Cardiopulmonary Symptoms Research Articles

Anxiety Predicts Poor Perceived Health in Patients With an Implantable Defibrillator

Implantation with an implantable cardioverter defibrillator (ICD) may cause psychological problems, including anxiety. The objective was to determine whether general anxiety and disease-specific anxiety differentially predict poor perceived health in ICD patients. Patient concerns about the ICD and feelings of disability were independently predicted by general as well as disease-specific anxiety. Clinical anxiety was predicted by general anxiety only, whereas cardiopulmonary symptoms were predicted by disease-specific anxiety. Identifying and supporting ICD patients with various anxiety symptoms is important. Future research should examine the differential predictive value of different forms of anxiety toward medical endpoints as well as possible interventions for disease-related anxiety.

Symptom profile of persons self-reporting whiplash: a Norwegian population-based study (HUNT 2)

The aetiology of chronic whiplash associated disorder (WAD) is unclear and the condition has been perceived both as a chronic pain disorder, based on the injury to the neck, and as a functional somatic disorder. Based on the hypothesis that chronic WAD should be perceived as a functional somatic syndrome, we compared the symptom profile of persons with chronic WAD with the profile of persons with a functional somatic disorder, and with the profile of persons with an organic pain disorder. A sample of 55,046 persons participating in a Norwegian population-based health study (HUNT 2) was divided into four study groups: chronic WAD, fibromyalgia, rheumatoid arthritis, and controls (none of these disorders). Symptoms were categorized as pain and stiffness, cardiopulmonary and gastrointestinal symptoms, and mental disorders. Odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression were used to compare the prevalence of symptoms among the groups. The chronic WAD group had a significantly higher prevalence of symptoms from all body parts, across organ systems and also mental symptoms, compared to the control group. The fibromyalgia group had an even higher prevalence of all symptoms, while the rheumatoid arthritis group showed an increase in the prevalence of particularly pain and stiffness symptoms and also a minor increase in the prevalence of other symptoms compared to the control group. We conclude that this study provide evidence in favour of the hypothesis that chronic WAD should be perceived as a functional somatic syndrome. Persons with chronic WAD had a symptom profile more similar to people with a functional somatic disorder than an organic pain disorder, consisting of a wide array of symptoms, not only predominantly pain symptoms.

Frequency of Acute Coronary Syndrome in Patients with Normal Electrocardiogram Performed during Presence or Absence of Chest Pain

The authors hypothesized that patients with active chest pain at the time of a normal electrocardiogram (ECG) have a lower frequency of acute coronary syndrome (ACS) than patients being evaluated for chest pain but with no active chest pain at the time of a normal ECG. The study objective was to describe the association between chest pain in patients with a normal ECG and the diagnosis of ACS. This was a prospective observational study of emergency department (ED) patients with a chief complaint of chest pain and an initial normal ECG admitted to the hospital for chest pain evaluation over a 1-year period. Two groups were identified: patients with chest pain during the ECG and patients without chest pain during the ECG. Normal ECG criteria were as follow: 1) normal sinus rhythm with heart rate of 55-105 beats/min, 2) normal QRS interval and ST segment, and 3) normal T-wave morphology or T-wave flattening. "Normal" excludes pathologic Q waves, left ventricular hypertrophy, nonspecific ST-T wave abnormalities, any ST depression, and discrepancies in the axis between the T wave and the QRS. Patients' initial ED ECGs were interpreted as normal or abnormal by two emergency physicians (EPs); differences in interpretation were resolved by a cardiologist. ACS was defined as follows: 1) elevation and characteristic evolution of troponin I level, 2) coronary angiography demonstrating >70% stenosis in a major coronary artery, or 3) positive noninvasive cardiac stress test. Chi-square analysis was performed and odds ratios (ORs) are presented. A total of 1,741 patients were admitted with cardiopulmonary symptoms; 387 met study criteria. The study group comprised 199 males (51%) and 188 females (49%), mean age was 56 years (range, 25-90 years), and 106 (27%) had known coronary artery disease (CAD). A total of 261 (67%) patients experienced chest pain during ECG; 126 (33%) patients experienced no chest pain during ECG. There was no difference between the two groups in age, sex, cardiac risk factors, or known CAD. The frequency of ACS for the total study group was 17% (67/387). There was no difference in prevalence of ACS based on the presence or absence of chest pain (16% or 42/261 vs. 20% or 25/126; OR = 0.77, 95% confidence interval = 0.45 to 1.33, p = 0.4). Contrary to our hypothesis concerning patients who presented to the ED with a chief complaint of chest pain, our study demonstrated no difference in the frequency of acute coronary syndrome between patients with chest pain at the time of acquisition of a normal electrocardiogram and those without chest pain during acquisition of a normal electrocardiogram.

Lyme Carditis in Children: Presentation, Predictive Factors, and Clinical Course

We sought to identify predictive factors for Lyme carditis in children and to characterize the clinical course of these patients. We reviewed all cases of early disseminated Lyme disease presenting to our institution from January 1994 through July 2008, and summarized the presentation and course of those patients with carditis. A case-control study was used to identify predictive factors for carditis. Controls were patients with early disseminated Lyme disease without carditis. Of 207 children with early disseminated Lyme disease, 33 (16%) had carditis, 14 (42%) of whom had advanced heart block, including 9 (27%) with complete heart block. The median time to recovery of sinus rhythm in these 14 patients was 3 days (range: 1-7 days), and none required a permanent pacemaker. Four (12%) of 33 patients with carditis had depressed ventricular systolic function, 3 (9%) of whom required mechanical ventilation, temporary pacing, and inotropic support. Complete resolution of rhythm disturbances and myocardial dysfunction occurred in 24 (89%) of 27 patients for whom follow-up data were available. Most patients with carditis also had other systemic Lyme involvement. By using multivariate logistic regression analysis, we found that children >10 years of age, those with arthralgias, and those with cardiopulmonary symptoms were more likely to have carditis. The spectrum of presentation for children with Lyme carditis is broad, ranging from asymptomatic, first-degree heart block to fulminant myocarditis. Variable degrees of heart block are the most common manifestation and occasionally require temporary pacing. Transient myocardial dysfunction, although less common, can be life-threatening. Advanced heart block resolves within 1 week in most cases. In children with early disseminated Lyme disease, older age, arthralgias, and cardiopulmonary symptoms independently predict the presence of carditis.

Cardio Pulmonary Monitoring during Phototherapy in near term neonates: current practice among NICUs and PICUs in Switzerland

Introduction: Despite updated recommendation by the Swiss Soc of Neonatology, the evidence for cardiopulmonary monitoring (CPM) during Phototehrapy (PT) in near-term neonates is unclear. With limited NICU beds, the need for CPM has to be evaluated. At first, we conducted a Switzerland-wide survey of current practice. Method: All 31 swiss NICU and PICUs received a questionnaire. Results: 22 were returned (71%). All had PT guidelines, 91% the updated version. 68% expected side effects in <5% of the babies (top 4 were: 54.5% hyperthermia, 45.5% irritability, 41% weight gain decrease and 36.5% feeding intolerance). Cardiopulmonary (CP) symptoms were less frequent: tachy-, bradycardia (22.5%, 13.5%), tachy- and apnea (32%, 13.5%). CPM by oxygen saturation (SpO2): 32% yes, 50% no, 18% depending on circumstances; by ECG monitoring: 9% yes, 59% no, 32% circumstance dependant. SpO2+ECG: 13.5% yes (similarly to non jaundiced babies). Discussion: Despite evidence for CP side effects, 63.5% of the units didnrsquor;t apply any CPM during PT. Bader showed statistically significant lower respiratory rate and higher heart rate (HR) during certain sleep states while SpO2, apneas or periodic breathing were unchanged. Yao reported a decreased systolic BP and a HR increase, which is consistent with cutaneous vasodilation (Jahnukainen). Benders showed a decreased left ventricular outpout. It remains unclear whether these changes have any biological impact and whether the used CPM is justified. Conclusion: Despite reported CP changes during PT, current CPM in Switzerland is inhomogeneous and the question whether a near-term neonate has to be admitted to a nursery for CPM during PT needs urgently to be answered.

A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presenting as a left lung mass

Aneurysm of a saphenous vein graft (SVG) is a rare but fatal complication of coronary artery bypass graft (CABG) surgery. The development of SVG aneurysms appears usually about 10-20 years after the operation at an estimated rate of <1%. A 68-year-old male was referred to the emergency department after frequent episodes of dyspnea, chest pain and hemoptysis. He previously had CABG surgery one year before. The physical examination was normal. Chest radiogram showed a left pulmonary midzone mass. CT-angiogram demonstrated a large aortic pseudoaneurysm (6.36 x 6.06 cm) in the middle part of the ascending aorta. After sternotomy, the ascending aorta above sinotubular junction near the origin of brachiocephalic artery was resected and replaced with a tube graft. The patient was transferred to ICU with stable hemodynamic status. SVG aneurysm should be considered while encountering mediastinal mass or undiagnosed cardiopulmonary symptoms in patients with a previous history of CABG because of its rarity and overlap of symptoms with other thoracic, pulmonary, and cardiac diseases. Surgery seems to be the treatment of choice to reduce the risk of rupture and embolism.

Successful Use of Octreotide to Treat Ménétrier’s Disease: A Rare Cause of Abdominal Pain, Weight Loss, Edema, and Hypoalbuminemia

A 75-year-old man presented with steadily increasing upper abdominal pain, worse after meals, over 6 weeks. He also described anorexia, early satiety, intermittent postprandial nausea and bilious vomiting, as well as bilateral ankle edema and an unintentional 10-lb weight loss, despite daily use of lansoprazole and furosemide. He described no heartburn, dysphagia, melena, hematemesis, diarrhea, fevers, night sweats, or other cardiopulmonary or urinary symptoms. His past medical history was notable for mild gastroesophageal reflux, hypertension, depression, and benign prostatic hyperplasia. Current medications included lansoprazole, valsartan, furosemide, and escitalopram. He had a negative family history and did not smoke or drink alcohol. Physical examination was normal except for 2? bilateral pitting edema to the knees. Laboratory studies were notable mainly for an albumin level of 1.5 g/dl. His white blood cell count was 10,800/ mm (54% neutrophils, 22% lymphocytes, 22% eosinophils), hematocrit 42%, and platelets 338,000/mm. Other liver function tests and serum chemistries were normal except for calcium of 6.9 mg/dl. Urinalysis was normal. Chest X-ray was normal, as was his electrocardiogram. IgA and IgG for Helicobacter pylori were positive. Abdominal computed tomography (CT) after intravenous and oral contrast showed significant thickening of the proximal gastric body and fundus with associated engorgement of the perigastric vessels and no mass (Fig. 1). The distal stomach wall was normal. Endoscopy revealed markedly thickened gastric folds with nodularity, erythema, and exudate involving the proximal stomach (Fig. 2a, b), but sparing the antrum and pylorus. The stomach was poorly distensible, and a small hiatal hernia was seen. Multiple superficial cold forceps biopsies revealed no evidence for active H. pylori infection and failed to show eosinophilia, viral inclusions, epithelial malignancy, or lymphoma. Interestingly, there were elongated gastric foveolae, many of which exhibited a corkscrew-like appearance. These hyperplastic foveolae were lined by gastric epithelium without regenerative features or mucin depletion. Atrophy of the parietal cell layer and mild lamina propria chronic inflammation were also noted. The patient was treated empirically for H. pylori with a 14day course of amoxicillin, clarithromycin, and lansoprazole based on the positive H. pylori serologies. After treatment, he continued taking a proton pump inhibitor twice daily but his symptoms did not change. He was also prescribed a brief course of prednisone that improved his peripheral eosinophilia; however, his symptoms continued to worsen. Full-thickness gastric biopsies, obtained using a jumbo forceps during a repeat endoscopy, showed foveolar hyperplasia with tortuous, corkscrew shapes and dilated mucin-filled gastric pits, atrophy of the parietal cell layer, and mild chronic inflammation of the lamina propria (Fig. 3). Some foveolar cells exhibited mucin depletion. There were no H. pylori organisms or cytomegalovirus M. Rothenberg (&) Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, MC: 5187, Stanford, CA 94305-5187, USA e-mail: rothenbergmike@gmail.com

Sildenafil (REVATIO) Therapy In Chronic Graft Versus Host Disease (cGVHD): Continued Improvement In Pulmonary cGVHD Symptoms

We retrospectively analyzed data collected over two years in ten patients with cGVHD of the lungs who were treated with sildenafil 20mg TID as part of their treatment regimen. Sildenafil is an inhibitor of cGMP (PDE5) in the smooth muscle of the pulmonary vasculature, which increases relaxation in smooth muscles thought to improve cardiopulmonary symptoms. The mean age of patients was 50.6 years, 7 patients were female, 7 patients received unrelated donor transplants, 8 patients received peripheral blood stem cells and the mean CD34+ dose was 4.8 ×106 cells/kg.

Childhood trauma and adulthood physical health in Mexico

The present study examined the effect of childhood trauma on adulthood physical health among a randomly selected sample of adults (N = 2,177) in urban Mexico. Adults were interviewed about their experiences of trauma, post-traumatic stress disorder, depression, and physical health symptoms using Module K of the Composite International Diagnostic Interview, the Center for Epidemiologic Studies Depression Scale, and the Physical Symptoms Checklist. Trauma was prevalent, with 35% reporting a traumatic event in childhood. In general, men reported more childhood trauma than women, with the exception of childhood sexual violence where women reported more exposure. For men, childhood sexual violence was related to total and all physical health symptom subscales. For women, childhood sexual violence was related to total, muscular-skeletal, and gastrointestinal-urinary symptoms; hazards/accidents in childhood were related to total, muscular-skeletal, cardio-pulmonary, and nose-throat symptom subscales. Depression mediated the relationship between childhood sexual violence and physical health symptoms for men and women. Among women only, PTSD mediated the relationship between childhood sexual violence and total, muscular-skeletal, and gastrointestinal-urinary symptoms. PTSD also mediated the relationship between hazards/accidents in childhood and total, muscular-skeletal, cardio-pulmonary, and nose-throat symptoms. These findings can be used to increase awareness among general practitioners, as well as community stakeholders, about the prevalence of childhood trauma in Mexican communities and its impact on subsequent physical health outcomes. With this awareness, screening practices could be developed to identify those with trauma histories in order to increase positive health outcomes among trauma survivors.

Äthylenglykolintoxikation

Ethylene glycol is an alcohol, which is mainly used as antifreeze. Intoxication with ethylene glycol can cause neurological and cardiopulmonary symptoms, metabolic acidosis and acute renal failure. Therapeutic options include reversal of metabolic acidosis, inhibition of alcohol dehydrogenase and early hemodialysis. In survivors of the acute phase, lasting damage is rare. The case of a 49-year-old patient with ethylene glycol intoxication is reported which was characterized by progressive impairment of consciousness, tetraparesis, hyperventilation and metabolic acidosis.

Follow-up After Asymptomatic Penetrating Thoracic Injury: 3 Hours is Enough

Patients with asymptomatic penetrating thoracic injuries routinely undergo chest radiographs (CXRs) upon emergency department (ED) arrival, and then 6 hours later to exclude delayed pneumothorax (PTX) or hemothorax (HTX). Although previous reports indicate that up to 12% (mean, 3%) of asymptomatic penetrating thoracic injuries are complicated by delayed PTX or HTX, we hypothesized that these events would be detectable after only 3 hours of observation. The purpose of this study was to compare the incidence of delayed thoracic injury at 3 hours and 6 hours using standard CXR. A prospective trial of asymptomatic patients with penetrating thoracic injuries was conducted during 36 months. CXRs were performed upon arrival (supine, AP), and at 3 hours (upright, PA/lateral) and 6 hours (upright, PA/lateral). Patients with either injuries detected on initial CXR or cardiopulmonary symptoms were excluded. Findings from 3 hour and 6 hour CXRs were compared. Assuming a delayed PTX or HTX rate of 3%, the probability of detecting at least one delayed event between 3 hours and 6 hours in 100 patients is 95.25%. Of 648 patients with penetrating thoracic injuries, 100 patients both met inclusion criteria and completed the study. Patients were predominantly young (32.5 years +/- 13.3 years [mean +/- SD]) men (75% men) with stab wounds (75% stab wounds, 25% gunshot wounds). The mean length of stay for patients discharged from the ED was 8.8 hours +/- 2.6 hours. Although two patients developed a PTX between arrival and 3 hours, none developed after 3 hours. Patient charges, hospital costs, and radiation exposure were calculated for patients in our proposed study protocol, totaling $2802, $189, and 0.08 mSv, respectively. No patient in our study population developed a delayed PTX or HTX after 3 hours. Our results suggest that shortening the observation period after asymptomatic penetrating thoracic injuries to 3 hours is safe, cost-effective, minimizes radiation exposure, and may help relieve congested urban EDs.

Liver Disease From Asymptomatic Constrictive Pericarditis

Congestive hepatopathy is a known complication of cardiac disease and is typically identified in the context of an established cardiac diagnosis and profound cardiopulmonary symptoms. We report the case of a 28-year-old man with liver disease secondary to asymptomatic constrictive pericarditis. This case highlights the need for gastroenterologists to consider occult cardiac disease as a cause of unexplained liver dysfunction.

Compartment Syndrome Following Intraosseous Infusion

Intraosseous infusion is a valuable technique in the resuscitation of critically ill pediatric patients in whom vascular access has proved otherwise impossible. Although it is well established as a safe and reliable means of emergent access, intraosseous infusion is not without danger, nor complication. One of the rare yet most grave complications of intraosseous access is compartment syndrome. We report a case of compartment syndrome as a result of intraosseous infusion that serves to remind of the potential pitfalls of this technique. An otherwise healthy 6-year-old girl presented to our institution's pediatric intensive care unit following emergent resuscitation for a prolonged cardiac arrest. Approximately 1 hour following an uneventful soccer practice, without any antecedent cardiopulmonary symptoms or complaints, the patient collapsed and was unresponsive, not breathing, and pulseless. In the course of resuscitation, right and left tibial intraosseous lines were started. After 30 minutes of resuscitation, with multiple rounds of lidocaine and epinephrine infused through the intraosseous lines, a sustained perfusing rhythm was established. Acute compartment syndrome was diagnosed, and through anterolateral and posteromedial incisions, all 4 fascial compartments were released. While the condition of the patient's extremity improved, the overall clinical condition of the patient did not. This case highlights the fundamental principles regarding the use of intraosseous infusion and the diagnosis and management of compartment syndrome in critically ill patients.

Paroxysmal hypertension due to baroreflex failure

CASE PRESENTATION A 78-year-old Caucasian male was referred to our hypertension clinic in February 2005 for severe blood pressure (BP) lability. He had a diagnosis of hypertension for about 10 years, but had been previously well controlled. Over the preceding 14 months, he had noticed fluctuations in BP that became progressively more severe. Based on self-monitored home BP readings, he reported systolic BP peaks of 220–240 mmHg and systolic BP nadirs of 80–90 mmHg, often happening within the same day. He also described that the rise in BP was associated with significant diaphoresis of the head and palms and facial flushing, analogous to a ‘thermometer rising inside his face and head’. Occasionally he also experienced palpitations. He had erectile dysfunction but no history of urinary incontinence or retention, or any other genitourinary complaints. He had no other cardiopulmonary, digestive, neurological or psychiatric symptoms. At the time of the initial visit, his hypertension was managed with labetalol 50 mg that he took irregularly, on average once daily. In the past, he had experienced symptomatic hypotension and fatigue with diltiazem, metoprolol, and diuretics. He did not abuse alcohol or any illicit substances and did not use any over-the-counter medications or nutriceuticals. In addition to hypertension, he had a history of squamous cell carcinoma of the left pyriform sinus (treated with extensive radiation to the neck and chemotherapy in 1998), coronary artery disease (coronary artery bypass grafting in 2000), nonproteinuric chronic kidney disease stage 3 (clinically presumed to be due to hypertensive nephrosclerosis), gastroesophageal reflux, and well-controlled hypothyroidism. In addition to labetalol, his medications included aspirin, levothyroxine, lovastatin, omeprazole, and fish oil. On examination, the patient appeared well and calm. BP averaged 184/84 mmHg in the supine position, 152/ 78 mmHg when seated, and 140/74 mmHg after 5 min of orthostasis. His heart rate was 68 b.p.m. and there were no changes with posture. Fundoscopic examination revealed arteriolar narrowing and occasional abnormal arteriovenous crossings. The skin overlying his neck was taut from previous radiation exposure. There was no jugular venous distension at 30 degrees. Bilateral carotid bruits were heard; carotid pulsations were normal. Examination of the heart, lungs, abdomen, and extremities were normal. The neurological examination showed normal focused sensory and motor examination, without any Parkinsonian or cerebellar features. Laboratory tests were significant for an elevated serum creatinine (1.9 mg dl ), with an associated estimated glomerular filtration rate of 38 ml per min per 1.73 m. Relevant laboratory tests, all of which were unremarkable, are listed in Table 1. A renal sonogram was unremarkable. A renal magnetic resonance angiogram was normal. Duplex ultrasound of the carotid arteries revealed hemodynamically significant bilateral carotid stenosis, confirmed by magnetic resonance angiography. A magnetic resonance scan of his brain was remarkable only for deep white matter ischemic lesions; there was no evidence of a brain stem lesion or infarct. Owing to the patient’s history of neck irradiation and clinical presentation, bedside evaluation of baroreflex pathway integrity was performed after he had been off antihypertensive drugs for 5 days. BP averaged 158/ 72 mmHg in the supine position, 158/64 mmHg when seated, and 156/80 in standing. The heart rate was 84 b.p.m. in all positions. The RR interval was unchanged (0.63 s) during slow deep breathing and throughout the Valsalva maneuver. We did not use a beat-to-beat monitor, so we were unable to assess the BP response to the Valsalva maneuver. The cold pressor test (hand/ forearm immersion) showed an unexpected response: he had a decline in both heart rate (93–70 b.p.m.) and BP (154/78–98/60 mmHg), both of which recovered to baseline levels after 5 min of monitoring. His 24 h ambulatory BP monitoring is displayed in Figure 1, demonstrating marked BP lability. t h e r e n a l c o n s u l t http://www.kidney-international.org

SU‐GG‐J‐196: Vascular Occlusion by Acoustically Vaporized Droplets for Potential Targeted Enhancement of Thermal Therapies

Purpose: Acoustic droplet vaporization (ADV) of perfluorocarbon droplets with boiling points below ambient temperature shows promise for spatially and temporally targeted vascular occlusion. Vascular occlusion of a tumor or other target tissue can decrease the local heat dissipation relative to adjacent normal tissues during less directed or slow thermal therapies, such as RF or ultrasonic ablation. Also, encapsulated drugs can be released with the occluding bubbles into the target tissues. Method and Materials: In six canines, in vivo gray scale imaging and color flow and pulse wave (PW) Doppler imaging were employed with low concentration droplet injections to identify exteriorized target arteries or tissues, avoiding major adjacent veins. Short tone bursts at 3.5 MHz with 0.25% duty cycle were used during bolus passage to vaporize droplets with concentrations comparable to clinical ultrasound contrast agent recommendations. Studies included multiple intracardiac (IC) and intravenous (IV) injections, the latter with lipid, rather than albumin, shell. Results: Bubble production by ADV in arteries or tissues is easily visible in gray scale images. Both IC and IV injections repeatedly produced ADV at will in the renal or segmental artery, each injection and ADV generating vascular occlusion as seen by gray scale and Doppler imaging. Mean cortex occlusion was ∼85% by colored microspheres in the targeted kidney or renal pole with an ∼10 min half life per droplet dose. Cardiopulmonary symptoms occurred in some IC injections. ADV was successful in a canine prostate using an intercavitary imaging array for ADV and targeting. Conclusion: Keys to the new, consistent success with both IC and IV injections include adequate concentrations of droplets, use of frequencies with ADV threshold well below those for cavitation, and reliable targeting. Conflict of Interest: This work was supported in part by NIH RO1EB00281.

“Still” Ill?

Our patient was a 59-year-old Caucasian man who had been in good health until 4 months prior to presentation. Then, he developed daily high fevers, drenching night sweats, malaise, and a profound 45-lb weight loss. He also suffered from a sore throat, migratory arthralgia, myalgia, and a diffuse, constant abdominal ache. He reported no nausea, emesis, or bowel changes, and he had no cardiopulmonary, neurologic, or dermatologic symptoms. He had not traveled outside of his home state of Pennsylvania recently, had not been exposed to ticks, and had no risk factors for human immunodeficiency virus (HIV) or tuberculosis.

A critical appraisal of epidemiological studies investigating the effects of ultrafine particles on human health

AbstractBackground Though several reviews investigating the health effects of particulate matter on human health exist, none of them focus exclusively on the impact of particulate matter in the ultrafine range.Objective This research consists of a critical appraisal of qualifying studies that investigates the impact of ultrafine particles on cardiopulmonary and circulatory health among humans.Methods The published articles were obtained from a search of electronic databases and bibliographies of identified articles. The critical appraisal was conducted using an Epidemiological Appraisal Instrument.Results Seven articles satisfied the inclusion criteria adopted in this research. The assessed quality of the published studies ranged from marginal to good.Conclusions The appraisal reveals that ultrafine particle exposure has different consequences compared to fine particle exposure. Also, it is likely that ultrafine particles do pose a health risk to human subjects who are already susceptible to cardiopulmonary disease. Further research is needed to extrapolate findings from lab studies and to determine the exact biological mechanism by which ultrafine particle exposure results in cardiopulmonary symptoms.Significance The reported findings indicate the need to investigate standards for ultrafine particle exposure and to list the three major cardiopulmonary symptoms resulting from ultrafine particle exposure. © 2008 Wiley Periodicals, Inc.

How Low-Risk Is a Coronary Calcium Score of Zero?

Coronary artery calcium (CAC) scoring by computed tomography (CT) has been the subject of intense interest and critical scrutiny since it was first reported as a clinical tool in 1990.1 With improvements in study design, greater availability of coronary CT scanners, and increased attention to the posttest prognosis of patient samples and asymptomatic individuals who have undergone coronary CT, CAC measurement is now considered a potentially useful test for improving coronary risk assessment in selected intermediate-risk asymptomatic patients in whom high CAC scores signify increased cardiovascular risk beyond that predicted by conventional cardiovascular risk factors alone.2 Article p 1693 At the other end of the spectrum, does a very low CAC score signify very low risk? An American Heart Association writing group3 stated that a CAC score of zero (CAC=0; ie, no calcified plaque detected) indicated 1) that the presence of atherosclerotic plaque, including unstable or vulnerable plaque, was highly unlikely; 2) that the presence of significant luminal obstructive disease was highly unlikely (negative predictive value on the order of 95% to 99%); and 3) that the risk of a cardiovascular event in the next 2 to 5 years was quite low (0.1 per 100 person-years). In addition, at least 1 early study suggested that CAC=0 might be useful in the emergency room setting as a tool to rule out myocardial ischemia in symptomatic patients.4 A recent review article5 suggested the same conclusions. However, as pointed out by a different …

Feasibility of Magnetic Resonance Imaging in Patients with an Implantable Loop Recorder

The implantable loop recorder (ILR) is a useful tool in the diagnosis of syncope. Our understanding of their functional and safety profile in interfering environments such as magnetic resonance imaging (MRI) becomes increasingly important as they become more prevalent. We report four patients with an ILR who underwent MRI. The ILR memory was cleared before MRI and no changes were made to programmed settings. Device interrogation took place immediately after the scan. Patients were surveyed for device movement and heating, in addition to cardiopulmonary symptoms after their MRI. Following MRI scanning, all patients were asymptomatic and no device movement or heating was observed. In addition, the functionality of the device remained unaffected. Artifacts mimicking arrhythmias were seen in all ILR patients regardless of the type of MRI scan. MRI scanning of ILR patients can be performed without harm to patient or device, but artifacts that could be mistaken for a tachyarrhythmia are seen frequently.

Relationship between cardiopulmonary fitness and depressive symptoms in cardiac rehabilitation patients with coronary artery disease

To identify independent predictors of depressive symptoms in a cohort of patients with coronary artery disease entering cardiac rehabilitation. Cross-sectional cohort study. Consecutive patients entering a cardiac rehabilitation and secondary prevention programme underwent screening for depressive symptoms using the Center for Epidemiological Studies Depression (CES-D) scale and cardiopulmonary fitness testing to quantify peak oxygen consumption. Of the 366 patients with coronary artery disease, 22.3% reported at least mild (CES-D > or = 16) and 10.4% reported significant (CES-D > or = 23) depressive symptoms. Antidepressant medications were being used by 6.3% of patients. Sociodemographic, cardiopulmonary and cardiac characteristics, and medical co-morbidities previously associated with depression accounted for 14.7% of the variance in a multiple linear regression model (F = 8.713, p < 0.001) predicting CES-D scores. Significant independent predictors of CES-D scores were lower peak oxygen consumption, younger age, female sex, lower maximum diastolic blood pressure, angina pectoris and antidepressant use. Reduced physical fitness, younger age, female sex and ischaemic symptoms of coronary artery disease predict higher depressive symptoms in patients entering cardiac rehabilitation.