Ventriculo-atrial gradient due to first degree atrio-ventricular block: a case report

BACKGROUND: Isolated, asymptomatic first degree AV block with narrow QRS has not prognostic significance and is not usually treated with pacemaker implantation. In some cases, yet, loss of AV synchrony because of a marked prolongation of the PR interval may cause important hemodynamic alterations, with subsequent symptoms of heart failure. Indeed, AV synchrony is crucial when atrial systole, the "atrial kick", contributes in a major way to left ventricular filling, as in case of reduced left ventricular compliance because of aging or concomitant structural heart disease. CASE PRESENTATION: We performed a trans-septal left atrium catheterization aimed at evaluating the entity of a mitral valve stenosis in a 72-year-old woman with a marked first-degree AV block, a known moderate aortic stenosis and NYHA class III symptoms of functional deterioration. We occurred in a deep alteration in cardiac hemodynamics consisting in an end-diastolic ventriculo-atrial gradient without any evidence of mitral stenosis. The patient had a substantial improvement in echocardiographic parameters and in her symptoms of heart failure after permanent pacemaker implantation with physiological AV delay. CONCLUSION: We conclude that if a marked first degree AV block is associated to instrumental signs or symptoms of heart failure, the restoration of an optimal AV synchrony, achieved with dual-chamber pacing, may represent a reasonable therapeutic option leading to a consequent clinical improvement

Surviving rape and the cultural stigma of rape: psychological distress and resilience amongst Eritrean asylum seekers in Israel

Eritrean asylum seekers have suffered severe trauma en passage via the Sinai Peninsula en route to Israel. This study seeks to understand the meaning of these experiences to these women. In depth interviews were conducted with 14 Eritrean women using qualitative methods in accordance with grounded theory. While the study found that these women reported traumatic experiences and suffered considerable distress as a result of their experiences, their general resilience and coping were central to their narratives. Both their distress and their resilience were mediated in tenns of their perceptions of the cultural stigma and existential plight associated with the trauma they had experienced and the aftennath they were living through. The presence of cultural stigma tends to increase distress, while their absence tends to reduce distress. Separately, the study showed that regardless of the relative severity of their distress, the women used a number of coping strategies which were also culturally mediated and enhanced the women's resilience. These included silence regarding their experiences, social support, reliance on religious bel iefs, adaptive avoidance and psychosocial assistance. The study concluded that constructing a theory of how the women perceive cultural stigma was crucial to an understanding of the psychological impact of rape for Eritrean asylum seekers. The study also concluded that the acknowledgement of the coexistence of the distress of rape with great resilience was essential to providing effective assistance. The implications of these conclusions are that psychosocial assistance among members of this population should be focused on resilience based mental health efforts. These efforts would be best supported by access to rights by state institution support of resilience (through provision of shelter, healthcare, and economic empowerment) in order to promote the mental health of Eritrean women who have been raped and tortured in the Sinai desert.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Atherosclerosis risk factors: The possible role of homocysteine

Atherosclerosis is the leading cause of death in North America. It is characterized by thickening of the coronary artery wall by the formation of plaques, resulting in reduced blood flow. Plaque rupture and the consequent thrombosis may lead to sudden blockage of arteries and causing stroke and heart attack. In the last several decades, more than 250 factors associated with the development of coronary artery disease have been identified. Recently, a relationship between atherosclerosis and elevated homocysteine level in the blood has been established. The mechanism for the production of atherosclerosis by homocysteine has been investigated. When human hepatoma cells (HepG2) were incubated with 4mM homocysteine, enhancements in the production of cholesterol and secretion of apolipoprotein B-100 were observed. The stimulatory effect on cholesterol synthesis was mediated via the enhancement of HMG-CoA reductase, which catalyzes the rate-limiting step in cholesterol biosynthesis. Cholesterol appears to play an important role in the regulation of apoB-100 secretion by hepatocytes. It is plausible that the increase in apoB secretion was caused by the elevated cholesterol level induced by homocysteine. The ability of homocysteine to produce a higher amount of cholesterol and promote the secretion of apoB would provide a plausible mechanism for the observed relationship between hyperhomocysteinemia and the development of atherogenesis and coronary artery disease