."

The authors point out that many monitors have a price point of $100, which they say is affordable.
The association recommends:

• People buy oscillometric monitors with cuffs that fit the upper arm — wrist monitors are not recommended.
• People take their blood pressure readings at the same time each day to maintain consistency.
• The optimal blood pressure with a home monitor is less than 135/85 millimetres of mercury or less than 130/80 in those patients who are high-risk.

The Heart and Stroke Foundation of Canada advises patients to talk to their health-care providers about which types of equipment are best and how to use them.

It recommends people select a unit that has been tested to meet the validation requirements of either the Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society (BHS) or the European Society of Hypertension (ESH).
It says that patients should still see their doctors concerning their blood pressure and that a home unit is not a substitute for regular testing.

For most adults, high blood pressure, or hypertension, is defined as a blood pressure greater than or equal to 140 mm/Hg over 90 mm/Hg systolic pressure, according to the Heart and Stroke Foundation of Canada.

Cardiology – 5th Edition

By R. H. Swanton
Published 2003
Blakwell Publishing
Cardiology/ Handbooks, manuals, etc
464 pages
ISBN:1405101970
Cardiology is a rapidly changing and expanding field. Management protocols change regularly, new categories of treatment options are being discovered, and there is a new focus on the prevention of cardiovascular diseases.Pocket Consultant: Cardiology is a highly practical, user-friendly guide to this expanding field. Now in its fifth edition, this book has been highly praised for its readability, conciseness and clear illustrations, and is an indispensable guide for those dealing with common cardiological problems. The author, the current president of the British Cardiac Society, is internationally known in the field of clinical cardiology. This is an ideal book for the junior doctor who wants a quick, easily understandable guide to cardiology.

First Ever Triple Heart Valve Replacement Surgery

At Portneuf Medical Center, it’s the first surgery in the history of the hospital, a successful triple heart valve replacement. Local News 8 introduces you to the recipient of that successful surgery and checks the recovery process.
“It’s great. It turned out so well.” says Sandra Matthews, the triple valve replacement surgery recipient. Sandra Matthews is a young 65-year-old woman from Pocatello and Tuesday she under-went a very risky surgery.
One that is usually performed on a university level but for the first time in the history of the Portneuf Medical Center, a triple heart valve replacement surgery was successfully completed. Doctors expected a double valve replacement, but when they got inside, they found 3 valves had to be replaced. “These are such high risk operations to be able to be done and we can do these operations here in Pocatello.” Says Dr. Jacob DeLaRose, Chief of Cardiac Surgery at Portneuf Medical Center.

Doctors tell Sandra she’s set to head back home in just a few days. But just 24 hours ago she was a little concerned going into surgery but knew her heart was in good hands. “I knew I was going to be out here. I’ve got too much fishing and 4-wheeling and camping to do yet.” Says Matthews.
Doctors at PMC say triple heart valve replacement surgery is one of high risk but one thing helped Sandra get through the extraordinary surgery.
“I’m a firm believer that to have a positive attitude and positive outlook is what gets you through the operation. We’re the technicians but you have to have it inside and in here and you’ll be able to do great.” Says Dr. DeLaRosa. As for Sandra, she already has a game plan after she leaves the hospital. “To get home and see my little dogs that are going crazy because I’m not there.” Says Matthews.
Portneuf Medical Center says future operations of this stature depend on an individual case-by-case basis. Doctors say they hope to perform more in the future.

Ventricular Premature Complexes

Background
Ventricular premature complexes (VPCs) are ectopic impulses originating from an area distal to the His Purkinje system. VPCs are the most common ventricular arrhythmia. Assessment and treatment of VPCs is challenging and complex. The significance of VPCs is interpreted in the context of the underlying cardiac condition.
The approach to the evaluation and management of VPCs has undergone dramatic changes in the last decade. Ventricular ectopy leading to ventricular tachycardia (VT), which, in turn, can degenerate into ventricular fibrillation, is one of the common mechanisms for sudden cardiac death. The treatment paradigm in the 1970s and 1980s was to eliminate VPCs in patients after myocardial infarction (MI). Recent arrhythmia suppression studies have demonstrated that eliminating VPCs with available antiarrhythmic drugs increases the risk of death to patients without providing any measurable benefit.
Pathophysiology
Very few studies have evaluated the pathophysiology of VPCs in human subjects. Most of the information is derived from animal studies. Three common mechanisms exist for VPCs, (1) automaticity, (2) reentry, and (3) triggered activity, as follows:

Automaticity: This is the development of a new site of depolarization in nonnodal ventricular tissue, which can lead to a VPC. In animal models, focal mechanisms without evidence of macro-reentry play a major role in the origin of ventricular arrhythmia associated with ischemic cardiomyopathy. Increased automaticity could be due to electrolyte abnormalities or ischemic myocardium.
Reentry circuit: Reentry typically occurs when slow-conducting tissue (eg, infarcted myocardium) is present adjacent to normal tissue. The slow-conducting tissue could be due to damaged myocardium, as in the case of a healed MI.
Triggered activity: Afterdepolarizations triggered by a preceding impulse can lead to premature activation if the threshold is reached, and this can cause a VPC. Afterdepolarization can occur either during (early) or after (late) completion of repolarization. Early afterdepolarizations commonly are responsible for bradycardia associated VPCs, but they also can be present with ischemia and electrolyte abnormalities.
Frequency
United States
The reported prevalence of VPCs varies between studies, depending on the population studied, duration of observation, and method of detection. In asymptomatic patients, VPCs are infrequent when only a single 12-lead ECG is used for screening. The Framingham heart study (with 1-h ambulatory ECG) suggested that the prevalence rate of 1 or more VPCs per hour was 33% in men without coronary artery disease (CAD) and 32% in women without CAD. Among patients with CAD, the prevalence rate of 1 or more VPCs was 58% in men and 49% in women. Other studies using 24-hour ambulatory monitoring showed a VPC prevalence rate of 41% in healthy teenage boys aged 14-16 years, 50-60% in healthy young adults, and 84% in healthy elderly persons aged 73-82 years. VPCs also are common in patients with hypertension, ventricular hypertrophy, cardiomyopathy, and mitral valve prolapse.
International
Data from the Gruppo Italiano per lo Studio della Sopravvivenza dell'Infarto Miocardico 2 study demonstrated that 64% of patients who had MI then had ventricular arrhythmia and 20% of patients had more than 10 VPCs per hour when 24-h Holter monitoring was used.
Mortality/Morbidity
Prognosis depends on the frequency and characteristics of VPCs and on the type and severity of associated structural heart disease. VPCs are associated with an increased risk of death, especially when CAD is diagnosed, but the relationship between VPC frequency and mortality, even in this group, is not robust and no benefit results in suppressing VPCs to improve survival in any population.

In asymptomatic patients, frequent ventricular ectopy (defined as a run of 2 or more consecutive premature ventricular depolarizations or with premature ventricular depolarizations constituting >10% of all ventricular depolarizations on any of the ECG recordings with the subject at rest, during exercise, or during recovery) recorded during exercise testing was associated with 2.5-fold increased risk of cardiovascular death. Less frequent VPCs did not increase the risk.

In general, multimorphic VPCs connote a poorer prognosis than uniform morphologic VPCs. In patients post-MI, frequent VPCs (>10/h) are associated with increased mortality in the prethrombolytic era, but the association in patients receiving thrombolysis is weak.

In a recent study, a frequent VPC (defined as the presence of 7 or more ventricular premature beats per minute during any given stage, ventricular bigeminy, ventricular trigeminy, ventricular couplets, ventricular triplets, sustained or nonsustained ventricular tachycardia, ventricular flutter, torsade de pointes, or ventricular fibrillation) during recovery from exercise was an independent predictor of death. However, frequent VPCs only during exercise did not independently predict an increased risk.

Frequent VPCs, especially when they occur in a bigeminal pattern, can precipitate tachycardia-induced cardiomyopathy that can be reversed by elimination of the PVCs through catheter ablation.
Sex
The Framingham heart study demonstrated increased prevalence of VPCs in men compared with women. The difference was especially higher in men with CAD than in women with CAD.
Age
VPCs are uncommon in children (suggested prevalence rate of 0.8-2.2% from the Vanderbilt Medical Center; exact prevalence not known). Prevalence increases with age.
History
Various symptoms are associated with VPCs, but the exact prevalence of symptoms is not known. Typical symptoms include palpitations, light-headedness, syncope, atypical chest pain, or fatigue. Palpitations are due to an augmented post-VPC beat and may be sensed as a pause rather than an extra beat.
Physical
VPCs frequently are associated with variable or decreased intensity of heart sounds. The augmented beat following a dropped beat is heard frequently. Bounding jugular pulse (cannon A wave) from a loss of atrioventricular (AV) synchrony may be present. The follow-up beat after a VPC is stronger due to the postextrasystolic compensatory pause, allowing greater left ventricular (LV) filling, which usually causes greater intensity of that beat. This is known as extrasystolic potentiation.
Lab Studies
Look for correctable causes of VPCs, such as medications, electrolyte disturbances, infection, and myocardial ischemia or MI.
Obtain serum electrolyte and magnesium levels.
Imaging Studies
Look for underlying structural heart abnormalities that can predispose to VPCs.
·
Assess the degree of LV dysfunction by noninvasive techniques such as echocardiography or radionuclide imaging.
Echocardiography may be preferable because it also provides structural information about the heart.
Other Tests
In high-risk patients, ie, those with reduced ejection fraction (EF) and VPCs, a 24-hour Holter monitor may help establish the degree of electrical instability.
·
The severity of LV dysfunction, along with the complexity and frequency of the VPC, determines the aggressiveness of management.
Suppressing the VPCs themselves is not the focus of treatment unless patients are extremely symptomatic; rather, treatment may be implemented if the patient is felt to be at high risk of sudden cardiac death.
Treatment of the underlying structural heart disease also is extremely important. This includes acute syndromes, such as ischemia and infarction, the treatment of which involves reperfusion.
ECG should be performed to look for structural cardiac abnormalities. Diagnostic criteria include the following:
·
Wide (duration exceeding the dominant QRS complexes) and bizarre QRS complexes are present.
No preceding premature P waves occur, and, rarely, a sinus P wave is conducted.
The T wave usually is in the opposite direction from the R wave.
Full compensatory pause is common.
VPCs originating from the left ventricle typically produce a right bundle-branch block (BBB) pattern on QRS.
VPCs originating from right ventricle typically produce left BBB-like pattern on QRS.
Idiopathic VPCs often originate from the right ventricular outflow tract and have a left bundle rightward axis morphology.
Electrophysiologic study
·
Electrophysiologic study (EPS) may be indicated for 2 types of patients with VPCs, (1) those with a structurally normal heart with symptomatic VPCs, for whom pharmacological treatment or catheter ablation is indicated and (2) those with VPCs and structural heart disease, for whom risk stratification for sudden cardiac death is indicated.
According to current American College of Cardiology/American Heart Association guidelines, class I indications for EPS are patients with CAD, low EF (<0.36), and nonsustained VT on ambulatory ECG. Class II indications for catheter ablation apply to patients with a highly symptomatic uniform morphology of VPC, couplets, and nonsustained VT.
Exercise stress testing should be performed to look for coronary ischemia, exercise-induced arrhythmia, or both.

Influence of right ventricular pressure overload on left and right ventricular filling in cor pulmonale assessed with Doppler echocardiography.

We evaluated the influence of right ventricular (RV) pressure overload on RV and left ventricular (LV) filling using Doppler echocardiography in cor pulmonale. The LV and RV inflow signals were recorded by Doppler flowmetry. The end-diastolic (ED) and end-systolic (ES) LV short axis images were detected by 2-dimensional echocardiography in 20 healthy subjects and in 36 cases of chronic pulmonary disease (CPD) with pulmonary hypertension. We measured (1) the ratio of the peak velocity of inflow due to atrial contraction to the peak velocity of rapid inflow (A/R), (2) the deceleration half-time of rapid inflow (delta TD), (3) the corrected radius of curvature (cRC) of the interventricular septum (IVS) at ES and ED, and (4) the percent change of length of 16 radial grids (%CL) using the fixed method on the ED and ES short axis images. In 17 of 36 patients with CPD, we measured the systolic pulmonary artery pressure (sPAP), the cardiac index (CI), the mean pulmonary capillary wedge pressure (mPCWP), the end-diastolic right ventricular pressure and the partial oxygen pressure of arterial blood (PaO2). The results were as follows: in CPD, (1) both the RV and the LV diastolic behavior were impaired as shown by increased A/R (1.04 +/- 0.20, 0.98 +/- 0.17, respectively) and prolonged delta TD (115 +/- 20, 100 +/- 17 msec, respectively), (2) the IVS was flattened at ED (cRC of IVS = 0.67 +/- 0.12), (3) the IVS wall motion was impaired (%CL of IVS = 133 +/- 13), (4) the sPAP had an adequate correlation with RV A/R (r = 0.80, p less than 0.01), RV delta TD (r = 0.59, p less than 0.05), LV A/R (r = 0.82, p less than 0.01), LV delta TD (r = 0.61, p less than 0.05), cRC of IVS (r = 0.67, p less than 0.01), %CL of IVS (r = -0.59, p less than 0.05). There was no significant correlation between the LV diastolic behavior and the CI, the mPCWP, the PaO2. It is concluded that the impairment of RV diastolic behavior was caused by the decreased RV compliance due to RV free wall hypertrophy. Moreover, the RV pressure overload interfered with the IVS motion during diastole, this regional impairment of diastolic behavior of the IVS subsequently causing impairment of LV diastolic filling.

Interventricular mechanical asynchrony in pulmonary arterial hypertension

Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular under filling.

OBJECTIVES: The purpose of this study was to explore in pulmonary arterial hypertension (PAH) whether the cause of interventricular asynchrony lies in onset of shortening or duration of shortening.
BACKGROUND: In PAH, leftward ventricular septal bowing (LVSB) is probably caused by a left-to-right (L-R) delay in myocardial shortening.
METHODS: In 21 PAH patients (mean pulmonary arterial pressure 55 +/- 13 mm Hg and electrocardiogram-QRS width 100 +/- 16 ms), magnetic resonance imaging myocardial tagging (14 ms temporal resolution) was applied. For the left ventricular (LV) free wall, septum, and right ventricular (RV) free wall, the onset time (T(onset)) and peak time (T(peak)) of circumferential shortening were calculated. The RV wall tension was estimated by the Laplace law.
RESULTS: The T(onset) was 51 +/- 23 ms, 65 +/- 4 ms, and 52 +/- 22 ms for LV, septum, and RV, respectively. The T(peak) was 293 +/- 58 ms, 267 +/- 22 ms, and 387 +/- 50 ms for LV, septum, and RV, respectively. Maximum LVSB was at 395 +/- 45 ms, coinciding with septal overstretch and RV T(peak). The L-R delay in T(onset) was -1 +/- 16 ms (p = 0.84), and the L-R delay in T(peak) was 94 +/- 41 ms (p < 0.001). The L-R delay in T(peak) was not related to the QRS width but was associated with RV wall tension (p < 0.05). The L-R delay in T(peak) correlated with leftward septal curvature (p < 0.05) and correlated negatively with LV end-diastolic volume (p < 0.05) and stroke volume (p < 0.05).
CONCLUSIONS: In PAH, the L-R delay in myocardial peak shortening is caused by lengthening of the duration of RV shortening. This L-R delay is related to LVSB, decreased LV filling, and decreased stroke volume.

Mechanical right ventricular dyssynchrony in patients after atrial switch operation for transposition of the great arteries.

Recent data suggest potential benefits of cardiac resynchronization therapy in the management of right ventricular (RV) dysfunction in congenital heart disease. The aim of this study was to determine the nature, prevalence, and functional implications of mechanical RV dyssynchrony in patients after Senning or Mustard procedures for transposition of the great arteries. Twenty-eight patients (mean age 21.1 +/- 3.5 years) at 19.9 +/- 3.2 years after atrial switch operations and 29 healthy controls were studied. The times from the onset of QRS to peak systolic strain (T epsilon) at the base of and the mid RV free wall, the ventricular septum (VS), and the left ventricular (LV) free wall were determined using tissue Doppler echocardiography. Intraventricular mechanical delay was defined as Delta T epsilon(RV-VS) and interventricular mechanical delay as Delta T epsilon(RV-LV). In patients, the magnitude of RV intra- and interventricular mechanical delay was correlated with cardiac magnetic resonance-derived RV volumes and ejection fractions (n = 26) and treadmill exercise testing parameters (n = 20). Compared with controls, patients had significantly longer Delta T epsilon(RV-VS) (48.1 +/- 50.9 vs 17.0 +/- 16.1 ms, p <0.001)>49 ms, control mean +/- 2SD), and 16 patients (57%) showed interventricular dyssynchrony (Delta T epsilon(RV-LV) >45 ms). In patients, RV intra- and interventricular mechanical delay was correlated negatively with the RV ejection fraction (both r = -0.42, p = 0.03) and percentage predicted maximum oxygen consumption (r = -0.50, p = 0.03, and r = -0.52, p = 0.02, respectively) and positively with minute ventilation/carbon dioxide production slope (r = 0.49, p = 0.03, and r = 0.56, p = 0.01, respectively). In conclusion, RV dyssynchrony is common in young adults after atrial switch operations and is associated with RV systolic dysfunction and impaired exercise performance.

Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion.

OBJECTIVES: The aim of the present study was to characterize the contraction pattern of the systemic right ventricle (RV). BACKGROUND: Reduced longitudinal function of the systemic RV compared with the normal RV has been interpreted as ventricular dysfunction. However, longitudinal shortening represents only one aspect of myocardial deformation, and changes in contraction in other dimensions have not previously been described.

METHODS: Fourteen Senning-operated patients age 18.4 +/- 0.9 years (mean +/- SD) with transposition of the great arteries were studied. We compared the contraction pattern of the systemic RV with findings in the RV and left ventricle (LV) of normal subjects (n = 14) using tissue Doppler imaging and magnetic resonance imaging.

RESULTS: In the systemic RV free wall, circumferential strain exceeded longitudinal strain (-23.3 +/- 3.4% vs. -15.0 +/- 3.0%, p < 0.001) as was also the case in the normal LV (-25.7 +/- 3.1% vs. -16.5 +/- 1.7%, p < 0.001), opposite from the findings in the normal RV (-15.8 +/- 1.3% vs. -30.7 +/- 3.3%, p < 0.001). Strain in the interventricular septum did not differ from normal. Ventricular torsion was essentially absent in the systemic RV (0.3 +/- 1.8 degrees ), in contrast to a torsion of 16.7 +/- 4.8 degrees in the normal LV (p < 0.001).

CONCLUSIONS: In the systemic RV as in the normal LV, there was predominant circumferential over longitudinal free wall shortening, opposite from findings in the normal RV. This may represent an adaptive response to the systemic load. Noticeably, however, the systemic RV did not display torsion as found in the normal LV.

Left ventricular function in patients with transposition of the great arteries operated with atrial switch.

In patients operated with atrial switch for transposition of the great arteries (TGA), the left ventricle (LV) supports the pulmonary circulation and is thus pressure unloaded. Evaluation of LV function in this setting is of importance, as LV functional abnormalities have been documented and might contribute to development of symptoms. The ventricular contraction pattern in 14 Senning-operated TGA patients and 14 healthy controls was studied using tissue Doppler and magnetic resonance imaging. In the subpulmonary LV free wall, longitudinal strain was greater than circumferential strain (-23.6 +/- 3.6% vs. -19.1 +/- 3.2%, p = 0.002) as in the normal right ventricle (RV) (-30.7 +/- 3.3% vs. -15.8 +/- 1.3%, p < 0.001), but opposite to findings in the normal LV (-16.5 +/- 1.7% vs. -25.7 +/- 3.1%, p < 0.001).
Subpulmonary strain and strain rate values were intermediate between those in the normal LV and RV. Ventricular free-wall torsion was reduced in the subpulmonary LV compared with both the normal LV (5.7 +/- 3.2 degrees vs. 16.7 +/- 5.6 degrees , p < 0.001) and RV (5.7 +/- 3.2 degrees vs. 11.4 +/- 2.6 degrees , p < 0.05). Furthermore, early diastolic filling of the subpulmonary LV differed from that of the normal LV. The subpulmonary LV displayed predominantly longitudinal shortening, as did its functional counterpart, the normal RV. However, the degree and rate of both longitudinal and circumferential shortening were intermediate between those of the normal LV and RV. This could represent a partial adaptation to the reduced pressure load. Decreased ventricular torsion and diastolic abnormalities might indicate subclinical ventricular dysfunction.

Heart Disease on rise among Indian Youth

We are a nation of the young where 54 percent of our population is enjoying the prime of youth. But a black spot in this sunny picture is the increasing rate of heart disease among the youth. Today, the average age in which a person may suffer a heart attack has come down from 40 years to 30 years. And this is mainly a result of today’s changing lifestyles. In fact the rate of coronary heart disease in the Indian community - particularly in young men - is almost twice as high as their western counterparts.

Causes of The Increase
So what are the reasons or factors which have resulted in an increase in the number of heart patients in India? “Modern life style has proven to be the stimulus for the growth of heart diseases among the youth” says Dr Ashok Seth , Chief Invasive and Interventional Cardiology, Escorts Heart Institute. "Improper food habits, lack of physical activity and this coupled with high level of stress and increase in smoking and alcohol consumption are all classic risk factors which can put one high on the risk zone of coronary heart diseases. Sadly all these have become a part of the Indian youth’s life style.”
Not only college and school going students, but even working professionals have adopted the ways of this modern life style, and this has proved to be the instigator of heart diseases.

Food Culture

Junk food joints like Mc Donald’s, Pizza Hut etc. have become “hang out“ points not only for college students, but also amongst young professionals, who go for a quick bite to save time. We Indians already have a food culture which indulges itself in rich food which is fried in ghee, or foods as sweetmeats etc. This along with the addition of junk food to our diet and reduced physical activity has translated into increased heart risks.

The Biological Factor

The LDL (low density cholesterol) which is a result of such food habits puts us in the high risk zone as far as the heart diseases are concerned. The cholesterol gets deposited in the arteries making them narrower and narrower. As a result the blood supply to the heart gets thwarted. This leads to heart attacks.

However a thing which renders us Indians vulnerable to the risk is the biological fact that we Indians have narrower arteries than our European counterparts. According to Dr. Upendra Kaul, Director Interventional Cardiology and Cardiac Electrophysiology, Batra Hospital and Medical Research Centre, “It is important that one keeps a regular check on his\her weight. A BMI ( Body Mass Index) of more than 23 is bad news for your heart.”

Stress & Work Pressure

High-strung lifestyle is also another reason for the increase in Coronary Heart Diseases (CHD).

With the increase in the competition levels and the pressure to perform, youngsters are faced with the problem of stress at a very early stage. Things only deteriorate once they get into a job.

With the advent of MNC work culture in India, increased work pressure and increasing need for performance in the workplace, it has led to increased stress in the executive lifestyles. This type of a lifestyle increases the risk of developing heart disease by 10-15 times.

A sedentary life style since childhood, lack of proper exercise, genetic factors, fat and dietary conditions also dramatically raise the risk of developing coronary heart diseases.

Smoking

A Fad Smoking has become a fad in the young generation. It is seen as an in thing today and is considered as a fashion statement. However found to be the predominant cause of mortality and morbidity in the world. WHO estimates that globally 1.1 billion people smoke and about one-third are below the 16 years of age. Now let us look at why tobacco is harmful to health. Tobacco smoke contains a host of chemicals in the form of particles and gases which are potential carcinogens. However the most harmful toxins that are present in tobacco are Tar, Nicotine and Carbon Monoxide.

Harmful Effects Of Smoking

Whereas, nicotine is a highly addictive and toxic substance that diffuses into the blood stream causing various types of disorders. This has a variety of adverse effects on the body like increasing heart rate, blood pressure and it damages the inner lining of the blood supply to the heart causing endothelial dysfunction, which increases the risk of a person being exposed to coronary artery disease.

Carbon monoxide on its part is absorbed into the blood stream via the lungs and replaces oxygen from hemoglobin. This decreases the oxygen carrying capacity of the blood and decrease in the oxygen content results in damage of body cells. Says Dr Kaul "Professionals smoke because they feel it helps them to ease their tension. What they don’t think about is the adverse effect it would have on their health.”

Effects Of Alcohol

Alcohol is another factor which is responsible for the rise of coronary diseases amongst the youth. Alcohol has shown to depress the left ventricle of heart, which pumps blood into the body.

When this part of the heart is depressed, two things happen: The heart has to pump harder to get blood to your cells, and your cells and tissues don't get the supply needed for optimal functioning. If you also consider that strength training increases the thickness of the left ventricle, it only makes sense that anything that interrupts optimal functioning of this structure won't help you in the gym.

A recent investigation examined the relationship of alcohol consumption, heart disease and low-density lipoprotein (LDL) or "bad" cholesterol. LDL moves into cells, such as the fibroblasts in the walls of the arteries, where it forms the plaque and fatty deposits that clog arteries. The higher the ratio of LDL to HDL, the greater the risk of heart attack.

Conclusion

Couple this with all the above said factors such as calorie rich food and a sedentary life style and you have put yourselves in the maximum danger zone as far as CHD ( Coronary Heart Diseases) are concerned.

So if all these habits apply to you sit up and take notice. If you are young, it does not mean you are impervious to heart diseases. The only solution to the problem is leading a well balanced and healthy life style. And it is never too early when it comes to matters of the heart.

Cardiovascular disease

Cardiovascular disease can manifest itself in many different ways because the blood vessels transport blood to every single part of the body. The heart is the organ that pumps the blood around the body, and it also receives nutrients from the blood vessels (via the coronary vessels). Any interruption of the supply of blood containing nutrients and oxygen to one of the body's organs leads to functional impairment and, in the worst case scenario, the death of the tissue. One typical example is cardiac arrest, which occurs when the blood supply to the heart muscle is restricted. Cardiovascular disease can have any number of causes. Some people are born with a susceptibility to vascular disease (e.g. varicose veins), which can be alleviated by taking medication. Other people's heart and blood vessels can be damaged by external factors. The majority of vascular diseases these days, however, are caused by our modern-day lifestyles. The walls of the blood vessel are always in contact with the blood which flows through them, so they are most commonly affected by unhealthy lifestyles. If someone has an unfavourable haemogram, i.e. if their blood contains too much glucose, cholesterol, triglycerides (fats) or nicotine, this can put the blood vessels under an enormous amount of stress. Glucose adheres to the walls of the blood vessels and the blood constituents, and cholesterol and triglycerides also accumulate on the blood vessel walls. As a result, the blood clumps, the blood vessel walls "calcify", turn porous and can no longer perform their biological function properly. Nicotine also constricts the blood vessels, so they narrow and the amount of blood circulating the body is reduced. If the condition is aggravated by a lack of vessel-protecting substances, the damaged vessels lose their ability to regenerate. The consequences include arteriosclerosis, leg ulceration, dilation of the abdominal artery (aneurysm), cardiac insufficiency, cardiac arrest and stroke. Cardiovascular disease is still the number one cause of death in Germany and many other western industrial nations. Substances such as vitamins C and E, some of the B vitamins, secondary phytochemicals (such as the flavonoids which are contained in vegetables, reservatol in red wine, catechine in tea) and omega-3 fatty acids (fish) can protect the blood vessels. Sufficient physical activity also helps the blood vessels to retain their elasticity. People who change their lifestyle can therefore contribute to the prevention of cardiovascular disease. Once cardiovascular disease manifests, the range of therapies available are as varied as the symptoms themselves. The objective of any therapy is to normalise circulation (e.g. with medication to 'thin' the blood) and to repair or remove the damaged vessels. It is therefore important to take an integral approach to therapy which doesn't simply eliminate specific damage, but improves the entire cardiovascular system. After all, the damaged blood vessels are the underlying problem, not the strokes and heart attacks.

Heart Rhythm Disorders

The primary function of the heart is to supply blood and nutrients to the body. The regular beating, or contraction, of the heart moves the blood throughout the body. Each heartbeat is controlled by electrical impulses traveling through the heart. In the normal heart these electrical impulses occur in regular intervals. When something goes wrong with the heart’s electrical system, the heart does not beat regularly. The irregular beating results in a rhythm disorder, or arrhythmia.
The electrical system regulating heartbeat consists of 2 main areas of control and a series of conducting pathways, similar to the electrical wiring in a house (See Multimedia File 1).
The sinoatrial, or SA, node is located in the right atrium. It provides the main control and is the source of each beat. The SA node also keeps up with the body's overall need for blood and increases the heart rate when necessary, such as during exercise, emotional excitement, or illness such as fever. The SA node is sometimes called the "natural pacemaker" of the heart.
Electrical impulses leave the SA node and travel through special conducting pathways in the heart to the other controller, the atrioventricular, or AV, node. The purpose of the AV node is to provide a pathway for impulses from the atria to the ventricles. It also creates a delay in conduction from the atria to the ventricle. This causes the atria to contract first and allow the ventricles to fill with blood before they contract themselves.
The delay ensures proper timing so that the lower chambers have time to fill completely before they contract.
Normally, the heart beats 60-100 times a minute. This state is called "normal sinus rhythm" or "normal rhythm." Depending upon the needs of the body, it may beat faster (sinus tachycardia) due to stress or slower (sinus bradycardia) such as during sleep.
Arrhythmias
Arrhythmias are abnormalities of the heartbeat. There are many types of arrhythmias, and they are classified by where they begin, (the atria, AV node, or the ventricles). Generally speaking, those that do not originate from the ventricles are called supraventricular arrhythmias while those that come from the ventricles are called ventricular arrhythmias.
The following are some of the more commonly encountered arrhythmias, starting with the supraventricular arrhythmias.
Premature atrial contractions, sometimes called PAC or APC, or premature supraventricular contractions: Another part of the atria sends an electrical impulse soon after the previous beat, causing the heart to contract earlier than expected. This is a very common occurrence in all ages and usually is not serious.
Supraventricular tachycardia, or paroxysmal SVT: Occurs when any structure above the ventricle (usually the atria or the AV node) produces a regular, rapid discharge.
Sick sinus syndrome: Irregular firing by the SA node causes a slower-than-normal heart rate (sometimes alternating with rapid heart rates).
Atrial fibrillation: A common condition caused by electrical impulses discharged at a rapid rate from many different areas of the atria. It usually causes a fast and irregular heartbeat.
Atrial flutter: A condition caused by a rapid discharge from a single place in the right atrium. Typically, the right atrium fires at a rate of 300 beats per minute, but only every other beat is conducted through the AV node, meaning that the ventricular rate is classically 150 beats per minute.
Arrhythmias arising in the ventricle are more likely to be found in people with more serious heart disease but may also be found in healthy individuals.
Premature ventricular complex, or PVC: This electrical impulse starts in the ventricle causing the heart to beat earlier than expected. Usually, the heart returns to its normal rhythm right away.
Ventricular tachycardia: Fast and usually regular impulses come from the ventricles and cause a very rapid heart rate. This is usually a life-threatening tachycardia and needs immediate medical attention, possibly electrical shock or defibrillation.
Ventricular fibrillation: Electrical impulses arise from the ventricles in a fast and disordered sequence. The resulting uncoordinated contractions cause the heart to quiver (appearing like a bag of worms) and lose the ability to beat and pump blood, leading to immediate cardiac arrest.
Arrhythmias can be frightening, but in many cases, especially in younger patients with normal underlying hearts, they are not life threatening and can be effectively treated with medications.
Supraventricular arrhythmias are very common in middle-aged and elderly adults. The older you get, the more likely you are to experience an arrhythmia, especially atrial fibrillation.
Many supraventricular arrhythmias are temporary and not serious, especially if no underlying heart disease is present. These arrhythmias are a response to normal activities or emotions.
Even if an arrhythmia has a serious underlying cause, the arrhythmia itself may not be dangerous. The underlying problem can often be treated effectively.

Accelerated Idioventricular Rhythm

Accelerated idioventricular rhythm (AIVR) is a form of ectopic or automatic ventricular arrhythmia usually noted in the acute care setting during cardiac rhythm monitoring. This condition is characterized by a ventricular rate that is slower than traditionally defined ventricular tachycardia (VT). Generally, the heart rate is less than 100 beats per minute (bpm), but some authors have used heart rate less than 120 bpm. It is often, but not always, slightly faster than the underlying sinus rhythm; therefore, the ventricular rate takes over as the predominant rhythm.
AIVR may also be defined as an ectopic rhythm with 3 or more consecutive premature ventricular beats and a rate faster than the normal ventricular intrinsic escape rate of 30-40 bpm but slower than VT.
AIVR is an electrocardiographic diagnosis and does not generally produce any particular symptoms. Making a correct diagnosis remains one of the most important concerns because the usual treatments for patients with the more common form of ventricular arrhythmia, such as VT, may not apply.
Pathophysiology
Enhanced automaticity appears to be the likely electrophysiologic mechanism behind the genesis of AIVR. Enhanced automaticity generally is ascribed to phase-4 depolarization of the action potential of the myocardial cell. AIVR can occur in the His-Purkinje fibers or myocardium under certain abnormal metabolic conditions.
AIVR arises from subordinate or second-order pacemakers and manifests itself when the patient's prevailing sinus rate becomes lower than the accelerated rate (AIVR) of the otherwise suppressed focus. Sinus bradycardia combined with enhanced automaticity of the subordinate site is the common pathophysiology.
Several conditions, including myocardial ischemia (especially inferior wall ischemia or infarction), digoxin toxicity, electrolyte imbalance (eg, hypokalemia), and hypoxemia may accentuate the phase-4 depolarization in the subordinate pacemaker tissues of the atrioventricular (AV) junction or His-Purkinje system, thus increasing the rate of impulse generation. Frequently, when inferior wall ischemia is present, the subordinate pacemaker acceleration coexists with sinus node depression. The latter permits escape and domination of the pacemaker function, which may occur with AV junctional or ventricular rates of only 60-70 bpm. The ectopic mechanism also can begin after a premature ventricular complex or, as described above, when the ectopic ventricular focus simply can accelerate sufficiently enough to overtake the intrinsic rhythm.
The onset of AIVR is gradual (nonparoxysmal). The ventricular rhythm can be regular or irregular and, occasionally, can show sudden doubling, suggesting the presence of exit block. The ventricular rate, commonly 60-110 bpm, usually stays within 10-15 beats of the sinus rate; therefore, the control of the cardiac rhythm occasionally passes back and forth between these 2 competing pacemaker sites.
Fusion beats often develop at the onset and termination of arrhythmia, which occurs when the pacemakers are competing for control of ventricular depolarization. Because of the slow rate, capture beats also are common. Due to the slow rate and nonparoxysmal onset, precipitation of more rapid ventricular arrhythmias rarely is observed. Rhythm termination generally occurs gradually, while the underlying sinus rhythm accelerates or the AIVR slows down.
Accelerated idioventricular rhythm in the reperfusion era
Ever since the beginning of the thrombolytic era, the occurrence of AIVR in patients with acute MI has been considered a specific marker of successful reperfusion following the infusion of the lytic agents.
Whether such association exists with reperfusion through direct percutaneous coronary intervention was investigated in a recent study of 125 consecutive patients undergoing direct percutaneous coronary intervention for a first acute MI. 24-hour Holter monitoring revealed that AIVR appeared in 15.2% of the patients. The incidence of AIVR was not different between patients with TIMI grade 2 flow and those with TIMI grade 3 flow (13% vs 16%). No differences were reported in the incidence of major cardiac events within 12-month follow-up in patients with and without AIVR. However, AIVR was associated with higher vagal tone and lower sympathetic activity, the occurrence of AIVR had no prognostic impact on the clinical course and was not able to discriminate between complete and incomplete reperfusion following percutaneous coronary intervention.