The end-systolic pressure-volume relation (ESPVR) is the relation between pressure Pm and volume Vm in the heart left ventricle when the myocardium reaches its maximum state of activation during contraction near end-systole. Relations between the ejection fraction (EF), parameters describing the ESPVR and the areas under the ESPVR are derived in this study for a linear model of the ESPVR. An important feature of the model is the inclusion of the active pressure generated by the myocardium during an ejecting contraction (also called isovolumic pressure Piso) in the mathematical expression of the linear ESPVR. Criteria that can help in understanding the problem of heart failure with normal or preserved ejection fraction (HFpEF) are discussed. Applications to clinical data published in the literature are presented, the applications show the consistency of the mathematical formalism used. When ratios of pressures are used, the calculation can be carried out with clinical data measured in a non-invasive way (the ratio of pressures can be calculated). This study shows that the EF is just one index of several indexes that can be derived from the ESPVR for the assessment of the ventricular function, and that using bivariate (or multivariate) analysis of data is superior to univariate analysis for the purpose of classification and segregation between different clinical groups.
{"title":"Ejection Fraction and Espvr: A Study in the Mechanics of Left Ventricular Contraction","authors":"","doi":"10.33140/coa.05.01.06","DOIUrl":"https://doi.org/10.33140/coa.05.01.06","url":null,"abstract":"The end-systolic pressure-volume relation (ESPVR) is the relation between pressure Pm and volume Vm in the heart left ventricle when the myocardium reaches its maximum state of activation during contraction near end-systole. Relations between the ejection fraction (EF), parameters describing the ESPVR and the areas under the ESPVR are derived in this study for a linear model of the ESPVR. An important feature of the model is the inclusion of the active pressure generated by the myocardium during an ejecting contraction (also called isovolumic pressure Piso) in the mathematical expression of the linear ESPVR. Criteria that can help in understanding the problem of heart failure with normal or preserved ejection fraction (HFpEF) are discussed. Applications to clinical data published in the literature are presented, the applications show the consistency of the mathematical formalism used. When ratios of pressures are used, the calculation can be carried out with clinical data measured in a non-invasive way (the ratio of pressures can be calculated). This study shows that the EF is just one index of several indexes that can be derived from the ESPVR for the assessment of the ventricular function, and that using bivariate (or multivariate) analysis of data is superior to univariate analysis for the purpose of classification and segregation between different clinical groups.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85760123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-29DOI: 10.31487/j.jicoa.2020.02.07
Cynthia Y. Y. Lai, F. H. Lai, S. Ng, Trevor W. K. Yung, Y. So
Although low levels of stress can be motivating, high levels of stress – especially when it is sustained – can be detrimental to mental and physical health. Mindfulness practice has been widely applied in health care worldwide as an effective stress management approach. This study compared the immediate effects of two types (religious: Serenity Prayer; and non-religious: Body Scan) of mindfulness practice with a control condition (resting: sitting) in six adults. This study found no statistically significant difference between the conditions, but data visualization showed a trend of cardiovascular modulation (increased high frequency of heart rate variability) and cortical modulation (increased alpha to beta ratio and theta to beta ratio of quantitative encephalogram) with a greater level of perceived stress-relieved by both types of mindfulness practice. In addition, religious belief may be a moderator of the effects of intervention. The results of this study offered insight into the effect of prayer on cardiovascular and cortical modulation for promoting the wellbeing of a person.
{"title":"Pre-Clinical Study of Immediate Effects of Religious and Non-Religious Mindfulness Practice on Cardiovascular and Cortical Modulation","authors":"Cynthia Y. Y. Lai, F. H. Lai, S. Ng, Trevor W. K. Yung, Y. So","doi":"10.31487/j.jicoa.2020.02.07","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.02.07","url":null,"abstract":"Although low levels of stress can be motivating, high levels of stress – especially when it is sustained\u0000– can be detrimental to mental and physical health. Mindfulness practice has been widely applied in\u0000health care worldwide as an effective stress management approach. This study compared the\u0000immediate effects of two types (religious: Serenity Prayer; and non-religious: Body Scan) of\u0000mindfulness practice with a control condition (resting: sitting) in six adults. This study found no\u0000statistically significant difference between the conditions, but data visualization showed a trend of\u0000cardiovascular modulation (increased high frequency of heart rate variability) and cortical\u0000modulation (increased alpha to beta ratio and theta to beta ratio of quantitative encephalogram) with\u0000a greater level of perceived stress-relieved by both types of mindfulness practice. In addition,\u0000religious belief may be a moderator of the effects of intervention. The results of this study offered\u0000insight into the effect of prayer on cardiovascular and cortical modulation for promoting the wellbeing of a person.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46285789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An elderly woman underwent placement of a pacemaker lead which was complicated by accidental azygos vein cannulation and perforation. However not a very uncommon complication, we report here several findings on CT-angiogram which highlight imaging pitfalls of this entity. We also review how the case was clinically managed.
{"title":"CT-Angiogram Appearance of Iatrogenic Azygos Vein Perforation","authors":"Catherine Lalonde, Étienne Dallaire, Gahide Gérald, Guillaume Garneau, M. Béland, Mireille Méthot","doi":"10.31487/j.jicoa.2020.02.10","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.02.10","url":null,"abstract":"An elderly woman underwent placement of a pacemaker lead which was complicated by accidental azygos\u0000vein cannulation and perforation. However not a very uncommon complication, we report here several\u0000findings on CT-angiogram which highlight imaging pitfalls of this entity. We also review how the case was\u0000clinically managed.\u0000","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42302085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parasympathetic and Sympathetic (P&S) imbalance is associated with increased morbidity and mortality risk, including heart failure, coronary artery disease, atrial and ventricular arrhythmias, hypertension and orthostatic disorders, and syncope. Most cardiac medications effect only one or the other of the P&S nervous systems, including: β-blockers, α-blockers, α-agonists, and anti-cholinergics. Non-pharmaceutical treatments also affect the P&S nervous systems; however, nonpharmaceutical treatment is rarely addressed or studied, despite significant evidence-based data demonstrating normalization of Sympathovagal Balance. Fifty consecutive patients from a busy suburban cardiology practice were enrolled in a supplement study. Patients were provided supplements that included 200mg of Alpha-Lipoic Acid (ALA) and 100mg of Co-Enzyme Q10 (CoQ10) which they were instructed to take twice a day, one each with breakfast and dinner. P&S Monitoring (Physio PS, Inc., Atlanta, GA, USA) and Quality of Life (QoL) questionnaires were administered at three month intervals. The combination of supplements, ALA and CoQ10, had a positive effect on the P&S nervous systems as measured directly and also indicated by improvements in BP, HR and reported QoL. The study indicates these supplements help to improve both the resting and challenge P&S responses and resultant physiology. The results suggest antioxidant therapy is a potential complimentary therapy to pharmacological management of patients with poorly controlled BP (i.e., hypertension and possible hypotension) as well as in patients with tachycardia or palpitations. This is a hypothesis generating study of significant importance in an often neglected area of cardiovascular disease in which additional research and studies are needed.
{"title":"Antioxidants Effect Changes in Systemic Parasympathetic and Sympathetic Nervous\u0000System Responses and Improve Outcomes","authors":"","doi":"10.33140/coa.05.01.05","DOIUrl":"https://doi.org/10.33140/coa.05.01.05","url":null,"abstract":"Parasympathetic and Sympathetic (P&S) imbalance is associated with increased morbidity and mortality risk, including\u0000heart failure, coronary artery disease, atrial and ventricular arrhythmias, hypertension and orthostatic disorders, and\u0000syncope. Most cardiac medications effect only one or the other of the P&S nervous systems, including: β-blockers, α-blockers,\u0000α-agonists, and anti-cholinergics. Non-pharmaceutical treatments also affect the P&S nervous systems; however, nonpharmaceutical treatment is rarely addressed or studied, despite significant evidence-based data demonstrating normalization\u0000of Sympathovagal Balance. Fifty consecutive patients from a busy suburban cardiology practice were enrolled in a supplement\u0000study. Patients were provided supplements that included 200mg of Alpha-Lipoic Acid (ALA) and 100mg of Co-Enzyme Q10\u0000(CoQ10) which they were instructed to take twice a day, one each with breakfast and dinner. P&S Monitoring (Physio PS,\u0000Inc., Atlanta, GA, USA) and Quality of Life (QoL) questionnaires were administered at three month intervals. The combination\u0000of supplements, ALA and CoQ10, had a positive effect on the P&S nervous systems as measured directly and also indicated\u0000by improvements in BP, HR and reported QoL. The study indicates these supplements help to improve both the resting and\u0000challenge P&S responses and resultant physiology. The results suggest antioxidant therapy is a potential complimentary\u0000therapy to pharmacological management of patients with poorly controlled BP (i.e., hypertension and possible hypotension)\u0000as well as in patients with tachycardia or palpitations. This is a hypothesis generating study of significant importance in an\u0000often neglected area of cardiovascular disease in which additional research and studies are needed.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82826506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.31487/j.jicoa.2020.02.02
Abdisamad M. Ibrahim, A. Kulkarni, A. Botchway, M. Regmi, M. Labedi, Mohammad Al-akchar, M. Siddique, N. Tandan, R. Maini
Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on whether these patients would benefit from chronic anticoagulation. Objective: To assess whether patients with POAF benefit from chronic anticoagulation. Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of ischemic stroke, and mortality. Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant differences found in mortality outcomes between POAF patients that received anticoagulation as compared to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857, P = 0.5447). Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further prospective studies into the question of length of POAF and how chronic anticoagulation therapy plays a role in decreasing risks of ischemic stroke and/or mortality.
背景:术后心房颤动(POAF)是一种相对常见的现象，约占20-40%的病例。先前的研究和AHA/ACC指南推荐对持续48小时以上的POAF患者进行抗凝治疗。然而，最近的一些研究表明，即使在POAF发生5分钟后进行抗凝治疗，结果也有所改善。我们的荟萃分析旨在阐明POAF患者缺血性卒中和死亡率的主要结局，并为这些患者是否可以从慢性抗凝治疗中获益提供指导。目的:评价慢性抗凝治疗对POAF患者是否有益。方法:通过PubMed、OVID和MEDLINE，我们对几项研究进行了文献回顾，以评估短期房颤患者是否从抗凝治疗中获益。虽然有几项研究提供了有价值的信息，但我们选择了6项报告POAF持续时间、缺血性卒中风险和死亡率的研究。结果:我们发现，因新诊断的POAF而接受抗凝治疗的患者发生缺血性卒中的可能性是未接受抗凝治疗的新诊断的POAF患者的3.5倍(IRR 3.54 (95% CI 2.12-5.91)， p=0.001)。接受抗凝治疗的POAF患者与未接受抗凝治疗的POAF患者的死亡率无统计学差异(合并IRR = 1.1449 (95% CI = 0.738952 ~ 1.773857,P = 0.5447)。结论:持续时间超过24小时的POAF患者如果给予抗凝治疗，发生缺血性卒中的可能性较小。我们希望这项荟萃分析能够促进对POAF长度问题的进一步前瞻性研究，以及慢性抗凝治疗如何在降低缺血性卒中风险和/或死亡率方面发挥作用。
{"title":"A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?","authors":"Abdisamad M. Ibrahim, A. Kulkarni, A. Botchway, M. Regmi, M. Labedi, Mohammad Al-akchar, M. Siddique, N. Tandan, R. Maini","doi":"10.31487/j.jicoa.2020.02.02","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.02.02","url":null,"abstract":"Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in\u0000approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended\u0000initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies\u0000suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to\u0000clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on\u0000whether these patients would benefit from chronic anticoagulation.\u0000Objective: To assess whether patients with POAF benefit from chronic anticoagulation.\u0000Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to\u0000assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several\u0000studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of\u0000ischemic stroke, and mortality.\u0000Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times\u0000less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly\u0000diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant\u0000differences found in mortality outcomes between POAF patients that received anticoagulation as compared\u0000to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857,\u0000P = 0.5447).\u0000Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic\u0000stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further\u0000prospective studies into the question of length of POAF and how chronic anticoagulation therapy\u0000plays a role in decreasing risks of ischemic stroke and/or mortality.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42274763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-14DOI: 10.31487/j.jicoa.2020.02.05
E. Langen, Jennifer Lewey, J. Triebwasser
Background: The American College of Obstetricians and Gynecologists and the American Heart Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong cardiovascular risks and transitioned to primary care for ongoing screening and management. Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and follow-up among women with hypertensive disorders of pregnancy. Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum visit note in the electronic medical record. We defined counseling as documentation of any one of the following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving counseling. Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71 women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3 (4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were no participants counseled on all three components. Later gestational age at delivery was associated with lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89). Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy, counseling about those risks is suboptimal. Improved communication of risks is the first step towards improving maternal health in the “fourth trimester” and beyond.
背景:美国妇产科医师学会和美国心脏协会建议妊娠期高血压疾病的妇女应接受终生心血管风险的咨询，并过渡到初级保健进行持续的筛查和管理。目的:了解妊娠期高血压疾病妇女心血管风险产后咨询的频率和内容及随访情况。研究设计:对一所三级专科医院进行的妊娠期高血压疾病(不包括慢性高血压)妇女的随机试验进行二次分析。我们从电子病历的出院总结和产后就诊记录中提取了高血压疾病的文献咨询。我们将咨询定义为以下任何一项的文件:1)在未来怀孕时推荐阿司匹林，2)初级保健随访，或3)心血管疾病的终生风险。我们使用逻辑回归模型来估计接受咨询的调整几率。结果:74名妇女参加了这项研究。71名妇女(96.0%)在出院总结中被诊断为高血压，但只有11名(14.9%)在出院总结或产后就诊记录中有任何书面咨询。在接受咨询的11名妇女中，5名(6.7%)被建议在未来妊娠期间服用阿司匹林，5名(6.7%)接受了初级保健随访咨询，只有3名(4.1%)接受了妊娠期高血压相关的终身心血管风险咨询。两名妇女(2.7%)接受了关于初级保健和终身心血管风险的随访咨询。没有人就这三个组成部分向参与者提供咨询。分娩时较晚的胎龄与较低的咨询几率相关(调整OR 0.49, 95% CI 0.27-0.89)。结论:尽管有一致的证据表明妊娠期高血压疾病存在长期风险，但对这些风险的咨询并不理想。改善对风险的宣传是改善"妊娠第四个月"及以后产妇保健的第一步。
{"title":"Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy","authors":"E. Langen, Jennifer Lewey, J. Triebwasser","doi":"10.31487/j.jicoa.2020.02.05","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.02.05","url":null,"abstract":"Background: The American College of Obstetricians and Gynecologists and the American Heart\u0000Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong\u0000cardiovascular risks and transitioned to primary care for ongoing screening and management.\u0000Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and\u0000follow-up among women with hypertensive disorders of pregnancy.\u0000Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of\u0000pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We\u0000abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum\u0000visit note in the electronic medical record. We defined counseling as documentation of any one of the\u0000following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong\u0000risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving\u0000counseling.\u0000Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71\u0000women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the\u0000discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on\u0000taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3\u0000(4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two\u0000women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were\u0000no participants counseled on all three components. Later gestational age at delivery was associated with\u0000lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89).\u0000Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy,\u0000counseling about those risks is suboptimal. Improved communication of risks is the first step towards\u0000improving maternal health in the “fourth trimester” and beyond.\u0000","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42195553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-13DOI: 10.31487/j.jicoa.2020.02.03
H. Ishibashi-Ueda, M. Harada‐Shiba, Michio Noguchi, M. Hori, Naotaka Ohta, T. Fujita, Tsutomu Tomita
Background: Patients with familial hypercholesterolemia are known to have an extremely high risk of coronary artery disease owing to high levels of low-density lipoprotein-cholesterol since birth. In addition, aortic stenosis among patients with familial hypercholesterolemia has also been reported besides coronary disease. The aim of this study was to characterize the histopathological differences in excised aortic valves for aortic stenosis between patients with familial hypercholesterolemia and non-familial hypercholesterolemia. Subjects and Methods: Six familial patients (3 homozygous, 3 heterozygous familial hypercholesterolemia patients), and 18 non-familial hypercholesterolemia patients underwent pathological and immunohistochemical examinations for aortic valves macroscopically and microscopically at aortic valve replacement surgery for stenosis. Results: Our study revealed that calcification of aortic valves among homozygous hypercholesterolemia showed a much milder degree than those of non-familial patients. Moreover, the age at surgery for stenosis in the case of homozygotes was significantly less than that of heterozygous hypercholesterolemia and nonfamilial hypercholesterolemia patients. In addition, CD68-positive macrophages infiltrated the aorta side (fibrosa) in all familial hypercholesterolemia patients. However, the macrophage accumulation in the aortic valves of non-familial hypercholesterolemia patients was recognized in the middle layer (spongiosa) near calcification and left ventricular side (ventricularis) of the aortic valves. Conclusion: Lipid is one of the important factors for aortic valve fibrosis and stenosis in hypercholesterolemia. This study suggested that the non-familial atherosclerotic aortic stenosis in the elderly is qualitatively different from aortic valves in familial hypercholesterolemia, primarily owing to calcification resulting from age and long-term degeneration and inflammatory responses.
{"title":"Morphological Characteristics of Aortic Stenosis in Familial Hypercholesterolemia and Non-Familial Hypercholesterolemia in the Elderly","authors":"H. Ishibashi-Ueda, M. Harada‐Shiba, Michio Noguchi, M. Hori, Naotaka Ohta, T. Fujita, Tsutomu Tomita","doi":"10.31487/j.jicoa.2020.02.03","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.02.03","url":null,"abstract":"Background: Patients with familial hypercholesterolemia are known to have an extremely high risk of\u0000coronary artery disease owing to high levels of low-density lipoprotein-cholesterol since birth. In addition,\u0000aortic stenosis among patients with familial hypercholesterolemia has also been reported besides coronary\u0000disease. The aim of this study was to characterize the histopathological differences in excised aortic valves\u0000for aortic stenosis between patients with familial hypercholesterolemia and non-familial\u0000hypercholesterolemia.\u0000Subjects and Methods: Six familial patients (3 homozygous, 3 heterozygous familial hypercholesterolemia\u0000patients), and 18 non-familial hypercholesterolemia patients underwent pathological and\u0000immunohistochemical examinations for aortic valves macroscopically and microscopically at aortic valve\u0000replacement surgery for stenosis.\u0000Results: Our study revealed that calcification of aortic valves among homozygous hypercholesterolemia\u0000showed a much milder degree than those of non-familial patients. Moreover, the age at surgery for stenosis\u0000in the case of homozygotes was significantly less than that of heterozygous hypercholesterolemia and nonfamilial hypercholesterolemia patients. In addition, CD68-positive macrophages infiltrated the aorta side\u0000(fibrosa) in all familial hypercholesterolemia patients. However, the macrophage accumulation in the aortic\u0000valves of non-familial hypercholesterolemia patients was recognized in the middle layer (spongiosa) near\u0000calcification and left ventricular side (ventricularis) of the aortic valves.\u0000Conclusion: Lipid is one of the important factors for aortic valve fibrosis and stenosis in\u0000hypercholesterolemia. This study suggested that the non-familial atherosclerotic aortic stenosis in the\u0000elderly is qualitatively different from aortic valves in familial hypercholesterolemia, primarily owing\u0000to calcification resulting from age and long-term degeneration and inflammatory responses.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48921496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anxiety disorders (DSM-5) and disorders having anxiety laden symptoms (e.g., PTSD and attention disorders) often include several physiologic symptoms which involve the Parasympathetic and Sympathetic nervous systems (P&S). Our research has identified four P&S disorders that are associated with these symptoms: 1) Sympathetic Excess (SE) secondary to Parasympathetic Excess (PE) as an abnormal stress response, 2) Sympathetic Withdrawal (SW) upon assuming headup posture (standing) associated with Orthostatic Dysfunction, 3) SE upon standing associated with Syncope, and 4) Autonomically mediated cardiac arrhythmia, including Sinus Arrhythmia. All four disorders involve poor brain profusion which is known to contribute to Anxiety-like symptoms. They also contribute to (sub-clinical) depression, another frequent co-morbidity. Resting and challenge P&S responses were assessed noninvasively using the ANSAR Medical Technologies, Inc. (Philadelphia, PA) software (ANX 3.0 autonomic function monitor). Patients diagnosed with Anxiety or Anxiety-like symptoms from a large cardiology practice serving both urban and rural areas were followed with more than one assessment over four years (an average of 3.3 assessments per patient; 50.5% Female; average age of 57 years). Patients diagnosed with Anxiety or Anxiety-like symptoms, with one of the four P&S disorders were also treated for their P&S disorder. Relieving P&S dysfunction within this cohort reduced Anxiety or Anxiety-like symptoms by over 45%. P&S guided therapy for patients with Anxiety or Anxiety-like symptoms, may reduce the burden of Anxiety, improve patient outcomes and quality of life, reduce the risk of suicide, aid the psychiatrist in focusing on the etiology of Anxiety, and reduce healthcare costs.
{"title":"Parasympathetic and Sympathetic Nervous System Monitoring and Anxiety-Like\u0000Symptoms: Improved Differentiation and Improved Outcomes","authors":"","doi":"10.33140/coa.05.01.04","DOIUrl":"https://doi.org/10.33140/coa.05.01.04","url":null,"abstract":"Anxiety disorders (DSM-5) and disorders having anxiety laden symptoms (e.g., PTSD and attention disorders) often include several physiologic symptoms which involve the Parasympathetic and Sympathetic nervous systems (P&S). Our research has identified four P&S disorders that are associated with these symptoms: 1) Sympathetic Excess (SE) secondary to Parasympathetic Excess (PE) as an abnormal stress response, 2) Sympathetic Withdrawal (SW) upon assuming headup posture (standing) associated with Orthostatic Dysfunction, 3) SE upon standing associated with Syncope, and 4) Autonomically mediated cardiac arrhythmia, including Sinus Arrhythmia. All four disorders involve poor brain profusion which is known to contribute to Anxiety-like symptoms. They also contribute to (sub-clinical) depression, another frequent co-morbidity. Resting and challenge P&S responses were assessed noninvasively using the ANSAR Medical Technologies, Inc. (Philadelphia, PA) software (ANX 3.0 autonomic function monitor). Patients diagnosed with Anxiety or Anxiety-like symptoms from a large cardiology practice serving both urban and rural areas were followed with more than one assessment over four years (an average of 3.3 assessments per patient; 50.5% Female; average age of 57 years). Patients diagnosed with Anxiety or Anxiety-like symptoms, with one of the four P&S disorders were also treated for their P&S disorder. Relieving P&S dysfunction within this cohort reduced Anxiety or Anxiety-like symptoms by over 45%. P&S guided therapy for patients with Anxiety or Anxiety-like symptoms, may reduce the burden of Anxiety, improve patient outcomes and quality of life, reduce the risk of suicide, aid the psychiatrist in focusing on the etiology of Anxiety, and reduce healthcare costs.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78763576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-30DOI: 10.31487/j.jicoa.2020.01.13
C. Du, Henggui Zhang, J. Hancox, Yihong Zhang
Congenital Short QT Syndrome (SQTS) is a rare but dangerous condition involving abbreviated ventricular repolarization and an increased risk of atrial and ventricular arrhythmias. Taking the example of the first identified SQTS mutation, N588K-hERG, we consider briefly the basic science approaches used to obtain an understanding of the mechanism(s) of arrhythmogenesis in this form of the syndrome. A combination of recombinant channel electrophysiology and in silico simulations has provided insights into causality between the identified mutation, accelerated repolarization and increased susceptibility to re-entry in N588K-hERG-linked SQTS. Subsequent studies employing a transgenic rabbit model or human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) have further demonstrated mechanisms predisposing to re-entry, spiral wave activity and arrhythmia in intact tissue. The complementarity between the findings made using these different approaches gives confidence that, collectively, they have identified major arrhythmia mechanisms and their potential mitigation by Class I antiarrhythmic drugs in this form of SQTS.
{"title":"Complementarity between Arrhythmia Mechanisms Found in Silico and in Genetic Models of N588K-hERG Linked Short QT Syndrome","authors":"C. Du, Henggui Zhang, J. Hancox, Yihong Zhang","doi":"10.31487/j.jicoa.2020.01.13","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.01.13","url":null,"abstract":"Congenital Short QT Syndrome (SQTS) is a rare but dangerous condition involving abbreviated ventricular\u0000repolarization and an increased risk of atrial and ventricular arrhythmias. Taking the example of the first\u0000identified SQTS mutation, N588K-hERG, we consider briefly the basic science approaches used to obtain\u0000an understanding of the mechanism(s) of arrhythmogenesis in this form of the syndrome. A combination of\u0000recombinant channel electrophysiology and in silico simulations has provided insights into causality\u0000between the identified mutation, accelerated repolarization and increased susceptibility to re-entry in\u0000N588K-hERG-linked SQTS. Subsequent studies employing a transgenic rabbit model or human induced\u0000pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) have further demonstrated mechanisms\u0000predisposing to re-entry, spiral wave activity and arrhythmia in intact tissue. The complementarity between\u0000the findings made using these different approaches gives confidence that, collectively, they have identified\u0000major arrhythmia mechanisms and their potential mitigation by Class I antiarrhythmic drugs in this form of\u0000SQTS.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42786408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-30DOI: 10.31487/j.jicoa.2020.01.11
I. Patrikios, M. Badri
Cardiac sympathetic afferent that signal the sensation of cardiac pain, ostensibly, has more underlying mechanisms than what scientists have ever been led to believe. Cardiac sympathetic afferent reflex, also known as (CSAR), has been shown to be responsive to a variety of stimuli. Many of which scientists observed in increased levels during ischemia hydrogen ion, oxygen radicals, potassium, lactate, ATP, prostaglandins bradykinin, substance p and, finally and most importantly, endogenous substances (neurohormones) such as norepinephrine (NE). In the outset of chronic heart failure (HF), it has been known for a long time, that there are abnormalities in arterial baroreceptor input which depress its sensitivity, and arterial chemoreceptors seem augmented. Therefore, they tend to not only initiate sympathetic outflow but also to sensitise cardiac afferents which are appearing to do the same thing where there are abnormalities in vagus mechano-reflexes as well. Some of these receptors are in the spinal reticulate tract and interestingly these a third pathways give off neurons to the brainstem some in the hypothalamus and trance translate through the thalamus and then ultimately up into the cortex where we have sensation of pain. Here in this essay, we aim to discuss important aspects of cardiac failure in relation to abnormal sympatho-activators through evaluation of different available studies and animal models.
{"title":"How Abnormal Sympatho-Activation Can Potentially Develop Heart Failure: A Mini Review","authors":"I. Patrikios, M. Badri","doi":"10.31487/j.jicoa.2020.01.11","DOIUrl":"https://doi.org/10.31487/j.jicoa.2020.01.11","url":null,"abstract":"Cardiac sympathetic afferent that signal the sensation of cardiac pain, ostensibly, has more underlying\u0000mechanisms than what scientists have ever been led to believe. Cardiac sympathetic afferent reflex, also\u0000known as (CSAR), has been shown to be responsive to a variety of stimuli. Many of which scientists\u0000observed in increased levels during ischemia hydrogen ion, oxygen radicals, potassium, lactate, ATP,\u0000prostaglandins bradykinin, substance p and, finally and most importantly, endogenous substances\u0000(neurohormones) such as norepinephrine (NE). In the outset of chronic heart failure (HF), it has been known\u0000for a long time, that there are abnormalities in arterial baroreceptor input which depress its sensitivity, and\u0000arterial chemoreceptors seem augmented. Therefore, they tend to not only initiate sympathetic outflow but\u0000also to sensitise cardiac afferents which are appearing to do the same thing where there are abnormalities in\u0000vagus mechano-reflexes as well. Some of these receptors are in the spinal reticulate tract and interestingly\u0000these a third pathways give off neurons to the brainstem some in the hypothalamus and trance translate\u0000through the thalamus and then ultimately up into the cortex where we have sensation of pain. Here in this\u0000essay, we aim to discuss important aspects of cardiac failure in relation to abnormal sympatho-activators\u0000through evaluation of different available studies and animal models.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44479561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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