Sex, the heart, and heart failure.

In the modern era of pharmacologic treatment of erectile dysfunction, men with heart disease increasingly approach their physicians regarding the possibility of restoring sexual activity. At the same time, patients are also frequently aware of public figures that have reportedly died during coitus, often in the arms of their mistresses or prostitutes. Added to this is the perception of patients, and oftentimes their physicians, that coitus and orgasm are associated with a near maximal or even "supermaximal" cardiac workload and therefore may be hazardous for a diseased heart. Accordingly, knowledge of the cardiovascular effects of sexual activity, the risks of triggering a cardiovascular event, and the potential risks inherent in the use of drug therapy of male impotence is important to properly advise patients and their spouses regarding this sensitive issue.

Determination of furosemide in plasma and urine using monolithic silica rod liquid chromatography.

In the present study we developed a fast and reliable HPLC assay for the determination of the loop diuretic furosemide in plasma and urine, using a Chromolith RP 18e (100 mm x 4.6 mm) monolithic silica rod HPLC column. After liquid-liquid extraction with diethylether plasma or urine samples were separated with a gradient consisting of solvent A (20% acetonitrile) and solvent B (80% acetonitrile), both in 0.25% acetic acid. The flow rate was 3.5 ml/min and the effluent was monitored by fluorescence with excitation at 230 nm and emission at 410 nm. The retention times for the internal standard (naproxen) and for furosemide were 2.1 and 3.7 min, respectively, and total run time was 8 min. The calibration curves were linear between 7.8 and 1000 ng/ml, and within-assay and between-assay coefficients of variation were <6.5% and <10%, respectively. The proposed assay for furosemide in plasma and urine using monolithic silica rod chromatography is fast, sensitive, and reliable, and, thus, well suited for pharmacokinetic studies.

Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension.

Dysfunction of the vascular endothelium is a hallmark of most conditions that are associated with atherosclerosis and is therefore held to be an early feature in atherogenesis. However, the mechanisms by which endothelial dysfunction occurs in smoking, dyslipidaemia, hyperhomocysteinaemia, diabetes mellitus, arterial hypertension, cerebrovascular diseases, coronary artery disease and heart failure are complex and heterogeneous. Recent data indicate that endothelial dysfunction is often associated with erectile dysfunction, which can precede and predict cardiovascular disease in men. This paper will provide a concise overview of the mechanisms causing endothelial dysfunction in the different cardiovascular risk factors and disease conditions, and of the impact of the intervention measures and treatments.

Induction ovens and electromagnetic interference: what is the risk for patients with implanted pacemakers?

Electromagnetic fields may interfere with normal pacemaker function. Despite the introduction of modern pacemakers and bipolar lead systems, electromagnetic interference (EMI) still remains to be a concern during daily lives when patients are exposed to cellular phones, electronic security systems, and several household appliances. The aim of this study was to evaluate potential EMI risk of induction ovens, which are increasingly used in private households. The study included 40 consecutive patients (22 men, 18 women; age 73 +/- 11 years) with implanted DDD, VVI, VDD, and AAI pacemaker systems. The pacemakers were programmed to unipolar sensing and pacing. Sensitivity remained unchanged, if the measured sensing threshold was more than twice the programmed value; otherwise, it was set at half of the measured sensing threshold. Patients were placed in a sitting position at the closest possible distance of about 20 cm between two cooking pots and pacemaker bending the upper part of the body slightly over the induction oven. The energy was increased stepwise to the maximum. One pot was removed and placed again at the highest oven level. Potential interference was monitored continuously. The study showed no incidence of pacemaker malfunction during the entire test while the patients with intrinsic cardiac rhythms were exposed to the induction oven at varying energy strengths. Likewise, there was no external interference when the patients were paced at heart rates of 10-15 beats/min above their heart rates. The programmed parameters remained unchanged after the study. In conclusion, this study shows no EMI risk of an induction oven in patients with bipolar or right-sided unipolar pacemakers.

Repair of postinfarction dyskinetic LV aneurysm with either linear or patch technique.

OBJECTIVES: Controversy still exists regarding the optimal surgical technique for postinfarction dyskinetic left ventricular aneurysm (LVA) repair. We compared the efficacy of two established techniques, linear vs. patch remodeling, for repair of dyskinetic LVA. PATIENTS AND METHODS: From 1989 to 1998, 95 (16 women, 79 men) consecutive patients were operated on for postinfarction dyskinetic LVA. Thirty-four patients underwent patch remodeling (R) and 61 linear (L) repair. The mean age was 61.1+/-8.5 years. Indications for surgery alone or in combination included angina in 72 patients, dyspnea in 64 and ventricular tachycardia in 41. Thirty-seven patients had a history of congestive heart failure (R 13 (38%), L 24 (39%), NS). The mean ejection fraction (EF) with aneurysm was 0.29+/-0.09 in R vs. 0.35+/-0.10 in L (P<0.04), whereas the mean EF without aneurysm was 0.43+/-0.11 in R vs. 0.46+/-0.08 in L (P=0.3). Seventy-one aneurysms were anterior (R 30 (88%), L 41 (68%), P<0.05). Concomitant coronary artery bypass grafting was performed in 84 patients (R 29 (85%), L 55 (90%), NS). Follow-up ranged from 1 to 12 years (mean 5.6+/-3.4 years, median 6.1 years). RESULTS: Early mortality was 8% (n=8) (R 4, L 4, NS). Survival at 1, 5 and 10 years was 88, 73, and 44%, respectively. It did not differ significantly between R (1 and 5 year survival 85, 66%) and L (90, 76%, P=0.58). Preoperative risk factors for mortality were history of congestive heart failure (1 and 5 year survival 81 and 57% vs. 90 and 78%, respectively, hazard ratio (HR)=1.95, P<0.05), non-anterior localization of the aneurysm (86 and 49% vs. 86 and 77%, HR=2.06, P<0.05), history of thromboembolic events (57 and 19% vs. 89 and 74%, HR=3.27, P<0.05), and left ventricular EF (HR=0.97 per %, P=0.05). At late follow-up the mean functional class was 1.8+/-0.6 in long-term survivors (preoperative 2.9+/-0.9, P<0.001) with no difference between the groups. CONCLUSIONS: The technique of repair of postinfarction dyskinetic LVA should be adapted in each patient to the cavity size and extent of the scarring process into the septum and subvalvular mitral apparatus. Applying these considerations to the choice of the technique of repair, both techniques achieved satisfactory results with respect to perioperative mortality, late functional status and survival.

Surgical management of acute mitral valve regurgitation due to post-infarction papillary muscle rupture.

BACKGROUND AND AIM OF THE STUDY: Acute myocardial infarction associated with mitral papillary muscle rupture and cardiogenic shock carries a high mortality. Data relating to early and late survival after emergency mitral valve surgery and concomitant complete coronary artery revascularization in this patient population were analyzed. METHODS: Between January 1988 and December 1998, 21 consecutive patients (mean age 62+/-9.7 years) underwent emergency coronary and concomitant mitral valve surgery for acute myocardial infarction and mitral papillary muscle rupture associated with cardiogenic shock. Mitral valve replacement was performed in 19 patients (90%), and mitral valve repair in two (10%). An average of 2.2 distal anastomoses per patient was performed. Revascularization was complete in 19 patients (90%). Preoperatively, intra-aortic balloon pumping was used in 11 patients (52%), and two (10%) had salvage surgery when arriving at the operating room under cardiopulmonary resuscitation. Early and late follow up was complete; mean follow up was 5+/-3 years (range: 16 months to 12 years). RESULTS: Thirty-day mortality was 19% (4/21), with two cardiac-related early deaths (10%). Early morbidity included perioperative stroke in 6% (1/17), myocardial infarction in 6% (1/17), and need for hemodialysis in 18% (3/17). There were three late deaths; one was cardiac-related. Actuarial survival at one, five and 10 years was 81, 68 and 56%, respectively. All survivors were in NYHA class I or II. CONCLUSION: Emergency surgery for acute post-infarction mitral papillary muscle rupture is justified, even as a salvage procedure. Concomitant mitral valve surgery and complete coronary artery revascularization achieve acceptable survival rates and satisfactory functional results.