Research Progress of the Relationship between SUNDS and OSAHS / 法医学杂志

Sudden unexplained nocturnal death syndrom e (SU N D S ) is alw ays a difficulty in forensic m edicine researches. A lthough the developm ent of m olecular genetics prom otes the etiologic study of SU N D S, the pathogenesis of m ost such cases is still unclear. Sleep apnea syndrom e (SA S) is one of the com m on form s of sleep disorders, and obstructive sleep apnea hypopnea syndrom e (O SA H S ) is the m ost com m on. In recent years, som e dom estic and international researches show that O SA H S is related to the developm ent of cardiovascular disease, w hich m ay cause cardiac arrhythm ia, even sudden death. T his article review s the relationship betw een SU N D S and O SA H S and aim s to provide new ideas for the pathogenesis of SU N D S.

The Changes of HIF-1α and VEGF-A in Myocardial Tissue of Rats with Arrhyth-mias / 法医学杂志

Objective T o observe the expression changes of hypoxia inducible factor-1α (H IF-1α) and vascular endothelial grow th factor-A (V E G F-A ) in rats w ith arrhythm ias, and to explore the differences of the expression pattern in the tw o indicators of acute m yocardial ischem ia caused by arrhythm ias and coronary insufficiency. Methods T he arrhythm ia w as induced by C aC l2, and the expression changes of H IF-1α and V E G F-A w ere detected by im m unohistochem istry, W estern blotting and real-tim e PC R w ithin 6 h after the arrhythm ia in rats. Results T he expression of H IF-1α and V E G F-A show ed diffuse in the m yocardial tissue of rats died from arrhythm ias. B oth of them increased in the early arrhythm ia, then decreased. E xtensive m yocardial ischem ia happened at the beginning of arrhythm ia occurrence and its range didn't expand w ith tim e. Conclusion T he expressions of H IF-1α and V E G F-A in m yocardium of the rats w ith arrhythm ia can provide evidence for the differential diagnosis of acute m yocardial is-chem ia caused by fatal arrhythm ia and coronary insufficiency.

Research Progress of the Correlation between Caveolin and Unexpected Sudden Cardiac Death / 法医学杂志

D ue to the negative autopsy and w ithout cardiac structural abnorm alities, unexpected sudden cardiac death (U SC D ) is alw ays a tough issue for forensic pathological expertise. U SC D m ay be asso-ciated w ith parts of fatal arrhythm ic diseases. T hese arrhythm ic diseases m ay be caused by disorders of cardiac ion channels or channel-related proteins. C aveolin can com bine w ith m ultiple m yocardial ion channel proteins through its scaffolding regions and plays an im portant role in m aintaining the depolar-ization and repolarization of cardiac action potential. W hen the structure and function of caveolin are af-fected by gene m utations or abnorm al protein expression, the functions of the regulated ion channels are correspondingly im paired, w hich leads to the occurrence of m ultiple channelopathies, arrhythm ia or even sudden cardiac death. It is im portant to study the effects of caveolin on the functions of ion channels for exploring the m echanism s of m alignant arrhythm ia and sudden cardiac death.

Correlação entre arritmia ventricular e remodelamento geométrico do ventrículo esquerdo na hipertensäo arterial / Correlation Between Ventricular Arrhythmias and Geometric Remodeling of the Left Ventricle in Essential Hypertension

PURPOSE--To study the presence and type of ventricular arrhythmias in patients with different geometric patterns of the left ventricle (LV). METHODS--Seventy-two patients with essential hypertension were divided in 4 groups, by the echocardiographic patterns: group I with concentric remodeling of the LV (normal LV mass with increased relative wall thickening); group II with concentric hypertrophy (both LV mass and relative wall thickening increased); group III with normal geometry of the LV (both LV mass and relative wall thickening normal); group IV, with eccentric hypertrophy (increased LV mass with normal relative wall thickening). The groups were compared by the quantity and quality of ventricular arrhythmia, measured by the number of ventricular ectopic beats (VEB) and episodes of ventricular tachycardia (VT) on Holter monitoring, and the presence of late potentials (LP) on signal-averaged electrocardiogram. RESULTS--Group I showed fewer VEB than group II (16.2 +/- 12.85 x 996.4 +/- 518.8, p < 0.05), and a statistic tendency to this result when compared with group IV (16.2 +/- 12.85 x 1634.2 +/- 1001.33, p = 0.063). When compared with group III, no statistical difference was found (16.2 +/- 12.85 x 19.8 +/- 14.81, p = NS). Episodes of VT and the presence of LP were noted only in groups II and IV. CONCLUSION--The group with concentric remodeling of the LV had fewer ventricular arrhythmias than hypertrophic groups, with characteristics closer to the patients with normal LV geometry

Objetivo - Estudar as arritmias ventriculares em pacientes hipertensos divididos em grupos de acordo com características geométricas do ventrículo esquerdo (VE). Métodos - Setenta e dois pacientes com hipertensão arterial primária foram divididos em 4 grupos, de acordo com características geométricas do VE, avaliadas pela ecocardiografia: grupo I com remodelamento concêntrico do VE (massa do VE normal com espessura relativa da parede aumentada); grupo II com hipertrofia concêntrica (massa do VE e espessura relativa da parede aumentadas); grupo III com geometria do VE normal (massa do VE e espessura relativa da parede normais); grupo IV com hipertrofia excêntrica (massa do VE aumentada e espessura relativa da parede normal). Os grupos foram comparados quanto à presença e características das arritmias ventriculares ao Holter - número de extra-sístoles ventriculares (EV) e episódios de taquicardia ventricular (TV) e quanto à presença de potenciais tardios ventriculares (PTV) no eletrocardiograma de alta resolução. Resultados - O grupo I apresentou menor quantidade de EV quando comparado com o grupo II (16,2±12,85 x 966,4±512,8, p<0,05). Mostrou também uma tendência estatística semelhante na comparação com o grupo IV (16,2±12,85 x 1634,2±1001,33, p=0,063). Quando comparado com o grupo III, não foi observada diferença estatística (16,2±12,85 x 19,8±14,81, p=NS). Episódios de TV e presença de PTV somente foram detectados nos grupos II e IV. Conclusão - O grupo com remodelamento concêntrico do VE teve menor quantidade de arritmias que os grupos hipertróficos, com um comportamento semelhante ao do VE geometricamente normal

Avaliaçäo do bloqueio atrioventricular do 3§ grau congênito pelo teste ergométrico / Study of the congenital complete heart block by the exercise te sting

Objetivo - Analisar o uso do teste ergométrico como método de avaliação inicial, acompanhamento e indicador prognóstico de pacientes portadores de bloqueio atrioventricular (BAV) do 3º grau congênito. Métodos - Cinco pacientes (3 masculinos) com idades variando de 7 a 34 anos (X = 22,8), utilizando-se o teste ergométrico em esteira rolante segundo o protocolo de Bruce, sintoma limitante. Resultados - Em todos os casos houve aumento da freqüência atrial, média de 74,40 bpm no basal atingindo 155,20 bpm no esforço máximo; tendo o cronotropismo atrial ficado pouco abaixo daquele prescrito para a faixa etária. A média da freqüência ventricular (FV) no esforço máximo foi de 94,80 bpm, ficando bem abaixo da prevista e demonstrando déficit cronotrópico ventricular. O consumo médio de oxigênio foi de 35,68ml02 ½Kg½min. Em 1 paciente (20%) não houve variação da FV com o esforço. Em 3 (60%) ocorreu aparecimento de arritmia ventricular complexa e em 1 (20%) foi indicado o implante de marcapasso definitivo...

Purpose - To analyse the use of the exercise testing as the method of initial avaliation, following a prognostic indicative of patients with congenital complete heart block. Methods - Five patients were analysed (3 men and 2 woman) with ages between 7 and 34 years (X = 22.8). The patients were submitted to a threadmill exercise testing using the Bruce protocol 1 and symptom limited. Results - In all patients the atrial frequency increased from a median of 74.40 bpm in the basal to 155.20 bpm in the maximum effort; the atrial chronotropism was a little below that calculated based on the age of the patients. The median of the ventricular frequency in the maximum effort was 94.80 bpm, very different from that foreseen and showing a deficit of ventricular chronotropism. The median consumption of oxygen was 35.68ml02 /Kg/min. In one patients (20%) there was not any change in the ventricular frequency with the effort, in 3 (60%) complex ventricular arrhythmia arise during the effort and in one (20%) a definitive ventricular pacemaker was implanted...