Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement

There are countless types of portable heart rate monitoring medical devices used variously by leisure-time exercisers, professional athletes, and chronically ill patients. Almost all the currently used heart rate monitors are capable of detecting arrhythmias, but this feature is not widely known or used among their millions of consumers. The aims of this paper were as follows: (1) to analyze the currently available sports heart rate monitors and assess their advantages and disadvantage in terms of heart rate and rhythm monitoring in endurance athletes; (2) to discuss what types of currently available commercial heart rate monitors are most convenient/adjustable to the needs of different consumers (including occasionally physically active adults and cardiac patients), bearing in mind the potential health risks, especially heart rhythm disturbances connected with endurance training; (3) to suggest a set of "optimal" design features for next-generation smart wearable devices based on the consensus opinion of an expert panel of athletes, coaches, and sports medicine doctors. Ninety-two experts aged 20 years and over, involved in endurance sports on a daily basis, were invited to participate in consensus-building discussions, including 56 long-distance runners, 18 cyclists, nine coaches, and nine physicians (sports medicine specialists, cardiologists, and family medicine doctors). The overall consensus endorsed by these experts indicates that the "optimal" sports heart rate monitor should be a one-piece device of the smartwatch type (with two or more electrodes), with integrated smartphone features, and able to collect and continually transmit data without exhibiting artifacts. It should continuously record at least a single-lead electrocardiography, send an alert after an unexpected fall, be of reasonable weight, come at an affordable price, and be user friendly

Il ricorso individuale costituzionale nell'ordinamento giuridico albanese.

Riassunto analitico Il ricorso individuale costituzionale nell'ordinamento giuridico albanese. Lo studio verte sulla protezione dei diritti costituzionali nell'ordinamento giuridico albanese garantiti tramite il ricorso diretto dinanzi alla Corte costituzionale. Più in specifico, esso riguarda il ricorso individuale costituzionale il quale può essere proposto dai singoli solo per la tutela dei loro diritti procedurali. Essendo tale ricorso per sua natura straordinario e sussidiario, il controllo della Corte costituzionale albanese diviene più intenso in riferimento ai diritti processuali. Pertanto, essa sviluppa una giurisprudenza molto articolata concentrandosi sui principi processuali come l’accesso alla giustizia e diritto di appellare le decisioni giudiziarie, il giudice imparziale costituito per legge, il diritto di difesa, la certezza del diritto, legalità della prova, motivazione delle decisioni giudiziarie, ragionevole durata del processo ed esecuzione delle decisioni giudiziarie, ecc. Partendo da tali principi, lo strumento è diventato utile per dare la possibilità alla Corte costituzionale di pronunciarsi nei confronti del principio di Stato di Diritto, inteso come un valore fondamentale per il consolidamento delle nuove democrazie nei paesi ex socialisti. Inoltre, lo studio riflette anche su gli altri mezzi previsti dalla Costituzione albanese per la protezione dei diritti costituzionali come il ricorso diretto delle organizzazioni, il giudizio in via incidentale e il ricorso proposto dall'Avvocato del Popolo. Infine, particolare riguardo ha avuto il rapporto che la Corte costituzionale ha costruito con gli altri organi interni in generale e in specifico con l’Alta Corte, ponendosi con quest’ultima molto spesso in posizioni contrapposte i quali a volte si sono rivelati dei veri e propri conflitti istituzionali. Inoltre, un capitolo a parte è stato dedicato al ruolo che la giurisprudenza della Corte Europea dei Diritti dell’Uomo ha avuto nell'ordinamento giuridico albanese, sia con riguardo alla sostanziale influenza di tale giurisprudenza nelle decisioni della Corte costituzionale, che del rapporto tra le due corti. Lo studio si chiude con delle riflessioni sul ricorso individuale e proposte su come cambiarlo per renderlo un mezzo giuridico più effettivo. Abstract Individual constitutional complaints in the Albanian legal system. The study deals with the protection of constitutional rights in the Albanian legal system guaranteed through direct appeal before the Constitutional Court. More specifically, it relates to the individual constitutional appeal which may be brought by individuals for the protection of their procedural rights, or due process of law. Being such appeal for its nature extraordinary and subsidiary, the control of the Constitutional Court of Albania becomes more intense in reference to due process or fair trial. Therefore, it develops a highly articulated activity focusing on procedural principles such as access to justice and the right to appeal court decisions, the impartial judge established by law, the right to defense, legal certainty, legality of evidence, reasoning of the judicial decisions, reasonable length of trials and enforcement of judgments, etc. Based on these principles, the instrument has become useful to give a chance to the Constitutional Court to enlarge the meaning of the rule of law, it understood as a fundamental value for the consolidation of the new democracies in the former socialist countries. In addition, the study also reflects on other means provided by the Constitution of Albania for the protection of constitutional rights such as the direct appeal of the organizations, the incidental control of constitutionality and the actions brought by the Lawyer of the People or Ombudsman. Finally, special attention is dedicated to the relations that the Constitutional Court has established with other internal organs in general and in particular with the High Court, placing with the latter often in contradictory positions which sometimes turned out to be institutional conflicts. In addition, a separate chapter was devoted to the role that the jurisprudence of the European Court of Human Rights had in the Albanian legal system, both regarding the substantial influence of this jurisprudence on the decisions of the Constitutional Court, and the relationship between the two courts. The study concludes with reflections on the individual constitutional appeal and proposals on how to change it to make it a more effective legal remedy

Exercise-Induced Arrhythmia or Munchausen Syndrome in a Marathon Runner?

A 36-year-old professional marathon runner reported sudden irregular palpitations occurring during competitions, with heart rates (HR) up to 230 bpm recorded on a sports HR monitor (HRM) over 4 years. These episodes subsided upon the cessation of exercise. Electrocardiograms, echocardiography, and cardiac magnetic resonance imaging results were borderline for athlete's heart. Because an electrophysiology study and standard exercise tests provoked no arrhythmia, doctors suspected Munchausen syndrome. Ultimately, an exercise test that simulated the physical effort of a competition provoked tachyarrhythmia consistent with the HRM readings. This case demonstrates the diagnostic difficulties related to exercise-induced arrhythmia and the diagnostic usefulness of sports HRMs

Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation—The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management

Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes. Keywords: athlete’s heart; block S-A; bradyarrhythmia; cardioneuroablation; deconditioning; heart rate monitors; heart rate variability; leisure time activity; pacing therapy; shared decision-making

Heart rate monitors used by athletes — from gadget to medical equipment. A decade of own observations

Introduction: For many years, many athletes have reported to the Centre for Sports Cardiology in Pułtusk that during endurance training, mainly running and cycling, they found unexpected increases in heart rate (HR) values observed on sports heart rate monitors (HRMs), in the vast majority of cases without the accompanying clinical symptoms. The authors have attempted to answer the question of whether the “arrhythmia” observed on HRMs is a rhythm disturbance or a mere technical artefact. The aim of the study: This article aimed to summarize the authors’ observations in the field of the usefulness of HRMs for the assessment of cardiac arrhythmias in the situation of introducing new technological solutions in the modernized and enriched ones with new functions HRMs. Material and methods: Over ten years, numerous studies have been carried out and the world literature has been also analysed many times, finally describing the authors’ study results and observations in numerous types of English-language articles published between 2017 and 2021. In this review article, the authors focused only on their publications from the Centre for Sports Cardiology in Pułtusk on the issues of heart rhythm disturbances observed on HRMs by endurance athletes, and on publications in which researchers from CKS participated and the articles themselves were related with the use of HRMs. Only a few references have been cited from other sources. Conclusions: The HRMs used in the past years were not significant for the treatment of asymptomatic exercise-stimulated arrhythmias. These HRMs, however, in a symptomatic arrhythmia situation, became an effective diagnostic tool confirming its occurrence. The analysis of cases and literature shows that modern sports heart rate monitors used by athletes of endurance disciplines (especially with the possibility of ECG recording) are becoming a useful, important and more and more effective diagnostic tool in the detection and final diagnosis of cardiac arrhythmias stimulated by exercise, both symptomatic and asymptomatic athletes and can significantly contribute to the increase of safety during training. It can be assumed that future HRMs will have comparable diagnostic value in detecting cardiac arrhythmias as the Holter ECG, surpassing them with the possibility of constant data transmission, ease of use and affordable price

Effectiveness of vitrectomy in Terson syndrome — case series

The visual outcomes of vitrectomy in a series of five eyes of three patients with vitreous haemorrhage due to Terson syndrome were retrospectively evaluated. There were two bilateral cases and one unilateral. The neurological diagnosis included cranio-cerebral trauma and cerebral aneurysm rupture. The mean time interval between intracranial haemorrhage and vitrectomy was nine months (range 7–10 months). Pars plana vitrectomy was performed with BSS as a tamponade in three eyes, SF6 gas in one eye, and silicone oil in one eye. The mean follow-up period was 12 months (range 1–27 months). Visual acuity improved significantly in all patients from counting fingers to the mean value of 0.6 (range 0.1–1.0). We observed one epiretinal membrane, one tractional retinal detachment, and two cataract formations. The best visual outcomes were achieved with BSS as a tamponade, the worst was with silicone oil as a tamponade and retinal detachment. Performing vitrectomy with BSS as a tamponade in patients with Terson syndrome significantly improves visual acuity, so early diagnosis and surgical treatment are crucial

Monitoring the visual field of a patient with secondary pseudotumour cerebri syndrome due to one-sided lymphadenectomy and internal jugular vein ligature — case report

We describe a case of a 37-year-old man who developed prolonged papilledema as a result of increased intracranial pressure following unilateral radical neck dissection due to diffuse large B-cell non-Hodgkin lymphoma. It seems that the increase in intracranial pressure was a result of insufficient collateral venous drainage of the brain. Clinical examination showed bilateral papilloedema, diplopia, and visual deterioration in the left eye. Magnetic resonance imaging and computed tomography of the brain were normal. Semi-automated kinetic perimetry was used to mo­nitor the visual function during 12 months of the follow-up. This method revealed enlargement of the blind spot in the left eye without progression. Peripheral borders of the visual field were within normal limits

Complex treatment of progressive proliferative diabetic retinopathy with concomitant diabetic macular edema — a case report

Proliferative diabetic retinopathy (PDR) is a major cause of visual impairment in working — age adult populationworldwide. The purpose of this article is to report the long observation and treatment of a patient with severe PDR.We present a case of 42 years old female who had been diagnosed with diabetes mellitus type 1 thirteen years ago,presenting a progressive PDR and macular edema in both eyes. The patient was monitored during three years ofthe follow-up. The treatment included laser photocoagulation, anty-VEGF injections and the surgical treatmentincluding vitrectomy with ILM peeling and gas or silicone oil tamponade

A multi objective memetic inverse solver reinforced by local optimization methods

We propose a new memetic strategy that can solve the multi-physics, complex inverse problems, formulated as the multi-objective optimization ones, in which objectives are misfits between the measured and simulated states of various governing processes. The multi-deme structure of the strategy allows for both, intensive, relatively cheap exploration with a moderate accuracy and more accurate search many regions of Pareto set in parallel. The special type of selection operator prefers the coherent alternative solutions, eliminating artifacts appearing in the particular processes. The additional accuracy increment is obtained by the parallel convex searches applied to the local scalarizations of the misfit vector. The strategy is dedicated for solving ill-conditioned problems, for which inverting the single physical process can lead to the ambiguous results. The skill of the selection in artifact elimination is shown on the benchmark problem, while the whole strategy was applied for identification of oil deposits, where the misfits are related to various frequencies of the magnetic and electric waves of the magnetotelluric measurements. 2016 Elsevier B.V