Manifestation Of Heart Disease Research Articles

Abstract We130: Novel Role of RBFox1 in Myocardial Infarction Induced Heart Failure

Introduction: Alternative mRNA splicing affects a broad spectrum of cardiac genes during pathological manifestation of heart diseases. Earlier studies from our lab have identified a muscle-specific isoform of RBFox1 to be a key RNA splicing regulator in pressure overload induced heart failure through regulating cardiac transcription factor alternative splicing. However, the physiological impact of RBFox1 in myocardial infarction (MI), and the RBFox1 downstream mRNA alternative splicing events during MI induced cardiac remodeling remains unknown. Goals: To investigate the functional impact of RBFox1 in MI induced cardiac remodeling. Method and Results: At both mRNA and protein levels, we found RBFox1 to be significantly decreased in Sprague-Dawley Rat hearts post MI. To investigate the functional impact of RBFox1 in myocardial infarction, we utilized AAV9 to achieve cardiac specific expression of RBFox1 in rats. Interestingly, expression of RBFox1 prevented cardiac dysfunction post MI characterized by improved cardiac function based on echocardiography. Expression of RBFox1 further reduced hypertrophy, cell death and fibrotic remodeling at both molecular and histological levels post MI. In vitro, expression of RBFox1 is sufficient to prevent hypoxia induced cardiac cell death based on TUNEL staining and cleaved caspase 3 level, while inactivation of RBFox1 promoted cardiac cell death. To further understand the molecular mechanism underlying RBFox1 mediated cardiac protection, we performed RNA-seq analysis to determine the transcriptome changes in vivo. RNA-seq showed insulin secretion, cAMP signaling and muscle contraction pathways to be top significantly changed pathways in RBFox1 expressed rat hearts post MI. Lastly, we have identified Mbnl1 mRNA alternative splicing to be regulated by RBFox1 through promoting a 36bp exon exclusion at the C-terminal of Mbnl1 protein, potentially affecting the function of Mbnl1. Conclusion: In summary, we have identified a previously uncharacterized role of RBFox1 in myocardial infarction injury. RBFox1 expression is critical to preserve cardiac function post MI, potentially through regulating downstream targets alternative splicing, including Mbnl1.

Short-term exposures to temperature and risk of sudden cardiac death in women: A case-crossover analysis in the Nurses' Health Study.

Sudden cardiac death (SCD) is a major source of mortality and is the first manifestation of heart disease for most cases. Thus, there is a definite need to identify risk factors for SCD that can be modified on the population level. Short-term exposures to temperature have been implicated as a potential risk factor. Our objective was to determine if short-term temperature exposures were associated with increased risk of SCD in a US-based time-stratified case-crossover study. A total of 465 cases of SCD were identified among participants of the prospective Nurses' Health Study (NHS). Control days were selected from all other matching days of the week within the same month as the case day. Average ambient temperature on the current day (Lag0) and preceding 27 days (Lags1-27) was determined at the residence level using 800-m resolution estimates. Conditional logistic distributed lag nonlinear models (DLNMs) were used to assess the relative risk (RR) of the full range of temperature exposures over the lag period. Warmer exposures in the days before event and colder temperatures 21-28 days prior were associated with increased risks of SCD. These results were driven by associations in regions other than the Northeast and among married women. Both warm and cold ambient temperatures are suggestively associated with risks of SCD among middle-aged and older women living across the United States.

Performance Evaluation of Machine Learning Model in Predicting Heart Disease Prevalent

Heart disease stands as the foremost contributor to global mortality in the present era. While a range of medical tests aids in diagnosing various manifestations of heart disease, anticipating its occurrence without resorting to these tests presents a formidable challenge. Machine learning has revealed a potential path for comprehending extensive medical datasets, unearthing concealed insights that elude human observation. Random Forest, Logistic Regression, XG Boost, k-nearest neighbor, and Gradient boosting was used to predict instances of heart diseases based on age and gender in this study. Regardless of the dataset's generalization or gender-specific characteristics, we observed that Random Forest, XG Boost, and K-Nearest Neighbors models exhibit high robustness and minimal sensitivity to hyperparameters. While the prediction accuracy remains consistent among Random Forest, Xgboost, and K-Nearest Neighbors, the crucial features responsible for achieving that accuracy vary among them. This observation indicates that it is important to test different machine learning algorithms when the interest is in prediction and understanding the most important feature(s). Keywords: Machine Learning, Heart Disease, Diagnosis, Predictions, Accuracy CISDI Journal Reference Format Abiola O. A. Adebisi R. O. Adeyemo A. B. (2024): Performance Evaluation of Machine Learning Model in Predicting Heart Disease Prevalent. Computing, Information Systems, Development Informatics & Allied Research Journal. Vol 15 No 1, Pp 63-72... dx.doi.org/10.22624/AIMS/CISDI/V15N1P5. Available online at www.isteams.net/cisdijournal

Non-Coding Ribonucleic Acids as Diagnostic and Therapeutic Targets in Cardiac Fibrosis.

Cardiac fibrosis is a crucial juncture following cardiac injury and a precursor for many clinical heart disease manifestations. Epigenetic modulators, particularly non-coding RNAs (ncRNAs), are gaining prominence as diagnostic and therapeutic tools. miRNAs are short linear RNA molecules involved in post-transcriptional regulation; lncRNAs and circRNAs are RNA sequences greater than 200 nucleotides that also play roles in regulating gene expression through a variety of mechanisms including miRNA sponging, direct interaction with mRNA, providing protein scaffolding, and encoding their own products. NcRNAs have the capacity to regulate one another and form sophisticated regulatory networks. The individual roles and disease relevance of miRNAs, lncRNAs, and circRNAs to cardiac fibrosis have been increasingly well described, though the complexity of their interrelationships, regulatory dynamics, and context-specific roles needs further elucidation. This review provides an overview of select ncRNAs relevant in cardiac fibrosis as a surrogate for many cardiac disease states with a focus on crosstalk and regulatory networks, variable actions among different disease states, and the clinical implications thereof. Further, the clinical feasibility of diagnostic and therapeutic applications as well as the strategies underway to advance ncRNA theranostics is explored.

Performance Evaluation of Machine Learning Model in Predicting Heart Disease Prevalent

Heart disease stands as the foremost contributor to global mortality in the present era. While a range of medical tests aids in diagnosing various manifestations of heart disease, anticipating its occurrence without resorting to these tests presents a formidable challenge. Machine learning has revealed a potential path for comprehending extensive medical datasets, unearthing concealed insights that elude human observation. Random Forest, Logistic Regression, XG Boost, k-nearest neighbor, and Gradient boosting was used to predict instances of heart diseases based on age and gender in this study. Regardless of the dataset's generalization or gender-specific characteristics, we observed that Random Forest, XG Boost, and K-Nearest Neighbors models exhibit high robustness and minimal sensitivity to hyperparameters. While the prediction accuracy remains consistent among Random Forest, Xgboost, and K-Nearest Neighbors, the crucial features responsible for achieving that accuracy vary among them. This observation indicates that it is important to test different machine learning algorithms when the interest is in prediction and understanding the most important feature(s). Keywords: Machine Learning, Heart Disease, Diagnosis, Predictions, Accuracy CISDI Journal Reference Format Abiola O. A. Adebisi R. O. Adeyemo A. B. (2024): Performance Evaluation of Machine Learning Model in Predicting Heart Disease Prevalent. Computing, Information Systems, Development Informatics & Allied Research Journal. Vol 15 No 1, Pp 63-72.dx.doi.org/10.22624/AIMS/CISDI/V15N1P5. Available online at www.isteams.net/cisdijournal

Abstract 17673: Sudden Cardiac Death as the First Manifestation of Heart Disease

Background: Clinical risk stratification is most challenging in the subgroup of individuals who present with sudden cardiac death (SCD) as the first manifestation of heart disease (SCD-FM) and there is a lack of current era population-based data. Hypothesis: Occurrence of SCD-FM SCD differs by ethnicity and access to health care. Methods: Consecutive out-of-hospital cases of SCD attended by emergency medical services were ascertained prospectively from a large ongoing population-based study in the Southwest US (population ~ 850K, 2015-2022) using an established multi-source ascertainment and adjudication process. A detailed review was conducted of the lifetime clinical record and available autopsy data, for each individual. SCD-FM cases were defined as SCD with no prior heart disease diagnosis. We calculated annual age-standardized incidence of overall SCD and SCD-FM per 100,000 residents using US census data. Ethnicity-stratified incidence of SCD-FM was calculated. Occurrence of all health care visits prior to SCD was evaluated. Results: From a total of 2681 SCD cases (age 71 ± 16, female 35%) age adjusted incidence of SCD was 40[38-41] per 100,000 out of which SCD-FM was 15[14-16] per 100,000 (n=1019 (38%), age 67±18, female 33%). There was no difference in SCD-FM incidence between Hispanic and non-Hispanic residents (15 [13-17] vs 15 [14-17], p=0.84). Individuals younger than 65 yr were more likely to have SCD-FM compared to those older than 65 yr (50% vs 33%, p <0.001). We observed that 91% of SCD-FM had visited healthcare providers and 3% had cardiac evaluations performed. Conclusion: A significantly higher proportion of SCD-FM were age <65 but the proportion of SCD-FM did not differ by ethnicity. The vast majority of SCD-FM (91%) underwent health care visits prior to SCD but cardiac evaluations were rare (3%). These findings highlight the need to discover and develop user-friendly, cost-effective pre-screening methods to reduce SCD-FM in the general population.

Abstract 16924: Lateral T Wave Inversion in Adolescent Individuals: The Beat-It Cardiac Screening Program

Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD. Aim: The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated. Methodology: A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who participated in organized sport and/or engaged in >4 hours of physical activity weekly. Results: 2672 adolescents gave consent (mean age 15 years, 50.4% female, 95.8% Caucasian, 39.0% athletes). 6 (0.22%) had lateral TWI, extending into the inferior (n=4, 0.15%) or anterior (n=2 (0.07%) leads. The prevalence was the same in both genders (p=0.477) and athletic status (p=0.580). 2 (0.07%) had symptoms, 4 (0.15%) were female, all were Caucasian, 3 (0.11%) were athletes. 4 (0.15%) had borderline or other pathological ECG changes (n=2 LAE, n=1 RAE, n=1 ST depression). 4 (0.15%) had deep TWI (≥2mm). One patient was diagnosed with HCM (0.04%). All subjects are under surveillance. Family screening in relatives (n=27) identified two (7.4%) with cardiomyopathy (n=1 HCM, n=1 DCM). Another 5 (18.5%) had an abnormal ECG requiring surveillance. These findings suggest that some of the participants identified at screening may harbour pre-clinical phenotypes. Conclusion: Lateral TWI is an infrequent finding in young individuals and requires surveillance as it may be a manifestation of heart disease. Family screening may help increase the degree of suspicion of pre-clinical disease in peripubertal individuals.

Analysis of the ECG data based on a Gaussian mixture model

With the development of The Times, heart disease has become the first killer of human health, and the initial manifestation of heart disease usually is arrhythmia, so it is particularly important to conduct real-time monitoring and analysis of heart rhythm. In this paper, the data analysis of electrocardiogram. First, we preprocessed the heart rate data to improve the accuracy of the subsequent analysis results. Then, the features of the data values were quantified and clustered using a Gaussian mixture model to determine the plausibility of the model. Next, the various characteristic values of the arrhythmia were compared with the normal data, and the arrhythmia was classified. Finally, the entropy weight method is used to empower the risk degree of different indicators, and to evaluate the model to determine the risk level.

Prevalence of concealed arrhythmogenic substrate for sudden cardiac arrest in the general population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): US National Heart Lung and Blood institute National Institute of Health. Background Individuals who present with SCA as the first manifestation of heart disease (Concealed Substrate) present the greatest challenge for clinical risk stratification but population-based information in the current era is lacking. We hypothesized that improved awareness and access to health care has resulted in a reduction in prevalence of Concealed Substrate. Purpose We compared the overall prevalence, secular trends and SCA etiologies of Concealed Substrate in two geographically distinct US populations. Methods Consecutive cases of SCA were ascertained prospectively from 2 large ongoing US studies, the Population Cohort A (PopulationCohortA, 2002-2018) and Population Cohort B (PopulationCohortB, 2015-2022), total population 1.85 million residents. All out-of-hospital SCA events attended by emergency medical services were determined following an established multi-source ascertainment and adjudication process, and detailed lifetime clinical record evaluation conducted for each individual. This included the comprehensive electronic health record, evaluation of SCA survivors as well as all available autopsy information. Concealed Substrate cases were defined as SCA with no prior heart disease diagnosis. Results From a total of 5708 SCA cases (age 66.5 ± 18.2, female 35%), n=3390 (age 64.3 ± 18.8, female 34%) were identified in PopulationCohortA and n=2318 (age 71.6 ± 15.7, female 36%) in PopulationCohortB. In PopulationCohortA, prevalence of Concealed Substrate was 39% (n=1282, age 58.6 ± 21.7, 32% female) and decreased modestly over time (Figure; 37% in 2002-06 vs. to 33% in 2014-18; p=0.001). In PopulationCohortB, overall prevalence of Concealed Substrate was 41% (n=949, age 68.3 ± 17.6, 33% female) and did not change significantly over time (Figure; 2015-2022; p=0.06). Etiology of SCA was determined in a subgroup of overall cases (n=3210, 56%) of which n=2727 (85%) were ischemic SCA and n=483 (15%) non-ischemic SCA. Non-ischemic SCA was more commonly identified in Concealed Substrate (29% vs. 11%; p<0001) and ischemic SCA was more common in Revealed Substrate (89% vs. 72%; p<0.0001). Conclusion There was a modest reduction in prevalence over time, 33-41% of individuals continued to present with Concealed Substrate, with higher likelihood of non-ischemic SCA. These findings suggest that widely available and inexpensive tests such as the 12-lead ECG warrant further evaluation as a pre-screening method in the general population.

MP-453090-5 SUDDEN CARDIAC ARREST AS THE FIRST MANIFESTATION OF HEART DISEASE IN THE GENERAL POPULATION

The subgroup of individuals who present with sudden cardiac arrest (SCA) as the first manifestation of heart disease (FM-SCA) present the greatest challenge to effective clinical risk stratification, but population-based data in the current era is lacking. We hypothesized that improved awareness and access to health care has resulted in a reduction in prevalence of FM-SCA. We compared the prevalence secular trends of FM-SCA in two geographically distinct US populations and evaluated distinguishing characteristics. Consecutive cases of SCA were ascertained prospectively from 2 large ongoing US studies, the Oregon Sudden Unexpected Death Study (OreSUDS, Portland OR, USA, 2002-2018) and Prediction of Sudden Death in Multi-ethnic Communities (PRESTO, Ventura CA, USA, 2015-2022), total population 1.85 million residents. All out-of-hospital SCA events attended by emergency medical services were determined following an established multi-source ascertainment and adjudication process, and a detailed review of the comprehensive lifetime clinical records was conducted for each individual. Both SCA survivors and non-survivors were included. FM-SCA cases were defined as SCA with no prior heart disease diagnosis. A multi-variable model using combined data from both cohorts was used to identify distinguishing characteristics of FM-SCA vs. other SCA. A total of 3390 SCA cases (age 64.3 ± 18.8, female 34%) were identified in OreSUDS and n=2318 (age 71.6 ± 15.7, female 36%) in PRESTO. In OreSUDS, prevalence of FM-SCA was 39% (n=1282, age 58.6 ± 21.7, 32% female) and decreased modestly over time (Figure; 37% in 2002-06 to 33% in 2014-18; p=0.001 for trend). In PRESTO, overall prevalence of FM-SCA was 41% (n=949, age 68.3 ± 17.6, 33% female) and did not change significantly over time (Figure; 2015-2022; p=0.06 for trend). In multivariate comparisons of FM-SCA vs. other SCA performed in the subset of individuals with healthcare visits, younger age, male sex and lower rates of diabetes, hypertension, seizure disorder, chronic obstructive pulmonary disease and chronic renal insufficiency were associated with FM-SCA (p <0.0001). There was a modest reduction in prevalence over time, but 33-41% of individuals continued to present with FM-SCA and were distinguished by younger age, male sex and lower rates of co-morbid conditions. These findings suggest the need to develop and investigate user-friendly and cost-effective pre-screening methods to reduce FM-SCA in the general population.

Infantile Pompe disease with intrauterine onset: a case report and literature review

BackgroundPompe disease is a rare autosomal recessive disease. Acid alpha−glucosidase (GAA) deficiency leads to glycogen storage in lysosomes, causing skeletal, cardiac, and smooth muscle lesions. Pompe disease is progressive, and its severity depends on the age of onset. Classic infantile Pompe disease, the most severe form, is characterized by an age of onset before 12 months. Pompe disease with intrauterine onset has rarely been reported.Case presentationThe proband was born at a gestational age of 40 weeks and 3 days and admitted to our hospital because of intrauterine cardiac hypertrophy, shortness of breath, and cyanosis until 13 min postnatally. Physical examination at admission revealed poor responsiveness, pale skin, shortness of breath, reduced limb muscle tone, and bilateral pedal edema. The heart sounds were weak, and no heart murmur was heard. Echocardiography showed left (9 mm) and right (5 mm) ventricular hypertrophies. The patient was subjected to non−invasive ventilator−assisted respiration, fluid restriction, diuresis, and metoprolol treatment. Infantile Pompe disease was diagnosed on day 16 with a GAA enzymatic activity of 0.31 µmol/L/h and with the full−penetrance genetic test showing the homozygous gene mutation c.1844G>T(p.Gly615Val). Enzyme replacement therapy was refused by the patient’s parents, and the patient died at seven months of age from cardiopulmonary failure.ConclusionInfants with intrauterine−onset Pompe disease usually have early manifestations of heart disease. Prompt GAA enzymatic activity determination and molecular genetic testing are helpful in aiding the parents’ decision and planning the treatment.

Cardiovascular Surgery Procedural Training and Evaluation: Current Status and Future Directions.

The increasing complexity of heart disease manifestations and treatments as well as technological advancements make cardiovascular surgery an evolving specialty. In this review, we provide an overview of the factors leading to new developments in this field and discuss the adopted pathways to train cardiovascular surgeons in the United States. We also review the current challenges to the existing training culture and discuss the need to adopt adjuvant strategies to fulfill the societal expectations of what it means to be a competent cardiovascular surgeon.

Heart Involvement in Diabetes mellitus Patients

Diabetes mellitus (DM) is one of the most significant medical and social health problems worldwide. The main cause of death in patients with DM is cardiovascular diseases, which leads to the significant decrease in quality of life and life expectancy. The aim of this literature review is analyze of the frequency, mechanisms and manifestations of heart disease in diabetes patients. A significant amount of the modern researches is devoted to the diagnosis and treatment of the diabetes complications, including diabetic cardiomyopathy (DC). According to many authors, heart disease in diabetes is associated with the formation of DC, comorbid coronary heart disease and arterial hypertension. DC occurs in 16.8–54% of patients with diabetes and is an independent factor which increases the death risk by 50–60%. Numerous scientific studies have been devoted to the diagnosis and treatment of DC, emphasizing that in order to reduce cardiovascular disease and mortality in patients with diabetes, it is necessary, above all, to achieve glycemic control. Diabetic history, age, comorbidities, atherosclerotic lesions, smoking, overweight or obesity also play an important role. The main aspects of the development and impact of diabetes on the health and life of patients are the untimely diagnosis of this disease, its multifactorial pathogenesis, progressive course and severity of complications. Due to development of the early complications and disability, studies of morphofunctional changes in the myocardium in diabetes are extremely relevant, as cardiomyopathy may increase the risk of myocardial infarction and heart failure. The rapid increase in the number of patients with diabetes, many of whom die from cardiovascular complications, makes the problem of diabetic heart disease one of the most pressing health problems. Treatment of these patients should include correction of carbohydrate metabolism, control of blood lipid composition, decrease in myocardial ischemia, correction of the myocardial metabolism and the risk of heart failure.

Genome-wide analyses reveal the detrimental impacts of SARS-CoV-2 viral gene Orf9c on human pluripotent stem cell-derived cardiomyocytes.

SummaryPatients with coronavirus disease 2019 (COVID-19) commonly have manifestations of heart disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome encodes 27 proteins. Currently, SARS-CoV-2 gene-induced abnormalities of human heart muscle cells remain elusive. Here, we comprehensively characterized the detrimental effects of a SARS-CoV-2 gene, Orf9c, on human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) by preforming multi-omic analyses. Transcriptomic analyses of hPSC-CMs infected by SARS-CoV-2 with Orf9c overexpression (Orf9cOE) identified concordantly up-regulated genes enriched into stress-related apoptosis and inflammation signaling pathways, and down-regulated CM functional genes. Proteomic analysis revealed enhanced expressions of apoptotic factors, whereas reduced protein factors for ATP synthesis by Orf9cOE. Orf9cOE significantly reduced cellular ATP level, induced apoptosis, and caused electrical dysfunctions of hPSC-CMs. Finally, drugs approved by the U.S. Food and Drug Administration, namely, ivermectin and meclizine, restored ATP levels and ameliorated CM death and functional abnormalities of Orf9cOE hPSC-CMs. Overall, we defined the molecular mechanisms underlying the detrimental impacts of Orf9c on hPSC-CMs and explored potentially therapeutic approaches to ameliorate Orf9c-induced cardiac injury and abnormalities.

Abstract 9051: Gender Differences and Aging on Beta-Adrenergic Receptor Subtypes Expression and Function in Murine Left Ventricular Myocytes

Background: Sex-specific modulation of β-adrenergic receptor (AR) stimulation plays a pivotal role in cardiac function and in the manifestation of heart disease, including aging. However, the sex and age influences on 3 cardiac β-AR subtypes have not been systematically evaluated. Their effects on β 1 -AR have yielded mixed results. Virtually no previous studies have examined sex and age-related changes on the functional cardiac β 3 -AR. We hypothesized that sex differences exist in aging-induced changes in myocyte β 1 - and β 3 -AR. Aged males may exhibit a greater selective β 1 -AR downregulation with a more pronounced decline of β-AR reserve. Methods: LV myocytes were obtained from young (Y) (6 mo) and aged (A) (24 mo) (6/group) male (M) and female (F) wild-type mice. We simultaneously compared LV myocyte protein levels of β 1 -, β 2 -, and β 3 -AR, and the responses of cell contractile function (dL/dt max ) to β-AR subtype stimulation by random exposure of myocytes to isoproterenol (ISO) (10 -8 M) or a selective β 1 -, β 2 -, or β 3 -agonist, Norepinephrine (NE, 10 -7 M), Zinterol (ZIN,10 -5 M) and BRL-37,344 (BRL,10 -8 M), respectively. Results: In Y mice, no sex differences were found in myocyte protein levels of β 1 - (YM: 0.73 vs YF: 0.74), β 2 - (0.28 vs 0.29) and β 3 -AR (0.19 vs 0.17). Consistently, there were similarly significant increases in dL/dt max in responses to ISO (YM: 73%, 209.5 vs121.1; YF: 72%, 210.7 vs122.5 μm/s), NE (48% vs 45%), ZIN (18% vs 20%) and decrease after BRL (8.1% vs 7.9%). Compared with sex-matched Y, in both AM and AF, aging caused a ~58% significant increase in β 3 (AM: 0.30 vs AF: 0.27) and slightly reduced β 2 (11% vs 6%) (P=NS). Aging caused ~30% decline in basal cell contractility. No sex differences in dL/dt max of aging myocyte response to ZIN (increased AM: 17% vs AF: 20%), and BRL (decreased 19% vs 21%). However, in AM, β 1 decreased 33% (0.48) which was significantly greater than that in AF (26%, 0.55). Versus AF, in AM, ISO caused significantly less increase in dL/dt max (34% vs 48%) accompanied by attenuated NE-mediated increase in dL/dt max (17% vs 26%). Conclusions: Aging is associated with LV myocyte β 1 -AR downregulation and β 3 -AR upregulation. Sex affects age-related β 1 -AR downregulation, with males exhibiting a more profound decrease with increasing age.

An uncommon presentation of varicose vein: Special manifestations of heart disease

Pulsating varicose veins are a very rare clinical manifestation and mostly have been reported with tricuspid regurgitation or right ventricular dysfunction. The exact etiology and treatment options for this disease are rarely reported in the literature. In this article, we described a 45-year-old woman who had varicose veins in her both lower limbs when she came to our department. Venous ultrasound showed arterial-like pulsations in both superficial and deep veins of the lower extremities, and echocardiography showed severe tricuspid regurgitation. We gave the patient compression therapy for elastic stockings, and the patient's symptoms were significantly relieved. In addition, in this article, we reviewd other cases reported in the current literature and discussed appropriate treatment options for this disease

Acute electrocardiogram pseudoinfarction pattern and reversible left ventricular systolic dysfunction in a patient with diabetic ketoacidosis and hyperkalemia: a case report

Coexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences.

Presentation and management of congenital heart disease in the first year of age

ResumenLas cardiopatías congénitas (CC) se definen como una anomalía estructural del corazón o de los grandes vasos intratorácicos. Constituyen la malformación congénita más frecuente al nacimiento. Al menos un tercio de los pacientes requieren algún tipo de intervención antes del año de edad. Las manifestaciones clínicas de las cardiopatías en la etapa neonatal se presentan con un amplio contexto clínico y se pueden confundir con problemas a nivel pulmonar o infeccioso, lo que dificulta su diagnóstico y con ello contribuyendo de forma importante a la mortalidad y morbilidad de estos pacientes, ya que se retrasa el diagnóstico y manejo oportuno. El monitoreo por oximetría de pulso en el periodo neonatal se utiliza actualmente como método diagnóstico para la detección de cardiopatías congénitas críticas; a pesar de que las detecta en forma temprana, en muchos países aún no se lleva a cabo. El objetivo de este artículo es ofrecer un panorama general de la presentación clínica, aspectos diagnósticos y manejo inicial de las CC en el primer año de edad que pueda ser de utilidad a los médicos de primer contacto para mejorar la atención en este grupo de pacientes.

Silent coronary artery disease in type 2 diabetes: a narrative review on epidemiology, risk factors, and clinical studies

Silent coronary artery disease (CAD) is one of the manifestations of heart disease that particularly affects subjects with type 2 diabetes mellitus (T2DM). From a clinical point of view, silent CAD represents a constant challenge for the diabetologist, who has to decide whether a patient could or could not be screened for this disease. In the present narrative review, several aspects of silent CAD are considered: the epidemiology of the disease, the associated risk factors, and main studies conducted, in the last 20 years, especially aimed to demonstrate the usefulness of the screening of silent CAD, to improve cardiovascular outcomes in type 2 diabetes.

Chapter 33 - Anxiety and psychological management of heart disease and heart surgery

Anxiety is associated with many forms and facets of heart disease, and, by extension, neurologic manifestations of heart disease. Despite its seeming self-evidence, anxiety is challenging to consistently define, measure, and operationalize in the context of medical research. Various diagnostic nosologies have been defined and refined over time, but anxiety is also a universal human experience that may be "normal" in many circumstances, particularly in the face of major medical issues. For these and other reasons, the research on anxiety and heart disease is mixed, incomplete, and often characterized by challenging questions of causality. Nonetheless, a broad body of literature has established clear connections between anxiety and vascular risk factors, cardiac disease, and cardiac surgery. These relationships are often intuitive, with research suggesting, for example, that chronic activation of the sympathetic nervous system is associated with increased risk of heart disease. However, they are sometimes complexly reciprocal or even surprising (e.g., with high-anxiety individuals found to have better outcomes in some cardiac conditions by virtue of seeking evaluation and treatment earlier). This chapter reviews the construct of anxiety and its complexities, its associations with heart disease, and the established treatments for anxiety, concluding with questions about anxiety, heart disease, and their optimal management that still need to be answered.