Rare Case of Rapidly Worsening REM Sleep Induced Bradycardia.

Sinoatrial arrest also known as sinus pause occurs when sinoatrial node of the heart transiently ceases to generate the electrical impulse necessary for the myocardium to contract. It may last from 2.0 seconds to several minutes. Etiologies of sinoatrial arrest can be complex and heterogeneous. During rapid eye movement (REM) sleep, sinus arrests unrelated to apnea or hypopnea are very rare and only a few cases have been reported. Here we report a case of 36-year-old male with no significant past medical history who presented to our hospital after a syncopal episode at night. Physical examination showed no cardiac or neurological abnormalities and initial EKG and neuroimaging were normal. Overnight telemonitor recorded several episodes of bradyarrhythmia with sinus arrest that progressively lengthened over time. Sleep study was done which confirmed that sinus arrests occurred more during REM sleep and are unrelated to apnea or hypopnea. Electrophysiology studies showed sinus nodal dysfunction with no junctional escape, subsequently a dual chamber pacemaker placed for rapidly worsening case of REM sleep induced bradycardia.

The effect of statins in heart failure: beyond its cholesterol-lowering effect.

BACKGROUND: Statins known as 3-hydroxyl-3-methyl-glutaryl-coenzyme A (HMG-CoA) are designed to lower plasma cholesterol levels. They are used to treat hypercholesterolemia, ischemic heart disease patients, heart transplant recipients, in prevention of Alzheimer's dementia, multiple sclerosis, and have also been shown to reduce cancer risk. METHODS AND RESULTS: The idea of statin treatment in chronic heart failure is not well established. It has been shown to be beneficial in patients with ischemic heart disease with heart failure. Emerging trends show their usefulness in patients with nonischemic heart failure. Statins exhibit pleiotropic effects in stabilizing the atherosclerotic plaques, improvement of endothelial function, inhibition of cell migration and proliferation, and reduction of inflammation and oxidative stress. They also improve autonomic function with an increased parasympathetic drive, downregulate the angiotensin II type I receptors, and induce angiogenesis. CONCLUSION: This article is a review on the current knowledge on statin use in heart failure.

Renal artery stenosis: an update on diagnosis and management.

Reno-vascular disease, along with diabetes mellitus, is the leading cause of dialysis in the elderly population, accounting for 50-66% of cases in patients above 65 years of age. Reno-vascular disease is a broad term, which includes renal artery stenosis, ischemic nephropathy, such as atherosclerotic obstruction, thrombo-embolic phenomenon, nephrosclerosis secondary to hypertension and acute occlusion of renal arteries (either bilateral or unilateral in singlekidney patients). Renal artery stenosis, defined as a 50% or greater occlusion of a renal artery (unilateral or bilateral), is an important cause of secondary hypertension. It often presents as drug refractory hypertension or renal insufficiency. Atherosclerotic renal artery stenosis accounts for 90% of such cases, the remaining 10% being caused by fibro-muscular dysplasia. The incidence of atherosclerotic renal artery stenosis is increasing among the aging population, who are at an increased risk due to cardiovascular complications. This is a review of the emerging trends in the diagnosis and management of renal artery stenosis.