Heart Rate Pressure Research Articles

Comparison of Controlled Hypotension Due to the Use of Dexmedetomidine, Magnesium Sulfate, and Esmolol in Craniotomy Surgery

Introduction: Craniotomy includes the temporary removal of bone flap from calvarium to access the intracranial contents, which is usually used to reduce intracranial pressure. Induced or controlled hypotension is a method by which arterial blood pressure is predictably reduced, thus reducing bleeding. Therefore, the present study aimed to compare the dexmedetomidine, magnesium sulfate, and esmolol in controlled hypotension in craniotomy of patients with brain injury. Materials and methods: In this randomized double-blind clinical trial, 45 patients entered into study based on inclusion criteria. All patients were monitored when entering operating room. The questionnaire was completed by all groups, in which PR, MAP (Mean Arterial Pressure), mean bleeding score, mean of received packed cells, controlled hypotension and bradycardia, and survival of patients were recorded. Data were analyzed using spss software version 19, and ANOVA and T-Test were used for statistical significance analysis. Results: The mean age and standard deviations of the three groups of dexmedetomidine, esmolol and magnesium sulfate were 36.78±10.32, 34.47±10.58, and 39.67±11.99 years, respectively. There was no significant difference between the three groups in terms of age, gender, initial heart rate and baseline blood pressure (BP). The MAP and bleeding score (P=0.04 and P=0.0001) was significantly lower in the dexmedetomidine group than in the other two groups. Although the heart rate in the esmolol group was lower than the other two groups, the difference was not significant (P = 0.128). Unlike esmolol and magnesium sulfate groups, GOS did not decrease in the dexmedetomidine group. Conclusion: Comparison of the three groups in controlled hypotension in craniotomy surgery showed that the MAP and bleeding score of dexmedetomidine group was significantly lower than the other two groups, and the GOS didn’t decrease in this group. In general, dexmedetomidine would be a better choice for controlled hypotension in craniotomy.

Medicinal Properties of Terminalia Arjuna: A Review

Terminalia arjuna, also commonly referred to as T. arjuna, is a deciduous tree that belongs to the family Combretaceae. It can be found in many regions of India. T. arjuna is a 60- to 80-foot-tall tree found alongside rivers and streams all over the Indo-sub-Himalayan areas of Delhi, Uttar Pradesh, Chota Nagpur, the southern part of Bihar, Madhya Pradesh and Deccan regions. It has been used to cure several ailments for as far back as the ancient times of India. It is most prevalently consumed to cure and manage several cardiac and vascular diseases, including those like CADs, Angina Pectoris, CHF/Hypertension, and Dyslipidaemia. Its extracts are used to improve cardiac muscles and thus effectively improve heart pumping, heart rate, and blood pressure. The many parts of the tree consist of several phytochemicals, including tannins, flavonoids, glycosides, and triterpenoids like Arjunolic acid, which contribute to its anti-oxidant anti-inflammatory antimicrobial, anticarcinogenic and antimutagenic properties. As of today, there have not been any reports of any harmful side effects regarding its administration. While there are various studies that support its use for a problem of diseases, further research is still required to understand its exact mechanisms. There is also a need for further research on T. arjuna regarding its drug interactions, its specific molecular mechanism of action, and the toxicology involved.

Cardiac Glycosides – The Review of Remedies in congestive heart Failure

Congestive heart failure, occurs when our heart muscle doesn't pump blood as well as it must. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. Herbal drugs like digitalis, squill, and stropanthus commonly find the treatment of heart diseases. Caridio active glycosides like having the purpurea glycosides A and B present in the herb of digitalis, glucoscillaren A and scillarenase having the squill and strophanthus having strophanthoside.

Portal Vein Pulsatility as a Dynamic Marker of Venous Congestion Following Cardiac Surgery: An Interventional Study Using Positive End-Expiratory Pressure.

We aimed to assess variations in the portal vein pulsatility index (PI) during mechanical ventilation following cardiac surgery. Method. After ethical approval, we conducted a prospective monocentric study at Amiens University Hospital. Patients under mechanical ventilation following cardiac surgery were enrolled. Doppler evaluation of the portal vein (PV) was performed by transthoracic echography. The maximum velocity (VMAX) and minimum velocity (VMIN) of the PV were measured in pulsed Doppler mode. The PI was calculated using the following formula (VMAX − VMIN)/(VMax). A positive end-expiratory pressure (PEEP) incremental trial was performed from 0 to 15 cmH2O, with increments of 5 cmH2O. The PI (%) was assessed at baseline and PEEP 5, 10, and 15 cmH2O. Echocardiographic and hemodynamic parameters were recorded. Results. In total, 144 patients were screened from February 2018 to March 2019 and 29 were enrolled. Central venous pressure significantly increased for each PEEP increment. Stroke volumes were significantly lower after PEEP incrementation, with 52 mL (50–55) at PEEP 0 cmH2O and 30 mL (25–45) at PEEP 15 cmH2O, (p < 0.0001). The PI significantly increased with PEEP incrementation, from 9% (5–15) at PEEP 0 cmH2O to 15% (5–22) at PEEP 5 cmH2O, 34% (23–44) at PEEP 10 cmH2O, and 45% (25–49) at PEEP 15 cmH2O (p < 0.001). Conclusion. In the present study, PI appears to be a dynamic marker of the interaction between mechanical ventilation and right heart pressure after cardiac surgery. The PI could be a useful noninvasive tool to monitor venous congestion associated with mechanical ventilation.

In This Issue

HomeCirculation ResearchVol. 129, No. 12In This Issue Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIn This Issue Ruth Williams Ruth WilliamsRuth Williams Search for more papers by this author Originally published2 Dec 2021https://doi.org/10.1161/RES.0000000000000521Circulation Research. 2021;129:1083is related toMyofilament Phosphorylation in Stem Cell Treated Diastolic Heart FailureCardiac Resident Macrophages Prevent Fibrosis and Stimulate Angiogenesisis related toAlternative Mitophagy Protects the Heart Against Obesity-Associated CardiomyopathyCardiac Resident Macrophages Prevent Fibrosis and Stimulate Angiogenesis (p 1086)Resident and recruited macrophages play different roles in cardiac hypertrophy, report Revelo et al.Download figureDownload PowerPointHigh blood pressure is a leading cause of cardiac hypertrophy—an increase in the heart’s muscle mass. In the short term, this growth helps the heart deal with the pressure overload but, if the pressure persists, pathological hypertrophy occurs, including fibrosis and stiffening of the muscle, and can lead to heart failure. It has been suggested that infiltrating macrophages may tip the scales towards pathology despite resident macrophages promoting tissue repair. To examine the roles of macrophages in hypertrophy more closely, Revelo and colleagues specifically depleted heart-resident macrophages in mice with a carefully designed antibody treatment that left circulating macrophages unaffected. They discovered that while the test and control mice responded similarly to heart pressure overload for the first week, in the long-term, the test mice exhibited accelerated decline in heart function and more severe fibrosis. Furthermore, mice whose circulating macrophages were also depleted were protected from this fibrosis. This suggests that recruited macrophages do indeed counteract the actions of resident ones and thereby promote pathology. Understanding the role of immune cells in heart failure will ultimately inform future therapies, say the team.Alternative Mitophagy Protects the Heart Against Obesity-Associated Cardiomyopathy (p 1105)An alternative form of mitophagy protects mouse hearts from obesity-related cardiomyopathy, say Tong et al.Download figureDownload PowerPointPeople with obesity or diabetes are at increased risk of developing cardiomyopathy which can eventually lead to heart failure. One of the major pathological features of obesity-related cardiomyopathy at the cellular level is a decrease in mitochondrial function, likely explained by a concurrent decrease in canonical mitophagy—a process whereby dysfunctional mitochondrial are degraded. An alternative mitophagy mechanism mediated by the factors Ulk1 and Rab9 has recently been discovered, however, and now Tong and colleagues show that this alternative version is actually upregulated steadily over 24 weeks in mice given a chronic high fat diet. Canonical mitophagy, by contrast, ceased after approximately two months. The team showed that suppressing the alternative mitophagy—either by knockout of Ulk1 or expression of a Rab9 loss-of-function mutant—further exacerbated the high-fat diet induced cardiac dysfunction, while over-expression of Rab9 in mouse hearts increased the alternative mitophagy and protected the animals from cardiac dysfunction. Together the results suggest that pharmacologically boosting this Ulk/Rab9-mediated alternative mitophagy may be a treatment strategy for preventing obesity-related cardiomyopathy.Myofilament Phosphorylation in Stem Cell Treated Diastolic Heart Failure (p 1125)Soetkamp et al suggest PKC inhibition as a way to treat a certain type of heart failure.Download figureDownload PowerPointWeakness, fatigue and trouble breathing are among the symptoms experienced by someone suffering heart failure with preserved ejection fraction (HFpEF). The pathology of the condition includes hypertrophy, fibrosis and stiffening of the heart with hyperphosphorylation of the cells’ sarcomeric proteins. Because this hyperphosphorylation is a key contributor to HFpEF pathology and because cardiosphere-derived stem cells (CDCs) show promise as a HFpEF treatment, Soetkamp and colleagues investigated whether CDC treatment reduces phosphorylation levels in the heart. Sure enough, administering CDCs to rats with HFpEF decreased the associated protein hyperphosphorylation compared with that seen in untreated animals. Bioinformatics analysis, based on the observed phosphorylation patterns and mass spectrometry data from test heart samples, suggested Protein Kinase C (PKC) as prime suspect behind the hyperphosphorylation—a suspicion strengthened by observing phosphorylation patterns in heart cells after inhibition or over-expression of PKC. The authors thus suggest CDCs alleviate HFpEF in part by reversing PKC-induced phosphoryation, and that PKC inhibition may be a desirable alternative treatment strategy especially as it avoids regulatory issues associated with cell-based therapies. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesMyofilament Phosphorylation in Stem Cell Treated Diastolic Heart FailureDaniel Soetkamp, et al. Circulation Research. 2021;129:1125-1140Cardiac Resident Macrophages Prevent Fibrosis and Stimulate AngiogenesisXavier S. Revelo, et al. Circulation Research. 2021;129:1086-1101Alternative Mitophagy Protects the Heart Against Obesity-Associated CardiomyopathyMingming Tong, et al. Circulation Research. 2021;129:1105-1121 December 3, 2021Vol 129, Issue 12 Advertisement Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/RES.0000000000000521 Originally publishedDecember 2, 2021 PDF download Advertisement

Changes of Cognitive Ability and Circulatory Physiological Parameters Among Adolescents Moving From Altitudes of 3600 m to 500 m in China: A 50-Day Follow up Study

Background: Travelling across altitude is increasing these days. The effects of travelling from high to low altitude on cognitive and physiological parameters of native highlander adolescents is not clear. The present study aimed to measure the changes of cognitive ability and circulatory physiological parameters when Tibetan adolescents move from high to low altitude, and to test the association between cognitive function change and changes in circulatory parameters.Method: General fluid intelligence, oxygen saturation, hemoglobin concentration, heart rate and blood pressure of 71 Tibetan adolescents were measured twice, initially at Lhasa city (altitude 3600 m) and again 50 days after arriving at Chengdu (altitude 500 m).Results: The mean intelligence scores remained unchanged when students moved from high to low altitude. However, the mean hemoglobin concentration, diastolic blood pressure and heart rate decreased while mean oxygen saturation and systolic blood pressure increased. No associations between change of intelligence and changes of circulatory physiological parameters were detected.Conclusions: Travelling from high to low altitude altered the mean value of circulatory physiological parameters but not cognition of Tibetan adolescents. Change of cognitive function was not associated with changes in physiological parameters.

The safety and efficacy of efonidipine, an L- and T-type dual calcium channel blocker, on heart rate and blood pressure in Indian patients with mild-to-moderate essential hypertension

The safety and efficacy of efonidipine, an L- and T-type dual calcium channel blocker, on heart rate and blood pressure in Indian patients with mild-to-moderate essential hypertension

Methodology of audit for the intensity restoration of the energy-structural status in patients, suffering an ischemic cerebral stroke

Objective. Creation of the audit methodology for іntensity of restoration of the energy-structure status while application of technologies of personified intensive therapy in superacute and acute periods of ischemic cerebral stroke.&#x0D; Materials and methods. The work was performed on the base of the audit results, obtained for intensity of the energy-structure status restoration in 134 patients, suffering the ischemic cerebral stroke, who stayed in the intensive therapy wards of Department of Neurology. In accordance to intensity of restoration of the energy-structure status the technologies of personified intensive therapy were applied: the homeostasis guaranteeing in eubiotic state; energy-protection in hypoergic dysfunction; energy-resuscitation in hypoergic damage; energy-correction in hypoergic insufficiency.&#x0D; Results. Using the achievement of the main physiological targeted indices of organism in the patients, suffering the ischemic cerebral stroke (the arterial blood saturation by the oxygen, average arterial pressure, the heart rate and central venous pressure), it became possible to improve the treatment results. Clinical application of the proposed method of personified restoration of the energy-structure status have promoted to prevent further development of the vital activity disorders, what have had reduced the disability index in patients, suffering an ischemic cerebral stroke. Achievement of the indices targeted realized, using the methods of personified intensive therapy, constitutes a guarantee for the vital skills exclusion in patients, suffering an ischemic cerebral stroke.&#x0D; Conclusion. The clinical investigation conduction have permitted to elaborate the audit methodology for the energy-structure status restoration in the ischemic cerebral stroke and in accordance to intensity of restoration of the energy-structure status indices to apply the іnnovative technologies of personified intensive therapy.

Effect of short-acting b--blockers on heart rate and blood pressure in patients with acute coronary syndrome during percutaneous and coronary intervention

Background. The use of b- blockers in acute coronary syndrome (ACS) is recommended for all patients, who has not contraindications. The study of the effects of esmolol during percutaneous coronary intervention (PCI) remains relevant. Objective. To evaluate the features of the effect of esmolol (Biblock, “YURiA-PHARM”) on heart rate and blood pressure in patients with ACS during PCI.Materials and methods. The study included 30 patients, 15 men and 15 women, who were hospitalized in a specialized cardiology department with ACS with elevation of the ST segment. All patients underwent a general clinical examination, ECG recording in 12 leads, PCI according to the standard protocol with ECG and blood pressure monitoring. All patients were given infusion of esmolol before the standard therapy. The level of heart rate reduction, systolic blood pressure (SBP), diastolic blood pressure (DBP), the correlation of heart rate reduction during esmolol infusion with the clinical and functional parameters of patients and the degree of coronary artery (CA) damage were analyzed.Results. Decreased heart rate and blood pressure during infusion of esmolol in all patients. Before the infusion, the heart rate av-eraged (109.8 ± 4.0) beats per minute. After the infusion – (92.8 ± 3.2) beats per minute, (p &lt; 0.001) with an average duration of infusion (18.2 ± 2.3) minutes. The decrease in SBP levels during infusion occurred on average by (22.8 ± 2.5) mm Hg, DBP – by (16.0 ± 2.1) mm Hg, no patient had hypotension. According to the results of correlation analysis, it was found that the decrease in heart rate with the use of esmolol has a correlation with the average age of patients (r = -0.47, p = 0.0012), with the presence of multivascular coronary artery disease (r = -0.38, p = 0.002). Weaker negative correlation was found with the initial level of SBP (r = -0.28, p = 0.015), the presence of a history of myocardial infarction (r = -0.27, p = 0.005), the presence of signs of left ventricular hypertrophy (LVH) on the ECG (r = -0.22, p = 0.008), and a history of arterial hypertension that was not treated according to current recommendations (r = -0.21, p = 0.032).Conclusions. The use of esmolol solution in patients with ACS who have supraventricular tachycardia and elevated blood pressure during PCI can improve control of heart rate, SBP and DBP, a significant decrease is observed after 10 minutes of dose titration. Careful titration of esmolol solution and monitoring of ECG and blood pressure revealed no side effects, including bradycardia and hypotension, which indicates a high safety profile of the drug.

CIRCADIAN RHYTHM AND CHRONIC DISORDERS OF CONSCIOUSNESS

Among the possible points of therapeutic action and predicting the outcome in patients in a vegetative state and minimally conscious state, the analysis of circadian rhythms, such as the sleep-wake cycle, melatonin secretion, temperature trends, heart rate, and blood pressure, attracts more and more attention. In this review, we analyzed studies on circadian rhythms in patients with chronic disorders of consciousness, assessed the possible limitations of standard methods, proposed a concept for the development of an assessment of the sleep-wake cycle, and assessed the role of exogenous factors that are likely to be involved in the disturbance of circadian rhythms in intensive care units. Based on the results of the study, we came to the conclusion that for the full realization of the rehabilitation potential, it is necessary to develop methods for assessing circadian rhythms based on a multicomponent approach, including 24-hour monitoring using actigraphy for more accurate identification of the rest -activity cycle, video monitoring of the orofascial area to increase the reliability of oculographic assessment and revealing hidden patterns, analysis of the temperature curve, the level of melatonin, TSH, cortisol, as well as exogenous factors. It is necessary to use the information obtained for therapeutic, prognostic, diagnostic and rehabilitation purposes

Normative Fitness in Undergraduate Exercise Science Students: How Do They Compare?

ABSTRACT The purpose of this study was to report normative physical fitness data for Exercise Science undergraduate students and compare the findings with criteria published by the American College of Sports Medicine (ACSM). 514 participants (males, n = 204; females, n = 310) aged from 18 to 29 years participated in this descriptive study. Pre-exercise heart rate and blood pressure, body mass index, waist circumference, skinfold thicknesses to estimate total body fat percentage (BF%), estimated maximal oxygen intake (VO2max), and muscular endurance were evaluated. Percentiles were calculated and compared to those from the ACSM, with hypothesis testing of the medians. The median BF% for male students was leaner (p < 0.001) than criterion standards. VO2max was lower compared to the published median in both sexes (p < 0.001). Students performed on par with ACSM-published muscular endurance assessments. Exercise Science students are not fitter than the normative data published by the ACSM.

Transcatheter mitral valve repair for the treatment of severe mitral regurgitation and exertional pre-syncope in a patient with non-obstructive hypertrophic cardiomyopathy: a case report

BackgroundHypertrophic cardiomyopathy (HCM) has a complex pathophysiology and heterogeneous phenotypic expression. In obstructive HCM with significant mitral regurgitation (MR), MitraClip device implantation reduces MR severity and symptoms. There are no data regarding MitraClip implantation in patients with non-obstructive HCM and significant MR.Case summaryA 78-year-old woman with non-obstructive HCM and significant functional MR (3+) was admitted to our centre for dyspnoea and episodes of pre-syncope under light stress. Transthoracic and transoesophageal echocardiography showed a normal left ventricular ejection fraction and normal right heart pressures, an inverted mitral filling pattern, and a central prevalent jet (A2-P2 origin) of MR. Exercise echocardiography performed to verify exercise tolerance was interrupted at the 50-W stage due to severe hypotension and pre-syncope. After transcatheter edge-to-edge repair using the MitraClip system, the patient exhibited a reduction in MR Grade from 3+ to 1+. Follow-up up to 1-year post-procedure revealed noticeable improvements in exercise tolerance and symptoms. There were no further episodes of pre-syncope.DiscussionIn non-obstructive HCM, the pathophysiological role of MR in symptom generation is unknown. In this patient, we speculated that significant MR contributed to the mechanisms responsible for severe hypotension and pre-syncope during exercise. A reduction in MR after MitraClip implantation was associated with symptomatic improvements. Our findings further highlight the potential utility of the exercise stress test in therapeutic decision-making for patients with non-obstructive HCM and MR.

Digital Integration and Automated Assessment of Eye-Tracking and Emotional Response Data Using the BioSensory App to Maximize Packaging Label Analysis.

New and emerging non-invasive digital tools, such as eye-tracking, facial expression and physiological biometrics, have been implemented to extract more objective sensory responses by panelists from packaging and, specifically, labels. However, integrating these technologies from different company providers and software for data acquisition and analysis makes their practical application difficult for research and the industry. This study proposed a prototype integration between eye tracking and emotional biometrics using the BioSensory computer application for three sample labels: Stevia, Potato chips, and Spaghetti. Multivariate data analyses are presented, showing the integrative analysis approach of the proposed prototype system. Further studies can be conducted with this system and integrating other biometrics available, such as physiological response with heart rate, blood, pressure, and temperature changes analyzed while focusing on different label components or packaging features. By maximizing data extraction from various components of packaging and labels, smart predictive systems can also be implemented, such as machine learning to assess liking and other parameters of interest from the whole package and specific components.

Abstract 10545: Hospital Teaching Status Increases the Frequency of Measurement of Right Heart Pressures in Patients Hospitalized for Heart Failure: A Nationwide Analysis

Introduction: Measurement of right heart pressures is a useful, yet non-routine diagnostic tool whose indications in heart failure are not standardized. In this study, we investigated teaching status as an independent predictor of measurement of right heart pressures. Methods: This was a retrospective cohort study using the 2018 Nationwide Inpatient Sample that included adult patients with a primary diagnosis of heart failure that were admitted to urban hospitals. Rural hospitals were excluded. The primary outcome was measurement of right heart pressures. Secondary outcomes included performance of coronary angiogram, length of stay, total hospitalization charges. Multiple regression analysis was used to adjust for hospital bed size, region, and type of ownership, as well as the patient’s age, type of insurance, income quartile, Charlson Comorbidity Index, chronic obstructive pulmonary disease, pulmonary hypertension, and other relevant comorbidities with a p-value &lt;0.2 in univariate screen. Statistical analysis was performed using Stata 17.0. Results: A total of 1,117,134 (weighted) heart failure hospitalizations were studied, of which a total of 31,085 underwent measurement of right heart pressures. Multivariate regression analysis revealed that hospital teaching status was associated with a greater frequency of measurement of right heart pressures with an odd ratio (OR) 3.03 (95% CI, 2.38 to 3.89, p=0.000). The secondary outcomes of coronary angiogram, length of stay, and total hospitalization charges were also increased. Conclusions: Teaching status increases the frequency of measurement of right heart pressures in heart failure hospitalizations. This might highlight the need to standardize indications applicable across the spectrum of hospital settings.

Abstract 11572: Plasma Proteomic Signature Implicates Impaired Calcium Handling and Cell-Matrix Adhesion in Repaired Tetralogy of Fallot with Right Ventricular Volume and Pressure Overload

Introduction: Patients with repaired tetralogy of Fallot (TOF) are subject to chronic volume and pressure loading leading to a 40% probability of right ventricular (RV) failure by the 3 rd decade of life. We sought to identify a non-invasive, circulating signature of the systemic response to right heart stress to better understand the mechanisms of RV failure and to develop novel therapies. Methods: High throughput mass spectroscopy was used to assess circulating plasma proteins in controls with structurally normal hearts (N=14) and in TOF s/p repair (N=74): no residual lesion (N=4), severe right heart volume overload (N=28), severe right heart pressure overload (N=20), and moderate right heart volume and pressure overload (N=22). Ingenuity pathway analysis was used to identify enriched biological processes using proteins with log2 fold change&gt;0.6, and q value &lt;0.05. Results: Mean age in controls was 15±2yrs, 50% male and in TOF s/p repair 17±14yrs, 34% male. The RV was moderately dilated with normal function in those with volume and/or pressure overload. We identified (i) excellent proteomic coverage identifying &gt;1500 proteins/sample; (ii) unique subset of proteins distinguishing control from tetralogy of Fallot with residual defects (Fig 1); (iii) upregulated pathways involved signal transduction (CREBBP), catabolic processes (NT5M), cell death and aging (FUCOA 2-fold); (iv) downregulated pathways involved immune response (IGHV4), complement and coagulation activation (VWF), regulation of calcium handling (S100A 12-fold) and cell-extracellular matrix adhesion. Conclusion: Patients with TOF s/p repair with RV volume and pressure overload have a distinct proteomic profile implicating heightened cell death pathways and impaired calcium handling which may predispose to heart failure and arrhythmias. These data suggest peripheral blood proteins can provide insight into the mechanisms of RV failure and can be used for monitoring disease progression.

Abstract 12913: Under Pressure: An Unusual Case of Pulmonary Hypertension and Pericardial Effusion

A 50-year-old male smoker with hypertension presented with subacute bilateral leg swelling, weight gain, and dyspnea. Exam revealed tachycardia, jugular venous distention, peripheral edema, diminished breath sounds, and pulsus paradoxus. Labs were notable for elevated creatinine and leukocytosis. ECG showed sinus tachycardia and low voltages. CXR showed left hemithorax opacification. TTE revealed normal LV function, septal flattening, severely dilated RV with reduced function, RVSP 81 mmHg, and a large pericardial effusion with exaggerated respirophasic variation in mitral inflow but no chamber collapse. The elevated RVSP with RV failure raised concern for acute pulmonary embolism (PE). CT chest excluded PE but revealed a large mediastinal mass compressing both pulmonary arteries (PA) and large left pleural effusion. Pulmonary angiogram demonstrated a totally occluded left PA and severe stenosis of the right PA. Right heart catheterization showed RAP 24, RV 83/21, PA 84/29 (mean 53), intrapericardial pressure 15 mmHg, and low cardiac index (1.6 L/min/m2). Pericardiocentesis was performed with close monitoring by PA catheter. Removal of 500cc fluid was well tolerated with stable hemodynamics, cardiac output, and intracardiac pressures. Pericardial fluid cytology and lymph node biopsy demonstrated small cell lung cancer. Cautious diuresis was initiated. After one cycle of chemotherapy, repeat CT chest showed reduced extrinsic compression of the right PA with improved lung perfusion. Repeat TTE showed dramatic improvement with normal RV size and function, RVSP 22 mmHg, and trivial pericardial effusion. Pericardial effusion in the setting of severe PH is associated with poor outcomes and presents both diagnostic and therapeutic challenges. Classic findings of tamponade (e.g. right sided chamber collapse) may be masked by elevated right heart pressures. Compression of the PA by a mediastinal mass is an unusual cause of PH and right heart failure that can mimic acute PE. This rare clinical scenario presents the following challenges: (1) diuresis may precipitate tamponade, (2) pericardiocentesis may enable an already enlarged RV to acutely dilate and thus worsen RV failure, and (3) there is uncertainty regarding the role for PA stenting.

Abstract 14258: Modulation of Kynurenine Pathway to Prevent Brain Injury After Cardiac Arrest and Cardiopulmonary Resuscitation in Mice

Introduction: Kynurenine pathway (KP) is emerging as one of the potential components affecting cardiac arrest (CA) outcomes. The aim of this study is to evaluate the effects of KP inhibition through genetic deletion of the rate-limiting enzyme of the KP, indoleamine-2,3-dyoxygenase (IDO) on survival and neurological outcome after CA. Methods and Results: Sixteen adult male wild-type (WT) and IDO-deleted (IDO -/- ) mice were subjected to 8 min untreated CA followed by resuscitation. At baseline heart rate and mean arterial pressure (MAP) did not differ among groups. At the time of return of spontaneous circulation, 30 and 60 min later, MAP was higher in the IDO -/- group compared to the WT one (p=0.0005). IDO -/- mice showed higher survival compared to WT at 7 days after CA (68.5% in IDO -/- vs 37.5% in WT; log rank p=0.036). Neurological function was higher in IDO -/- than in WT mice during the 7 days following CA (p=0.0124). IDO -/- mice also showed an improved locomotor function compared to WT mice (p=0.037). Brain magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) sequences showed a reduction in fractional anisotropy in the external capsule of the corpus callosum in WT mice compared to IDO -/- mice at 7 days after resuscitation (p=0.015). We then treated additional IDO -/- mice with L-kyn 15 min before CA, to revert the IDO -/- phenotype. Brain MRI with diffusion-weighted imaging (DWI) sequences and histological analysis were performed 24h after CA in WT, IDO -/- , and IDO -/- +L-Kyn mice. Brain MRI revealed restriction of water diffusivity 24h after CA in WT mice. IDO-deletion reduced water diffusion abnormalities while the beneficial effect was reverted in the L-kyn group (p=0.01). Degenerating neurons in the frontal cortex, represented as Fluoro-Jade B positive cells, were more numerous in WT compared to IDO -/- mice; L-kyn halted this IDO deletion-induced reduction in degenerating cells (p=0.05). Conclusion: KP inhibition improves survival and neurological outcome after CA. The neuroprotective effect of IDO-deletion was associated with preservation of brain white matter microintegrity and with reduction of cerebral cytotoxic edema. Reversal of these beneficial effects by L-kyn administration in IDO -/- mice further confirm the KP role in CA outcome.

The Effect of Dog Videos on Subjective and Physiological Responses to Stress

ABSTRACT Research indicates that animal-assisted therapy programs can reduce stress responses. However, animals are not always permitted in public settings. Thus, alternative forms to the physical presence of an animal could be beneficial. The objective of this study was to determine (1) whether exposure to an active-dog video can help improve subjective and physiological responses to stress more than a tranquil-dog video, (2) whether exposure to dog videos can improve subjective and physiological stress responses more than nature videos, and (3) whether exposure to dog (and nature) videos can improve subjective and physiological stress responses more than a control video. Participants (n = 103; female = 78, male = 25) completed a stressful task and were randomly assigned to watch one of five videos: active dog (dog playing with a toy), tranquil dog (dog lying down quietly), active nature (fast-paced waterfall in a forest), tranquil nature (slow-moving stream in a forest), or blank screen (control video; a video of a black screen). Improvements in subjective (i.e., decrease in stress, anxiety, negative affect, and/or increase in happiness, relaxation, positive affect) and physiological (decrease in heart rate and blood pressure) responses to the stressor were examined. This study found no evidence that the active-dog video improved subjective or physiological responses more than the tranquil-dog video. However, this study found evidence that dog videos can decrease subjective anxiety and increase positive affect more than nature videos. Similarly, this study also found that dog videos can decrease subjective anxiety and increase happiness and positive affect more than can the control video. The effects of the dog videos and nature videos (and control video) on the remaining subjective measures and all physiological responses did not differ. Together, the results show some evidence that dog videos may be better at improving subjective anxiety, happiness, and positive affect responses than nature and/or control videos. However, the results did not show evidence that dog videos could alleviate any physiological responses more than the other videos. Practical applications of these findings include how to improve subjective anxiety and affect responses in public settings (e.g., universities) when animals are not allowed.

Abstract 10459: Adenosine versus Diltiazem in Stable Supraventricular Tachycardia Unresponsive to Vagal Maneuver

Introduction: The treatment of stable supraventricular tachycardia (SVT) in the emergency department includes intravenous adenosine. There is evidence to show that calcium channel blockers such as diltiazem have a better conversion rate. This study was conducted to determine the relative effectiveness and to examine the adverse effects of these drugs on converting stable SVT into sinus rhythm. Methods: A prospective randomized controlled study with one group receiving an intravenous bolus dose of 6mg adenosine followed by 12mg if conversion not achieved, and followed by diltiazem if not reverted, and other group receiving diltiazem 0.25mg/kg IV followed by 0.35mg/kg if conversion is not achieved which was followed by continuous infusion. Heart rate and blood pressures were continuously monitored for 1-hour post-conversion with monitoring of other adverse events results: A total of 52 patients with stable SVT were enrolled and were randomized into two groups. Of these 26 patients were given IV Adenosine in one arm and 26 patients were given IV Diltiazem. The conversion rates with adenosine 76.9% were statistically lesser than the diltiazem group 100% with the statistically significant p value of 0.023. The mean change in the blood pressures in either group was statistically insignificant and also the adverse events in either group had no significance. Conclusion: Calcium channel blockers such as diltiazem may be superior to adenosine in the emergency department in the treatment of stable SVT. In this study IV Diltiazem had better conversion rates than the IV adenosine bolus with minimal adverse events. Hence calcium channel blockers are found to be better, safe, and cost-effective in converting stable SVT.

Abstract 10432: Simultaneous Recording of Skin Sympathetic Nerve Activity and Blood Pressure in Ambulatory Outpatients with Postural Orthostatic Tachycardia Syndrome

Introduction: neuECG is a method to simultaneously record ECG and skin sympathetic nerve activity (SKNA). Postural orthostatic tachycardia syndrome (POTS) is known to be associated with increased cardiac sympathetic norepinephrine release. Hypothesis: Average SKNA correlates positively with heart rate (HR) and blood pressure (BP) in POTS patients. Methods: We used Bittium Faros 180 Holter Monitor (sampling rate 1,000 Hz) to record neuECG and SpaceLab OnTrak arterial BP monitor (ABPM) to record BP simultaneously over 24-hr in 20 POTS patients (19 women, 38±12 years old). The Faros signals were high pass filtered at 300 Hz to display the SKNA. The same original signals were bandpass filtered 0.05-150 Hz to display ECG. BP was measured every 30-min when awake (7AM to 9 PM) and hourly at night (9 PM to 7 AM). Results: Fig 1 shows an example of typical recording from a 38-year-old woman. Panel A shows average SKNA (aSKNA) 1-min prior to HR and BP measurement. The overall successful ABPM measurement was 90% with average BP of 126/75 mmHg. B shows bursts of SKNA in daytime (red dot in A), but no bursts at night (blue dot in A). C shows a positive correlation between HR, systolic BP (SBP) diastolic BP (DBP) and mean BP (MBP) with aSKNA. For all patients studied, 16 of 20 showed positive correlation between MBP and aSKNA (r=0.559±0.152, p&lt;0.05 for all) and 15 of 20 showed positive correlation between HR and aSKNA (r=0.511±0.175, p&lt;0.05 for all). The nocturnal aSKNA averaged 0.919±0.059 μV (N=17) and 1.060±0.215 (N=3) (p&lt;0.001) in patients with and without nocturnal dip, respectively. However, the overall 24-hr aSKNA (1.036±0.120 vs 1.044±0.095, μV) was not different between these two groups. Conclusions: aSKNA positively correlated with BP and HR in ambulatory outpatients with POTS. High aSKNA at night was associated with nocturnal non-dipping of BP.