Is Endurance Training Harmful to Older Athletes in the Long Run? An Interesting Case of Exercise-Induced Ventricular Tachycardia.

There is limited data on how endurance training can impact cardiac function and arrhythmogenesis. Intense endurance training has been associated with pathological remodeling of the right ventricle (RV) that can act as a substrate for fatal ventricular arrhythmias in older athletes. A previously healthy 63-year-old female marathon runner presented with symptomatic monomorphic ventricular tachycardia (VT) while exercising. Transthoracic echocardiogram (TTE) demonstrated no structural or functional abnormalities. Electrophysiology study (EPS) with three-dimensional mapping and programmed electrical stimulation was performed demonstrating significant scarring of the RV, including RV outflow tract and RV free wall. VT ablation was successfully performed. Unfortunately, exclusion of arrhythmogenic right ventricular cardiomyopathy (ARVC) was limited due to the lack of cardiac magnetic resonance imaging (MRI). Therefore, a single chamber implantable cardioverter defibrillator (ICD) was placed for secondary prevention. Currently, the clinical significance of exercise-induced ventricular arrhythmias in trained athletes without cardiovascular disease is still unknown. This case highlights the need for investigation with larger studies and longer follow up to help us understand the mechanism of exercise-induced scar formation and standardize our management regarding screening, exercise recommendations, and ICD placement in older athletes.

Herpes Zoster-induced Progressive Heart Block: A Case Report.

Varicella-zoster virus (VZV) can produce painful, cutaneous lesions in human beings. Reactivation of this neurotropic virus leads to herpes zoster or shingles: a painful, unilateral, vesicular eruption in a restricted dermatomal distribution. Rarely, reactivation of this virus can lead to cardiac complications, such as myocarditis and even conduction abnormalities. In this case report, we present a patient with a cardiac complication post VZV reactivation and address an unusual question and concern resulting from latent VZV presentation in adults.

Obesity and metabolic phenotypes (metabolically healthy and unhealthy variants) are significantly associated with prevalence of elevated C-reactive protein and hepatic steatosis in a large healthy Brazilian population.

BACKGROUND: Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities. METHODS: We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with <2 metabolic risk factors (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis (HS) was determined via abdominal ultrasound. RESULTS: Overall, 40% of OW individuals were metabolically healthy, and 12% normal-weight had ≥2 MRF. The prevalence of elevated CRP (≥3 mg/dL) and HS in MHO versus normal weight metabolically healthy group was 22% versus 12%, and 40% versus 8% respectively (P < 0.001). Both MHO individuals and metabolically unhealthy normal weight (MUNW) phenotypes were associated with elevated hsCRP and HS. CONCLUSION: Our study suggests that MHO and MUNW phenotypes may not be benign and physicians should strive to treat individuals in these subgroups to reverse these conditions.