Historical aspects of infective endocarditis

SummaryInfective endocarditis was a fatal disease three generations ago. Temporal evolution of knowledge made possible important advances in diagnostic techniques, specially in echocardiography, the possibility of cardiac surgery during the active infeccious process and new guidelines for antibiotic prophylaxis before interventional procedures. Nowadays infective endocarditis is curable. In this review we describe historical aspects of endocarditis since Osler's observations in the 19th century until the change from a “clinically possible” to a “clinically definite” disease

Evidence that the degree of obstructive sleep apnea may not increase myocardial ischemia and arrhythmias in patients with stable coronary artery disease

There is controversy regarding whether obstructive sleep apnea is responsible for triggering myocardial ischemia, arrhythmias and heart rate variability in patients with coronary artery disease. OBJETIVE: The objective of this study was to identify relationships between sleep apnea, myocardial ischemia and cardiac arrhythmia in patients with coronary artery disease. METHODS: Fifty-three patients with stable coronary disease underwent simultaneous polysomnography and electrocardiographic Holter recording. The apnea-hypopnea index (AHI) was defined as the number of apneas/hypopneas per hour of sleep. Patients were divided into a Control group (AHI15, n=23 pts) and an Apnea group (AHI>;15, n=30 pts). A subgroup of 13 patients with an AHI>;30 (Severe Apnea group) was also studied. We analyzed ischemic episodes (ST-segment depressions >;1 mm, >; 1 min), heart rate variability and the occurrence of arrhythmias during wakefulness and sleep. RESULTS: Baseline clinical characteristics among the groups were similar except for higher blood pressure in the Apnea groups (