The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude

Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy

Neškodljivost i djelotvornost glogova ekstrakta WS 1442 i nordijskog hodanja na profil lipida i funkciju endotela: randomizirano, djelomice slijepo probno istraživanje u dobrovoljaca prekomjerne tjelesne težine

Overweight and physical inactivity adversely affect endothelial function and are risk factors for atherosclerosis and cardiovascular disease. Both Crataegus extract WS 1442 and physical exercise exert beneficial effects on endothelial function. We investigated whether WS 1442 and Nordic walking (NW) had comparable effects on endothelial function and lipid profile in overweight subjects. In this partially blinded pilot study, overweight, otherwise healthy volunteers aged 45-75 years were randomized into four groups as follows: WS 1442 2x450 mg/day (WS-standard), WS 1442 2x900 mg/day (WS-double), exercise 2x30 minutes/week (NW-low), and exercise 4x45 minutes/week (NW-high) for 12 weeks. Safety was assessed based on adverse events. Endothelial function testing (EndoPAT®), assessment of endothelial progenitor cells, lipid profiles, and treadmill testing were performed. Sixty subjects participated in the study. At baseline, subjects in WS-standard/-double groups had higher lipid levels and greater impairment of endothelial function. Subjects with impaired endothelial function showed improvement regardless of the type of intervention. Subjects in WS-standard and WS-double groups showed a trend towards modest decrease in triglycerides and modest increase in HDL-cholesterol; most changes were within the normal limits. In NW-low/-high groups, values also remained within the normal range. Exercise capacity improved in both NW groups. WS-double showed no additional benefits over WS-standard. All adverse events were unrelated or improbably related to treatment. In conclusion, WS 1442 and exercise training were safe and showed beneficial effects on endothelial function and lipid profile in overweight but otherwise healthy volunteers; exercise capacity improved only by Nordic walking.Prekomjerna težina i tjelesna neaktivnost štetno djeluju na funkciju endotela i predstavljaju rizične čimbenike za aterosklerozu i srčanožilne bolesti. Glogov ekstrakt WS 1442 i tjelesna aktivnost oboje utječu povoljno na endotelnu funkciju. Ispitivali smo imaju li WS 1442 i nordijsko hodanje (NH) usporedive učinke na endotelnu funkciju i profil lipida u osoba prekomjerne tjelesne težine. U ovom djelomice slijepom probnom istraživanju su inače zdravi dobrovoljci prekomjerne tjelesne težine u dobi od 45 do 75 godina nasumce podijeljeni u četiri skupine: WS 1442 2x450 mg/dan (standardna doza WS), WS 1442 2x900 mg/dan (dvostruka doza WS), tjelovježba 2x30 minuta na tjedan (niska razina NH) i tjelovježba 4x45 minuta na tjedan (visoka razina NH) kroz 12 tjedana. Neškodljivost se procjenjivala na osnovi štetnih događaja. Provedeno je testiranje endotelne funkcije (EndoPAT®), procjena endotelnih progenitorskih stanica, profila lipida te test opterećenja. U istraživanju je sudjelovalo 60 ispitanika. Ispitanici na standardnoj/dvostrukoj dozi WS imali su bazalno više razine lipida i veći poremećaj endotelne funkcije. Ispitanici s poremećenom endotelnom funkcijom pokazali su poboljšanje bez obzira na vrstu intervencije. Ispitanici na standardnoj i dvostrukoj dozi WS pokazivali su tendenciju ka skromnom sniženju triglicerida i skromnom porastu HDL-kolesterola; većina ovih promjena bila je unutar normalnih granica. Uz nisku/visoku razinu NH vrijednosti su također ostale unutar normalnog raspona. Sposobnost za tjelovježbu poboljšala se u objema skupinama NH. Dvostruka razina WS nije pokazala dodatnih koristi u usporedbi sa standardnom dozom WS. Svi štetni događaji bili su nevezani ili malo vjerojatno povezani s tretmanom. U zaključku, WS 1442 i tjelovježba pokazali su se neškodljivima i imali su povoljan učinak na funkciju endotela i profil lipida kod inače zdravih osoba prekomjerne tjelesne težine; sposobnost za tjelovježbu poboljšala se samo pomoću NH

Myocardial Infarction by a Myocardial Bridge in the LAD Combined With Atrioventricular Re-Entrant Supraventricular Tachycardia

We present the case of a patient who presented with palpitations and was found to have atrioventricular re-entrant tachycardia with unusually elevated cardiac biomarkers. A coronary computed tomographic angiography showed a myocardial left anterior descending artery bridge; an accessory pathway was ablated, and cardiac magnetic resonance revealed anteroseptal myocardial infarction resulting from hypoperfusion during tachycardia caused by the left anterior descending artery myocardial bridge. (Level of Difficulty: Intermediate.)

Hypertensive Response to Exercise in Athletes: Unremarkable Finding or Relevant Marker for Future Cardiovascular Complications?

BACKGROUND In the general population, hypertensive response to exercise (HRE) predicts new-onset resting hypertension or other cardiovascular diseases. METHODS PubMed was searched for English articles published between January 1st 2000 and April 30th 2020. Additional studies were identified via reference lists of included studies. 92 papers were selected for full text analysis, finally 30 studies were included. RESULTS The results from 5 follow-up studies suggested an association between HRE and the risk of developing hypertension, while 10 studies reported a link with adverse cardiovascular events in the general population. Another study showed an association between HRE and future hypertension in athletes after a follow-up of 7 years. HRE in athletes was associated with left ventricular hypertrophy in three studies. Two other studies showed a link between HRE and focal myocardial fibrosis in triathletes and myocardial injury, respectively. One study found lower Apoliprotein-1 serum levels in athletes with HRE leading to a higher risk for cardiovascular disease. Only in one study no association with cardiovascular dysfunction in athletes with HRE was found. CONCLUSIONS Based on current evidence, HRE is not a normal finding in athletes. If detected, it should be interpreted as a risk factor for future cardiovascular complications. Future research should address the adequate follow-up and management of athletes with HRE

Brake response time before and after total knee arthroplasty: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Although the numbers of total knee arthroplasty (TKA) are increasing, there is only a small number of studies investigating driving safety after TKA. The parameter 'Brake Response Time (BRT)' is one of the most important criteria for driving safety and was therefore chosen for investigation.</p> <p>The present study was conducted to test the hypotheses that patients with right- or left-sided TKA show a significant increase in BRT from pre-operative (pre-op, 1 day before surgery) to post-operative (post-op, 2 weeks post surgery), and a significant decrease in BRT from post-op to the follow-up investigation (FU, 8 weeks post surgery). Additionally, it was hypothesized that the BRT of patients after TKA is significantly higher than that of healthy controls.</p> <p>Methods</p> <p>31 of 70 consecutive patients (mean age 65.7 +/- 10.2 years) receiving TKA were tested for their BRT pre-op, post-op and at FU. BRT was assessed using a custom-made driving simulator. We used normative BRT data from 31 healthy controls for comparison.</p> <p>Results</p> <p>There were no significant increases between pre-op and post-op BRT values for patients who had undergone left- or right-sided TKA. Even the proportion of patients above a BRT threshold of 700 ms was not significantly increased postop. Controls had a BRT which was significantly better than the BRT of patients with right- or left-sided TKA at all three time points.</p> <p>Conclusion</p> <p>The present study showed a small and insignificant postoperative increase in the BRT of patients who had undergone right- or left-sided TKA. Therefore, we believe it is not justified to impair the patient's quality of social and occupational life post-surgery by imposing restrictions on driving motor vehicles beyond an interval of two weeks after surgery.</p

Recommendations for return to sport during the SARS-CoV-2 pandemic

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted - from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process

Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in “enclosed spaces” where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures

Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

The aims of this paper were to provide an overview of available activity monitors used in research in patients with heart failure and to identify the key criteria in the selection of the most appropriate activity monitor for collecting, reporting, and analysing physical activity in heart failure research. This study was conducted in three parts. First, the literature was systematically reviewed to identify physical activity concepts and activity monitors used in heart failure research. Second, an additional scoping literature search for validation of these activity monitors was conducted. Third, the most appropriate criteria in the selection of activity monitors were identified. Nine activity monitors were evaluated in terms of size, weight, placement, costs, data storage, water resistance, outcomes and validation, and cut-off points for physical activity intensity levels were discussed. The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.The International Takotsubo Registry was supported by the Biss Davies Charitable Trust. Dr. Scheitz has been supported by the Corona Foundation. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation.info:eu-repo/semantics/publishedVersio