Search Results (1,605)

Background and Clinical Significance: Mexiletine is a class 1B antiarrhythmic drug commonly prescribed for ventricular arrhythmias and neuropathic pain. It works as a blocker of the sodium channel that modulates cardiac conduction and reduces aberrant nerve signaling. While it is generally well tolerated, gastrointestinal side effects, such as nausea, vomiting, and abdominal pain, are relatively common. Esophagitis and esophageal ulcerations have been described as rare side effects; however, they are poorly documented in the literature. Esophageal ulceration induced by oral medications, termed pill esophagitis, occurs due to prolonged contact between the medication and the esophageal mucosa. Factors contributing to this phenomenon include improper administration, such as swallowing without sufficient water, taking medication before lying down, or inherent irritant properties of the drug itself. Mexiletine-induced esophageal ulceration has not been extensively reported, making such cases clinically significant and worth investigating. In particular, the prompt diagnosis of mexiletine-induced esophageal injury is essential for timely treatment initiation or the discontinuation of the drug, preventing complications such as bleeding, strictures, or perforation. Altogether, these actions are important to prevent the onset of potentially serious complications, such as bleeding, strictures, and the perforation of the esophagus. Case Presentation: Two different patients were included in this case report on mexiletine-induced esophageal ulceration: a 78-year-old woman affected by primary dilated cardiomyopathy and atrial fibrillation with high ventricular response and a 19-year-old man affected by dilated cardiomyopathy and systemic sclerosis. Conclusions: This case report underscores the importance of recognizing mexiletine-induced esophageal ulceration, and it advocates for timely diagnosis and management to optimize patient outcomes. Full article

As snorkelling and breath-hold diving are conducted in a potentially hostile environment by participants with varying skills and health, fatalities occur. In this study, snorkelling and breath-hold diving fatalities were investigated in Australia from 2000 to 2021 to identify causes and countermeasures. The Australasian Diving Safety Foundation database and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths from 2000 to 2021. Relevant data were extracted, recorded, and analysed. The median age of the 317 victims was 48 years, two-thirds were overweight or obese, and almost half had health conditions, including ischaemic heart disease (IHD) and left ventricular hypertrophy (LVH), predisposing them to an arrhythmia-related snorkelling incident. One-third of victims were likely disabled by cardiac arrhythmias and at least 137 deaths were from primary drowning, with 34 following apnoeic hypoxia. Pre-existing health conditions, particularly IHD and LVH, predispose to many snorkelling deaths in older participants and may be somewhat mitigated by targeted health screening. Drownings from apnoeic hypoxia persist in younger breath-hold divers who should avoid pushing their limits without close monitoring. Skills practice in a controlled environment, increased focus on the importance of an effective buddy, and improved supervision are necessary to mitigate risk in the inexperienced. Full article

Under normal conditions, potassium is predominantly found within cells. The concentration gradient of sodium and potassium ions between intracellular and extracellular spaces enables signal transmission through membrane depolarization. The disruption of this transcellular process leads to elevated potassium ion levels in the extracellular space, and thus in the blood, a condition known as hyperkalemia. Clinically, hyperkalemia may present as cardiac arrhythmias, muscle weakness, and palpitations. The post-mortem accumulation of potassium ions in various human tissues and organs, such as the heart, liver, kidneys, lungs, and vitreous body, particularly in cases of overdose, has been an area of research interest for years. Unfortunately, deaths caused by hyperkalemia are difficult to identify due to their non-specific symptoms and are often misinterpreted as cardiovascular-related. Furthermore, most potassium ion concentration tests developed in recent years are non-specific, have limitations, or are based on outdated techniques. Consequently, alternative methods, such as histopathological tissue analysis, potassium concentration assessment in the vitreous body, and aldosterone level measurement, show promise for improving the post-mortem detection of exogenous hyperkalemia. Full article

Background/Objectives: Cardiac rhabdomyoma (CR), the most frequently occurring fetal cardiac tumor, is often an early marker of tuberous sclerosis complex (TSC). This study evaluates outcomes of fetuses with prenatally diagnosed cardiac tumors managed at a single tertiary center. Methods: Medical records of fetuses diagnosed with cardiac tumors between 2009 and 2024 were retrospectively reviewed. Results: Sixteen cases were identified, with a median follow-up of 6.7 years. TSC was confirmed in 14 cases (88%). Multiple tumors were observed in 13 cases (81%), while 3 cases (19%) had solitary tumors. Both non-TSC cases involved solitary tumors. Cardiac complications (arrhythmias, conduction disorders, and hemodynamic abnormalities) occurred in 38% of cases prenatally and 69% postnatally, with larger tumor diameters significantly associated with complications (p = 0.02). No fetal hydrops or mortality occurred; however, one child died at age five due to a seizure. Postnatal tumor regression occurred in 56% of cases and complete regression in 38% by a median age of 2.3 years (range: 0.6–4.4). One tumor remained stable. Brain MRI revealed TSC-related changes in all TSC-affected patients except one, who had a developmental brain anomaly. Most TSC patients experienced epilepsy (71%) and developmental delays. Conclusion: While CRs are typically benign and regress spontaneously, their strong association with TSC highlights the importance of early diagnosis and family counseling. TSC-related epilepsy and psychomotor delays significantly impair the quality of life. Early mTOR inhibitor therapy offers promise in mitigating TSC-related complications and improving outcomes. Full article

Processed Fu-Zi (the lateral roots of Aconitum carmichaeli) is beneficial for the cardiac system, but, because it contains toxins, raw Fu-Zi produces arrhythmia and breathing difficulties. C₁₉ diester diterpenoid alkaloids (DDAs), including aconitine, mesaconitine, and hypaconitine, are toxic Aconitum alkaloids found in Fu-Zi and can be hydrolyzed to nontoxic monoester diterpenoid alkaloids (MDAs), including benzoylaconine, benzoylmesaconine, and benzoylhypaconine. In this study, six processed Fu-Zi decoction pieces and herbal medicines were analyzed. The highest DDA contents were found in Shengfupian, the raw Fu-Zi samples. A processing quality index (Grades A to D) was established to evaluate the processing quality of Fu-Zi. The data demonstrated that few Fu-Zi decoction pieces did not conform to the government regulation. The results of testing the inorganic elements showed that the calcium content increased by approximately 5 to 30 fold compared to raw Fu-Zi due to substances assisting with processing. Raw Fu-Zi processed by boiling, without additional substances, may have a decreased DDA content. This study provides a method of determining the quality status of pieces of Fu-Zi decoction and establishes a processing quality index for pieces of Fu-Zi decoction and herbal medicine. Furthermore, our results suggest that it is not necessary to use additional substance to assist with the processing of Fu-Zi. Through the established processing quality index, Fu-Zi may be used more safely and may demonstrate a greater consistency in quality. Full article

The rate of major surgery is constantly increasing worldwide, and approximately 85% are non-cardiac surgery. More than half of patients over 45 years presenting for non-cardiac surgical interventions have cardiovascular risk factors, and the most common: chronic coronary syndrome and history of stroke. The preoperative cardiovascular risk is determined by the comorbidities, the clinical condition before the intervention, the urgency, duration or type. Cardiovascular risk scores are necessary tools to prevent perioperative cardiovascular morbidity and mortality and the most frequently used are Lee/RCRI (Revised Cardiac Risk Index), APACHE II (Acute Physiology and Chronic Health Evaluation), POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity), The American University of Beirut (AUB)-HAS2. To reduce the perioperative risk, there is a need for an appropriate preoperative risk assessment, as well as the choice of the type and timing of surgical intervention. Quantification of surgical risk as low, intermediate, and high is useful in identifying the group of patients who are at risk of complications such as myocardial infarction, thrombosis, arrhythmias, heart failure, stroke or even death. Currently there are not enough studies that can differentiate the risk according to gender, race, elective versus emergency procedure, the value of cardiac biomarkers. Full article

The electrophysiological mechanisms underlying melatonin’s actions and the electrophysiological consequences of superimposed therapeutic hypothermia (TH) in preventing cardiac ischemia-reperfusion (IR) injury-induced arrhythmias remain largely unknown. This study aimed to unveil these issues using acute IR-injured hearts. Rabbits were divided into heart failure (HF), HF+melatonin, control, and control+melatonin groups. HF was induced by rapid right ventricular pacing. Melatonin was administered orally (10 mg/kg/day) for four weeks, and IR was created by 60-min coronary artery ligation and 30-min reperfusion. The hearts were then excised and Langendorff-perfused for optical mapping studies at normothermia, followed by TH. Melatonin significantly reduced ventricular fibrillation (VF) maintenance. In failing hearts, melatonin reduced the spatially discordant alternans (SDA) inducibility mainly by modulating intracellular Ca²⁺ dynamics via upregulation of sarcoplasmic reticulum Ca²⁺-ATPase (SERCA2a) and calsequestrin 2 and attenuating the downregulation of phosphorylated phospholamban protein expression. In control hearts, melatonin improved conduction slowing and reduced dispersion of action potential duration (APD_dispersion) by upregulating phosphorylated connexin 43, attenuating the downregulation of SERCA2a and phosphorylated phospholamban and attenuating the upregulation of phosphorylated Ca²⁺/calmodulin-dependent protein kinase II. TH significantly retarded intracellular Ca²⁺ decay slowed conduction, and increased APD_dispersion, thereby facilitating SDA induction, which counteracted the beneficial effects of melatonin in reducing VF maintenance. Full article

BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative efficacy of the latter two tests for detecting arrhythmias and heart conditions remains unclear. METHODS: This study examined 511 paediatric athletes (8–18 years, 76.3% male) without known cardiovascular, renal, or endocrine diseases. All athletes underwent both HST and MET within 30 days. Absolute data and data relative to theoretical peak heart rates, arrhythmias (supraventricular and ventricular) and cardiovascular diagnoses were collected. RESULTS: HST resulted in a lower peak heart rate than MET (181.1 ± 9.8 vs. 187.5 ± 8.1 bpm, p < 0.001), but led to the detection of more supraventricular (18.6% vs. 13.1%, p < 0.001) and ventricular (30.5% vs. 22.7%, p < 0.001) arrhythmias, clustering during recovery (p = 0.014). This pattern was significant in males but not females. Among athletes diagnosed with cardiovascular diseases (22.3%), HST identified more ventricular arrhythmias (26.3% vs. 18.4%, p = 0.05), recovery-phase arrhythmias (20.2% vs. 14.0%, p = 0.035), and polymorphic arrhythmias (6.1% vs. 1.8%, p = 0.025). CONCLUSIONS: HST detects arrhythmias more effectively than MET in young male athletes, especially during recovery. More ventricular arrhythmias were highlighted even in athletes with cardiovascular conditions. Full article

Background: Vitiligo is a pigmentation disorder that impacts approximately 0.5% to 2% of the global population. Growing interest surrounds the comorbidities associated with vitiligo. This study aimed to describe the socio-demographic characteristics of the patients with vitiligo in Aragón (Spain) and to investigate their associated comorbidities. Methods: A retrospective observational study was conducted using clinical data from individuals in the EpiChron Cohort (reference population of 1.3 million) who were diagnosed with vitiligo between 1 January and 31 December 2019. The prevalence of chronic comorbidities was calculated using logistic regression models, obtaining the odds ratio (OR) of each comorbidity (dependent variable) according to the presence or absence of vitiligo (independent variable). We used a cut-off point for a statistical significance of p-value < 0.05. Results: In total, 218 patients diagnosed with vitiligo were analyzed. The mean age was 44.0 years, and 56.42% were female. The largest proportion of patients (34.86%) were aged between 18 and 44 years. Among all vitiligo patients included, 71.5% presented multimorbidity, with an average of 3.21 diagnosed comorbidities. The conditions most frequently associated with vitiligo included thyroid disorders (OR: 3.01, p < 0.001), ocular and hearing abnormalities (OR: 1.54, p < 0.020), inflammatory skin disorders (OR: 2.21, p < 0.001), connective tissue diseases (OR: 1.84, p < 0.007), lower respiratory tract diseases (OR: 1.78, p < 0.014), urinary tract infections (OR: 1.69, p < 0.032), and cardiac arrhythmias (OR 1.84, p < 0.034). Conclusions: This research highlights the importance of understanding the broader health implications of vitiligo and provides a foundation for further exploration into the complex interplay between this dermatologic condition and a diverse range of comorbidities. Full article

Anderson–Fabry disease (AFD) is a rare X-linked lysosomal storage disorder characterized by the accumulation of globotriaosylceramide, leading to multi-organ involvement and significant morbidity. Cardiovascular manifestations, particularly arrhythmias, are common and pose a considerable risk to affected individuals. This overview examines current approaches to arrhythmic risk stratification in AFD, focusing on the identification, assessment, and management of cardiac arrhythmias associated with the disease. We explore advancements in diagnostic techniques, including echocardiography, cardiac MRI, and ambulatory ECG monitoring, to enhance the detection of arrhythmogenic substrate. Furthermore, we discuss the role of genetic and biochemical markers in predicting arrhythmic risk and the implications for personalized treatment strategies. Current therapeutic interventions, including enzyme replacement therapy and antiarrhythmic medications, are reviewed in the context of their efficacy and limitations. Finally, we highlight ongoing research and future directions with the aim of improving arrhythmic risk assessment and management in AFD. This overview underscores the need for a multidisciplinary approach to optimize care and outcomes for patients with AFD. Full article

Cardiovascular diseases (CVDs) are the leading global cause of death, impacting nations worldwide. Despite medical advancements, managing patients who require temporary pacing (TP) after cardiac surgery remains challenging. TP devices are essential for stabilizing patients with unstable arrhythmias or post-surgical complications but demand manual adjustments and precise clinician management, unlike permanent pacemakers. There is an urgent need for improved TP training and standardisation, hindered by a lack of formal guidelines and adequate protocols. Existing simulators often omit crucial haemodynamic parameters and complex clinical scenarios, limiting their effectiveness. This paper introduces an advanced Temporary Cardiac Pacing Simulator (TCPS) that provides comprehensive physiological signals and complex scenarios for realistic training. It simulates various pacing modes—atrial, ventricular, and dual-chamber—while modeling pacing failures and haemodynamic changes. Sophisticated algorithms replicate clinical responses, offering real-time feedback and dynamic visualizations to enhance learning. Additionally, an innovative feature optimises atrioventricular (AV) delay settings, crucial for improving patient outcomes in both acute and postoperative care. Full article

Hypertrophic cardiomyopathy (HCM) is a heterogeneous cardiac disease and one of its major challenges is the limited accuracy in stratifying the risk of sudden cardiac death (SCD). Positron emission tomography (PET), through the evaluation of myocardial blood flow (MBF) and metabolism using fluorodeoxyglucose (FDG) uptake, can reveal microvascular dysfunction, ischemia, and increased metabolic demands in the hypertrophied myocardium. These abnormalities are linked to several factors influencing disease progression, including arrhythmia development, ventricular dilation, and myocardial fibrosis. Fibroblast activation can also be evaluated using PET imaging, providing further insights into early-stage myocardial fibrosis. Conflicting findings underscore the need for further research into PET’s role in risk stratification for HCM. If PET can establish a connection between parameters such as abnormal MBF or increased FDG uptake and SCD risk, it could enhance predictive accuracy. Additionally, PET holds significant potential for monitoring therapeutic outcomes. The aim of this review is to provide a comprehensive overview of the most significant data on disease progression, risk stratification, and prognosis in patients with HCM using cardiac PET-CT imaging. Full article

Background/Objectives: QTc prolongation can result in lethal arrhythmia. Risk scores like the Tisdale score can be used for risk stratification for targeted pharmaceutical interventions. However, the practical usability across different medical specialties has not been sufficiently investigated. The aim of this study was to compare relevant risk factors for QTc prolongation and to investigate the use of the Tisdale score in cardiology and gastroenterology patients. Methods: For patients on a cardiology and a gastroenterology ward receiving a weekly pharmaceutical electronic chart review, risk factors for QTc prolongation, QTc-prolonging drugs, and electrocardiograms (ECGs) were retrospectively collected for a four-month period (07-10/2023), and the Tisdale score and its sensitivity and specificity were calculated. Results: A total of 627 chart reviews (cases) (335 cardiology, 292 gastroenterology) were performed. The median age was 66 (range 20–94) years, and 39% (245) of patients were female. The presence of established risk factors (hypokalemia, renal impairment, age ≥ 68 years, cardiac diseases) differed significantly between the specialties. A median of 2 (range 0–5) QTc-prolonging drugs were prescribed in both groups. Baseline and follow-up ECG were recorded in 166 (50%) cardiology cases, of which prolonged QTc intervals were detected in 38 (23%) cases. In the 27 (9%) gastroenterology cases with baseline and follow-up ECG, no QTc prolongations were detected. Across both specialties, the Tisdale score achieved a sensitivity of 74% and a specificity of 30%. Conclusions: The presence of established risk factors for QTc prolongation differed significantly between cardiology and gastroenterology cases. The Tisdale score showed acceptable sensitivity for risk stratification; however, the limited availability of ECGs for gastroenterology cases was a limiting factor. Full article

Chemotherapy-induced cardiotoxicity is a critical issue in cardio-oncology, as cancer treatments often lead to severe cardiovascular complications. Approximately 10% of cancer patients succumb to cardiovascular problems, with lung cancer patients frequently experiencing arrhythmias, cardiac failure, tamponade, and cardiac metastasis. The cardiotoxic effects of anti-cancer treatments manifest at both cellular and tissue levels, causing deformation of cardiomyocytes, leading to contractility issues and fibrosis. Repeated irradiation and chemotherapy increase the risk of valvular, pericardial, or myocardial diseases. Multi-OMICs analyses reveal that targeting specific pathways as well as specific protein modifications, such as ubiquitination and phosphorylation, could offer potential therapeutic alternatives to current treatments, including Angiotensin converting enzymes (ACE) inhibitors and beta-blockers that mitigate symptoms but do not prevent cardiomyocyte death, highlighting the need for more effective therapies to manage cardiovascular defects in cancer survivors. This review explores the xenobiotic nature of chemotherapy agents and their impact on cardiovascular health, aiming to identify novel biomarkers and therapeutic targets to mitigate cardiotoxicity. Full article

Supraventricular arrhythmias (SVAs), including the often-asymptomatic supraventricular extrasystole (SVE), pose significant challenges in early detection and precise diagnosis. These challenges are of paramount importance, as recurrent SVEs may elevate the risk of developing severe SVAs, potentially resulting in cardiac weakening and subsequent heart failure. In the study conducted, an innovative approach was introduced that combined a convolutional neural network (CNN) architecture to enable the early identification and characterization of SVEs within electrocardiogram (ECG) signals. The analysis leveraged a dataset comprising 78 half-hour recordings from the highly regarded MIT-BIH Arrhythmia Database, which included annotation headers serving as labels for each recording. Signals were down-sampled by a factor of 2 and split into windows of 512 samples, with 12,288 observations for training. Following the methodology, classic signal preprocessing techniques (filtering and data normalization) were used. The proposed model was based on the UNET 1D model. A binary cross-entropy loss function, Adam optimizer, and a batch size of 128 were obtained after a hyperparameter tuning. As a training-validation methodology, a 50-fold cross-validation technique was used. The approach demonstrated a Dice coefficient of 79.01%, a precision of 80.96%, and a recall rate of 86.60% in detecting SVE events. These findings were corroborated through meticulous comparison with the annotations provided by the MIT-BIH database. The results underscore the immense potential of CNN and deep learning techniques in the early detection of supraventricular arrhythmias. This approach not only offers a valuable tool for healthcare professionals engaged in telemonitoring and early intervention strategies but also represents a significant contribution to the field of cardiac health monitoring. By facilitating efficient and precise identification of SVEs, our research sets the stage for improved patient outcomes and the prevention of severe SVAs, marking substantial advancements in this critical domain. Full article