Worsening thoracic impedance as a ventricular tachyarrhythmia risk.

The use of heart failure classification to identify patients with systolic dysfunction who are at risk for ventricular tachyarrhythmias (VAs), sudden cardiac death, and shocks from implantable cardioverter defibrillators (ICDs) is limited by its subjectivity. Measurement of thoracic impedance offers a more objective tool for assessing worsening of heart failure. We sought to look at the correlation between ventricular arrhythmia and heart failure as assessed objectively by thoracic impedance. We reviewed device interrogation data on thoracic impedance from ICD with Medtronic's OptiVol® feature (Medtronic Inc., Minneapolis, MN) at two medical centers. Data from the last two interrogations of the same device separated by at least 2 months were included. An OptiVol fluid index threshold of 60 represented early heart failure prior to appearance of symptoms. VAs included were ventricular fibrillation and/or ventricular tachycardia lasting more than 16 beats. Chi square distribution test was used in statistical data analysis. There were 24 VAs identified among the 322 interrogations reviewed (7.5%). Elevated OptiVol fluid index was seen in 71% (17/24), whereas normal OptiVol index was seen in the remaining 29% (7/24) of these interrogations with VA (P < .05). Our review shows that heart failure patients who have VA are approximately 2.5 times as likely to have worsening thoracic impedance as assessed objectively by the OptiVol fluid index. Careful monitoring of the OptiVol fluid index may identify a population at high risk of VA that merits more intense attention.

Incidence of Vitamin D Insufficiency in Coastal South-Eastern US Patient Population With Cardiovascular Disease.

BACKGROUND: Vitamin D insufficiency is increasingly gaining prominence as an associated cardiovascular disease (CVD) risk factor, often thought to be an issue in colder climates and higher altitudes. The intent of this study was to ascertain vitamin D levels in the southern Alabama gulf-coast region that has a high number of sunny days along with an annual average elevated UV ray index. METHODS: An observational retrospective study of 204 patients with established CVD treated at the University of South Alabama's Heart Center from January 2007 through January 2013 was undertaken. One-way ANOVA analyses were performed to determine any significant difference in the mean 25-hydroxyvitamin D (25(OH)D) serum based on gender and also based on race/ethnicity. Further, odds ratio (OR) was computed to ascertain if there was a relationship between vitamin D insufficiency and elevated body mass index (BMI). RESULTS: Out of 204 patients, 53.4% (n = 109) were found to have vitamin D insufficiency (25(OH)D = 20.1 ng/mL), while 46.6% (n = 95) were within the normal range (25(OH)D = 37.8 ng/mL). The mean 25(OH)D of the entire group was 28.3, indicating a general trend of vitamin D insufficiency for patients treated at the cardiology clinics. CONCLUSION: This study established the prevalence of vitamin D insufficiency in the hot and high UV ray index climate of the coastal south-eastern United States. Also, it revealed the relationship of increased BMI with low 25(OH)D serum level. More extensive studies should be conducted in similar climates to further assess vitamin D insufficiency.

The normal and abnormal owl monkey (Aotus sp.) heart: looking at cardiomyopathy changes with echocardiography and electrocardiography.

BACKGROUND: Cardiovascular disease, especially cardiomyopathy, was the major cause of death among owl monkeys (Aotus sp.) at a major colony and threatened colony sustainability. For this study, echocardiography (echo) and electrocardiography (ECG) normal values were established, and cardiomyopathy animals identified. METHODS: Forty-eight owl monkeys were studied, 30 older than 10 years of age ('aged') and 8 of age 5 years ('young'). Eight aged owl monkeys had cardiomyopathy. RESULTS AND CONCLUSIONS: Aged Aotus had increased left ventricular posterior wall thickness over young animals. Left ventricular diameter and ejection fraction appeared to be the best identifying measurements for cardiomyopathy. There were no differences in the ECG.

Is primary hyperaldosteronism a risk factor for aortic dissection?

Primary hyperaldosteronism is a rare (<1%) and underdiagnosed cause of secondary hypertension. We present a case of aortic dissection in a patient with primary hyperaldosteronism. To our knowledge, there are six other reported cases of aortic dissection in patients with primary hyperaldosteronism. Our case strengthens the hypothesis that primary hyperaldosteronism is a potential independent risk factor for aortic dissection.

Studies of heart disease and failure in aged female squirrel monkeys (Saimiri sp.).

Lesions consistent with heart failure were found in 23 of 88 adult squirrel monkeys that died between 1995 and 1999 at the Squirrel Monkey Breeding and Research Resource (SMBRR). This provided a rationale for a study surveying aged animals in the SMBRR for normal cardiac characteristics, using echocardiography (ECHO) and electro-cardiogram. In the pilot study, ECHO and electrocardiography were performed on 59 healthy female squirrel monkeys aged 10 years or older and 39 five-year-old monkeys. Parameters were heart rate, P-wave duration and amplitude, and PR, QRS, and QT intervals (electrocardiography), and ejection fraction. Two animals with cardiomyopathy were identified and received similar testing. Advanced-study animals had the same measurements, plus left ventricular internal diameter-systole (LVIDs) and -diastole (LVIDd), left atrial diameter-diastole (LADd) and aortic root diameter-diastole (AoRDd) by use of ECHO. Significant differences were found between groups in LADd, and P-wave and QRS interval durations. In a clinical context, these differences were not considered to be substantial. Normal aged female squirrel monkeys had significant increases in heart dimension and longer P- and QRS-wave durations than did monkeys of a five-year-old control group, although the increases were not considered clinically relevant. This study documents myocardial dynamics in healthy saimiri and those with cardiomyopathy.

Myocardial ischemia secondary to a large coronary-pulmonary fistula--a case report.

Coronary-pulmonary fistulas are rare. The majority of these fistulas arise from the left anterior descending or the right coronary arteries; the circumflex coronary artery is rarely involved. The majority of patients are asymptomatic, but heart failure, angina, myocardial infarction, endocarditis, and dyspnea have rarely been reported. The management is controversial and recommendations are based on anecdotal cases or very small retrospective series. A case of a 62-year-old female is reported who presented with chest pain and was found to have myocardial ischemia on SPECT sestamibi. Cardiac catheterization revealed no obstructive coronary artery disease and a large coronary pulmonary fistula communicating from the left circumflex coronary artery to the left pulmonary artery.