The Value of the Electrocardiogram in Adult Congenital Heart Disease.

The electrocardiogram is the first test that is undertaken when evaluating a patient's heart. Diagnosing congenital heart disease in an adult (ACHD) can be facilitated by knowing the classical electrocardiographic (EKG) findings. These EKG findings often result from the congenital defect that prevents a part of the cardiac conduction system from occupying its normal anatomic position. When these classical EKG findings are not present, the clinician should consider alternate diagnoses. As the patient with congenital heart disease ages, with native anatomy or after surgical or device repair, the EKG can be used to assess the patient's status and to decide if and when treatment requires adjustment. This is because the electrocardiogram (EKG) can diagnose the hypertrophy or enlargement in a cardiac chamber that results from the congenital defect or anomaly and can diagnose an arrhythmia that might compromise an otherwise stable anatomy. While ACHD often involves intracardiac shunting, in many cases the abnormality only involves cardiac electrical conduction block or ventricular repolarization. These life-threatening diseases can be diagnosed with an EKG. This review will demonstrate and explain how the EKG can be used to diagnose and follow adults with congenital heart disease. When coupled with history and physical examination, the value of the EKG in ACHD will be apparent. A diagnosis can then be made or a differential diagnosis proposed, before an imaging study is ordered.

Chest Radiography Pearls in Select Adult Congenital Heart Disease.

Congenital heart disease in adult patients (ACHD) includes individuals with native anatomic deformities and those who have benefited from corrective, ameliorative, or interventional heart and vascular interventions. Congenital heart disease is the most common birth defect, although with interventions most survive into adulthood. Newborns and children with complex congenital heart diseases that feature cyanosis fail to thrive, and once this is identified, heart failure can promptly undergo diagnostic evaluations and treatment. However, patients with simple congenital heart disease and subtle clinical signs and symptoms may escape diagnosis until adulthood or experience changes in their cardiac hemodynamics and physiology in settings such as pregnancy or newly diagnosed arrhythmias. The chest X-ray (CXR) is the most common X-ray among all radiological procedures. Individual features or a constellation of features on a CXR are often present in patients who have congenital heart disease. The ability to recognize these CXR features is a valuable skill for making the diagnosis of ACHD and for following these patients as they age, and can complement echocardiographic findings. When used well to diagnose ACHD, the CXR will be the sharpest arrow in the quiver.

When What Is Beautiful Is Not Good: The Role of Trait Self-Control in Resisting Eye Candy.

People are drawn to and like others who are physically attractive. In the present research, we investigated the influence of trait self-control on individuals' interest in relationships with physically attractive others. We hypothesized that high (vs. low) self-control individuals would approach relationships by considering information beyond appearance about potential partners, including partners' self-control. We additionally explored the influence of other traits (e.g., Big 5, self-esteem, and attachment styles) on relationship interest. Across studies, we consistently found that individuals with higher self-control avoided pursuing relationships with attractive individuals who display low self-control. In Study 3, we observed a similar pattern for three other traits: conscientiousness, extraversion, and positivity embracement. These results suggest perceivers' self-control shapes relationship interest, particularly when attractive individuals possess less desirable qualities. The findings extend past research that attractiveness increases interest in others and highlights the potential for trait self-control to direct relationship interest during initial interactions.

Partner-Involved Financial Incentives for Smoking Cessation in Dual-Smoker Couples: A Randomized Pilot Trial.

INTRODUCTION: Members of dual-smoker couples (in which both partners smoke) are unlikely to try to quit smoking and are likely to relapse if they do make an attempt. The purpose of this study was to investigate the feasibility, tolerability, and preliminary outcomes of dyadic adaptations of financial incentive treatments (FITs) to promote smoking cessation in dual-smoker couples. AIMS AND METHODS: We enrolled 95 dual-smoker couples (N = 190) in a three-arm feasibility RCT comparing two partner-involved FITs (single vs. dual incentives) against a no-treatment control condition. Participants in all conditions were offered nicotine replacement and psychoeducation. A 3-month follow-up provided information about retention, tolerability (ie, self-reported benefits and costs of the study), and preliminary efficacy (ie, program completion, quit attempts, point-prevalent abstinence, and joint quitting). RESULTS: Results suggest dyadic adaptations were feasible to implement (89% retention rate) and highly tolerable for participants (p < .001). Neither feasibility nor tolerability varied across the treatment arm. Preliminary efficacy outcomes indicated partner-involved FITs have promise for increasing smoking cessation in dual-smoker couples (OR = 2.36-13.06). CONCLUSIONS: Dyadic implementations of FITs are feasible to implement and tolerable to participants. IMPLICATIONS: The evidence that dyadic adaptations of FITs were feasible and tolerable, and the positive preliminary efficacy outcomes suggest that adequately powered RCTs formally evaluating the efficacy of dyadic adaptations of FITs for dual-smoker couples are warranted.

Correction: Politicization of COVID-19 health-protective behaviors in the United States: Longitudinal and cross-national evidence.

[This corrects the article DOI: 10.1371/journal.pone.0256740.].

Feasibility, tolerability, and potential advantages of a dyadic financial incentive treatment for smoking cessation among dual-smoker couples: A pilot study.

As of 2019, 34.1 million adults in the United States smoke cigarettes. People who smoke and who are partnered with other smokers (i.e., dual-smoker couples [DSCs]) represent an estimated two-thirds of U.S. smokers. DSCs face unique obstacles to quitting, are less likely to try to quit, and are more likely to relapse during a quit attempt. Although joint quit attempts hold promise for DSCs' abstinence, few DSCs report trying to quit together. Financial incentive treatments [FITs]-where individuals receive monetary incentives for quitting and maintaining abstinence-increase motivation to quit, and so may help DSCs engage in joint quit attempts. We tested the feasibility and tolerability of adapting a financial incentive treatment to a dyadic context (N = 14 DSCs), in which both individuals of a smoking couple are offered incentives for attendance in a smoking cessation program ($100 USD) and abstinence at follow-up ($100 USD). Ten DSCs (71.4%) completed the follow-up session. Seven participants had biochemically verified abstinence at the follow-up session; of these, six of the seven (86%) were members of DSCs in which both partners were abstinent. Among participants who completed the follow-up session, cravings to smoke and tobacco withdrawal symptom severity were reduced over the study period. Participants rated the study as highly tolerable and listed many benefits and few costs from participation. The present study demonstrates the feasibility, tolerability, and potential advantages of implementing a dyadic financial incentive treatment for smoking cessation for DSCs in the U.S. over the course of 2 months. Public Health Significance: This pilot study demonstrates the feasibility, tolerability, and potential advantages of implementing a dyadic financial incentive treatment for smoking cessation for people who smoke who are coupled with other smokers (dual-smoker couples). The majority of participants (86%) who were abstinent at 2-month follow-up were in a relationship with another smoker who was abstinent at follow-up, suggesting advantages of a dyadic financial incentive treatment to promote joint quit attempts among dual-smoker couples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Politicization of COVID-19 health-protective behaviors in the United States: Longitudinal and cross-national evidence.

During the initial phase of the COVID-19 pandemic, U.S. conservative politicians and the media downplayed the risk of both contracting COVID-19 and the effectiveness of recommended health behaviors. Health behavior theories suggest perceived vulnerability to a health threat and perceived effectiveness of recommended health-protective behaviors determine motivation to follow recommendations. Accordingly, we predicted that-as a result of politicization of the pandemic-politically conservative Americans would be less likely to enact recommended health-protective behaviors. In two longitudinal studies of U.S. residents, political conservatism was inversely associated with perceived health risk and adoption of health-protective behaviors over time. The effects of political orientation on health-protective behaviors were mediated by perceived risk of infection, perceived severity of infection, and perceived effectiveness of the health-protective behaviors. In a global cross-national analysis, effects were stronger in the U.S. (N = 10,923) than in an international sample (total N = 51,986), highlighting the increased and overt politicization of health behaviors in the U.S.

Straight back syndrome as a clue to diagnosing asymptomatic congenital valvular heart disease and limiting the risk of weightlifting.

Although both are initially asymptomatic, mitral valve prolapse/myxomatous mitral valve disease (MVP/MMVD) and bicuspid aortic valve (BAV), with its associated aortic disease, are currently the two most common congenital valvular heart diseases. Severe mitral regurgitation due to rupture of chordae tendineae (CTR) prompts surgery for MVP/MMVD. Surgery for BAV is performed for severe aortic stenosis and/or regurgitation, often with management of root and/or ascending aortic enlargement. There may be an association between straight back syndrome (SBS) and MVP/MMVD, which may be a key to earlier diagnosis. Other associations link weightlifting with ascending aortic enlargement and with CTR, where the common theme is blood pressure elevation. As the number of people with fitness center memberships continues to increase, this potentially exposes more undiagnosed individuals with MVP/MMVD or BAV to risk from weightlifting. Challenges include making the public aware of this risk and preparing the osteopathic physician to recognize patients at risk through a structured history-taking and targeted cardiovascular examination.

Association Between Myxomatous Mitral Valve Disease and Skeletal Back Abnormalities.

BACKGROUND: Myxomatous mitral valve disease (MMVD) is one of the most prevalent valvular heart diseases, while back pain, neck pain and upper-extremity numbness are some of the most common complaints in outpatient settings. Decreased thoracic kyphosis (straight back) is a known cause of hastening back or neck problems, radiculopathy, or even myelopathy. The study aim was to examine the relationship between MMVD, straight back, and the need for cervical fusion. METHODS: In this single-center retrospective study, patients who underwent mitral valve repair or replacement due to MMVD (cases) based on age, gender and body mass index (BMI), were matched with patients who underwent coronary artery bypass grafting (CABG) surgery and had no history of mitral valve disease (controls). The number of patients in each group who required cervical fusion was also noted. Patients included were aged <65 years at the time of surgery, which was performed between January 2014 and December 2015. Thoracic kyphosis curvature was measured from the length of a perpendicular line drawn from the middle of the anterior border of T8 vertebral body to a vertical line connecting anterior superior T4 and anterior inferior T12 on a lateral chest radiograph (AP distance). An AP distance <12 mm was defined as straight back. A Wilcoxon rank-sum test was used to compare the AP distance between cases and controls, and a chi-square test was used to compare the prevalence of straight back in the two groups. RESULTS: The study cohort included 75 patients in the MMVD group and 225 patients in the CABG group. Straight back was present in 27% of the MMVD group versus only 6.7% of the CABG group (p <0.0001) (Odds ratio 5.1; 95% CI 2.4-10.6). The mean AP distance in the MMVD group was 19.8 ± 8 mm, compared to 22.4 ± 6 mm for CABG cohort (p = 0.017). Of those patients with MMVD who had straight back, 10% required cervical fusion, compared to none in the CABG group. CONCLUSIONS: MMVD is associated with straight back and a relatively high requirement for cervical fusion. Patients with MMVD should be screened for straight back and, if the condition is identified, should consider preventive measures to obviate the need for cervical fusion.

Cardiac tamponade: 12 pearls in diagnosis and management.

Cardiac tamponade shares symptoms and signs such as dyspnea, edema, and low urine output with other, more-common diseases. Consider it when there is chest trauma or when the patient has a chronic medical illness that can involve the pericardium. Successfully treating it can be rewarding for both the patient and the physician.

Imaging myocardial carcinoid with T2-STIR CMR.

We used T2-STIR (Short Tau Inversion Recovery) cardiovascular magnetic resonance to demonstrate carcinoid tumor metastases to the heart and liver in a 64-year-old woman with a biopsy-proven ileal carcinoid tumor who was referred because of an abnormal echocardiogram.