Basic science curriculums in nuclear cardiology and cardiovascular imaging: evolving and emerging concepts.

The teaching of basic science with regard to physics, instrumentation, and radiation safety has been part of nuclear cardiology training since its inception. Although there are clear educational and quality rationale for such, regulations associated with the Nuclear Regulatory Commission Subpart J of old 10 CFR section 35 (Title 10, Code of Federal Regulations, Part 35) from the 1960s mandated such prescriptive instruction. Cardiovascular fellowship training programs now have a new opportunity to rethink their basic science imaging curriculums with the era of "revised 10 CFR section 35" and the growing implementation of multimodality imaging training and expertise. This review focuses on the history and the why, what, and how of such a curriculum arising in one city and suggests examples of future implementation in other locations.

Risk of thrombogenicity among nonionic radiocontrast agents.

Several contrast agents have been approved in the United States for radiographic imaging purposes. Most of the older ionic, high-osmolar contrast agents are no longer used because of their side effect profile. Therefore, newer nonionic, low or iso-osmolar contrast agents have been widely accepted as an alternative due to their improved tolerability and safety. We investigated the thrombogenicity of the 6 different nonionic radiocontrast media in terms of their platelet reactivity and noted some minor differences among them. In the 50% contrast concentration group, all of the nonionic contrast agents inhibited aggregation, whereas in the 10% contrast concentration group, all agents showed similar aggregation curves in comparison to the normal control. At 50% contrast concentration, the inhibitory effect of aggregation appeared to be related to the inhibition of calcium mobilization, which may be one of the mechanistic effects.

HIV disease in thrombocardiology.

Human immunodeficiency virus (HIV) infection affects multiple organs including the cardiovascular system. Postmortem studies have revealed multiple abnormalities including abnormal coronary artery pathology, arteriopathy/endothelial dysfunction, hyperlipidemia and hypercoagulability prior to the use of protease inhibitors. With the introduction of antiretroviral medications, specifically protease inhibitor therapy, patients with HIV have been further noted to have premature coronary artery disease, hypercoagulability, hyperlipidemia, insulin resistance, fat redistribution syndrome and increased tendency to myocardial infarction. In this article, we report on one patient with HIV disease on protease inhibitor therapy that presented with non-Q-wave myocardial infarction and underwent percutaneous coronary intervention, and was later found to have stent thrombosis. A review of the literature showed no other previous reports of stent thrombosis secondary to acquired hypercoagulability due to protease inhibitor therapy. Possible predictors of stent thrombosis and hypercoagulability are also discussed.

Serotonin syndrome and other serotonergic disorders.

Serotonin syndrome is an iatrogenic disorder induced by pharmacologic treatment with serotonergic agents that increases serotonin activity. In addition, there is a wide variety of clinical disorders associated with serotonin excess. The frequent concurrent use of serotonergic and neuroleptic drugs and similarities between serotonin syndrome and neuroleptic malignant syndrome can present the clinician with a diagnostic challenge. In this article, we review the pathophysiology, diagnosis, and treatment of serotonin syndrome as well as other serotonergic disorders.