Late presentation of arrhythmogenic right ventricular cardiomyopathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Arrhythmogenic right ventricular cardiomyopathy is an inherited myocardial disease affecting predominantly young people and manifests as sustained ventricular tachycardia with left bundle branch block morphology, sudden death or isolated right or biventricular heart failure. However, its first manifestation as sustained ventricular tachycardia in older patients without preceding symptoms of heart failure is infrequent. To our knowledge, our patient is among the oldest reported in the literature presenting with ventricular tachycardia because of arrhythmogenic right ventricular cardiomyopathy without preceding symptoms of heart failure.</p> <p>Case presentation</p> <p>We present an unusual case of a very late presentation of a right ventricular cardiomyopathy in a 72-year-old white Caucasian man. The patient was admitted with symptoms of weakness, dizziness and chest discomfort for several hours. His electrocardiogram showed a wide-complex tachycardia with left bundle branch block morphology and left axis deviation. Because of continuing hemodynamic instability, the patient was cardioverted to sinus rhythm with a single 300 J shock. His post-cardioversion electrocardiogram, cardiac echocardiogram, coronary angiogram, magnetic resonance imaging and electrophysiological study confirmed the diagnosis of arrhythmogenic right ventricular cardiomyopathy. The patient was treated with an implantable cardioverter defibrillator and discharged on sotalol.</p> <p>Conclusion</p> <p>This case report demonstrates that arrhythmogenic right ventricular cardiomyopathy may have a very late presentation and this diagnosis should be considered as a potential cause of sustained ventricular tachycardia of right ventricular origin among the elderly and should be treated accordingly.</p

and of Hemoglobin Filter Cigarettes on Autonomic Cardiac Control

T he adverse effects of smoking onthe cardiovascular system have beenstudied both in extensive epidemio-logical studies and on a basic research le-vel. The conclusions of these studies are in such close agreement that smoking has been identified by the American Heart Association (AHA) as the most signifi-cant modifiable risk factor of coronary artery disease in the USA1. One of the mechanisms by which smoking impairs the cardiovascular fun-ction is its effect on Autonomic Nervous System (ANS) control2-4. Out of all the biologically active substances detected in cigarettes and tobacco products, nicotine, tar and carbon monoxide have been most widely studied. Nicotine acts as an ago-nist of nicotine receptors in the central and peripheral nervous system exerting a ganglioplegic effect and causing suppres-sion of vagal (predominantly) and sympa-thetic control. However in the latter the-re seems to be a direct enhancing effect at the central nuclei level resulting in an overall increase of sympathetic tone. In addition, nicotine affects the chemore-ceptors of the aorta and the carotid thu