Alcohol and the heart: to abstain or not to abstain?

Alcohol has been consumed by most societies over the last 7000 years. Abraham Lincoln said It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing. Light to moderate alcohol consumption reduces the incidence of coronary heart disease (CHD), ischemic stroke, peripheral arterial disease, CHD mortality, and all-cause mortality, especially in the western populations. However, heavy alcohol consumption is detrimental causing cardiomyopathy, cardiac arrhythmias, hepatic cirrhosis, pancreatitis, and hemorrhagic stroke. In this article, we review the effects of alcohol on CHD, individual cardiovascular risk factors, cardiomyopathy, and cardiac arrhythmias, including the most recent evidence of the effects of alcohol on CHD

Incidence of, predictors for, and mortality associated with malignant ventricular arrhythmias in non-ST elevation myocardial infarction patients.

BACKGROUND: The incidence of non-ST elevation myocardial infarction (NSTEMI) is increasing. Although life-threatening ventricular arrhythmias have been well-documented in patients with ST elevation MI (STEMI), their incidence and importance in NSTEMI have not been examined in similar detail. We examined the incidence, predictors, and mortality rates of ventricular arrhythmias in a cohort of NSTEMI patients undergoing an early invasive strategy. METHODS: Consecutive patients admitted with NSTEMI who underwent cardiac catheterization within 48 h of admission were identified by chart review. Presence and type of ventricular arrhythmias and 30-day mortality were recorded. Malignant arrhythmias were defined as sustained ventricular tachycardia (VT, \u3e100 beats/min lasting \u3e30 s) or fibrillation (VF). Clinical risk factors, laboratory values, findings on electrocardiogram, echocardiogram, cardiac catheterization, and revascularization procedure data were recorded. RESULTS: VT/VF occurred in 21 (7.6%) of 277 NSTEMI patients. Sixty percent of these events occurred within the first 48 h after hospital admission, with a median occurrence at 72 h. Twelve patients (4.3%) required defibrillation. Troponin levels were higher and left ventricular ejection fraction was lower in the VT/VF group. Multivariable analysis also identified the presence of left bundle branch block and need for urgent coronary artery bypass grafting as significant predictors of malignant ventricular arrhythmias. Thirty-day mortality was significantly higher in NSTEMI patients with malignant ventricular arrhythmias than without (38 vs. 3%, P\u3c0.001). CONCLUSION: Despite an early invasive strategy, malignant ventricular arrhythmias are frequent in NSTEMI patients and are associated with increased 30-day mortality

Meditation: should a cardiologist care?

Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals. Religious and spiritual associations are common but are not requisite for meditation practice and it should be recognized that the basis of many if not all practices is the training of the brain and body, a process that appears to have profound effects on both structure and function. In recent decades there has been interest regarding the effects of these ancient practices on the cardiovascular system, as meditation has intuitive appeal for benefit in this area. Though there is a relative shortage of quality data, available evidence suggests that meditation may exert beneficial effects on autonomic tone, autonomic reflexes, and decrease blood pressure acutely and after long term practice. In addition, meditation has the potential to positively influence the cardiovascular system through the mind-heart connection and the anti-inflammatory reflex. There is limited but promising data to suggest that meditation based interventions can have beneficial effects on patients with established cardiovascular disease. More high quality and unbiased studies of meditation practices on relevant endpoints in cardiovascular disease are needed, including the effects of such practices on inflammation, baseline heart rate variability, arrhythmias, myocardial infarction, and cardiovascular mortality

Regular dipyridamole therapy produces sustained protection against cardiac ischemia-reperfusion injury: is it time to revisit PARIS?

BACKGROUND: Increased activated Akt and eNOS expression coincide with this persistent cardioprotection. Emergent coronary reperfusion therapies are rarely carried out before considerable myocardial injury has occurred. Moreover, reperfusion after prolonged ischemia produces paradoxical ischemia-reperfusion injury, attenuating the efficacy of reperfusion therapies. This has provided impetus for identifying chronic therapies to protect against ischemia-reperfusion injury in those at risk. We previously found that regular dipyridamole therapy produces a chronic preconditioning-like effect mediated through adenosine A1 receptors. METHODS: To determine how long this chronic preconditioning effect of dipyridamole remains present after discontinuing therapy, guinea pigs received 4 mg/kg/day in their water for 6 weeks. Ischemia-reperfusion was performed at 0, 2, 3, and 4 days after dipyridamole discontinuation (0 day, 2 days, 3 days and 4 days; n=8 per group). Left ventricular developed pressure (LVDP), end-diastolic pressure (LVEDP), coronary flow (CF), infarct size, and western blot analyses for Akt and endothelial nitric oxide synthase (eNOS) were studied. RESULTS: After ischemia-reperfusion, 0 day, 2 days and 3 days, but not 4 days, had significantly higher LVDP and lower LVEDP compared to control. Myocardial infarct size was significantly reduced at 0 day, 2 days and 3 days, but not 4 days, compared to control. Western blot analyses demonstrated upregulation of phospho-Akt and phospho-eNOS expression at 0 day, 2 days, and 3 days, but not 4 days. CONCLUSIONS: A chronic preconditioning-like cardioprotection by regular dipyridamole treatment persists for 3 days after discontinuing therapy. Increased activated Akt and eNOS expression may play a role in this persistent cardioprotection

Association between obesity and infarct size: insight into the obesity paradox.

Abstract: Background: In patients with coronary heart disease, being overweight or obese is associated with better outcomes, a phenomenon known as the \u27obesity paradox\u27. Despite the high prevalence of obesity in the United Sates, its effects on infarct size are largely unexplored. Methods: Prospective cross-sectional study of 102 consecutive patients admitted with acute myocardial infarction (MI). Standardized forms were used to collect data on body mass index (BMI), waist circumference (WC), cardiovascular risk factors, and medications. Peak troponin I and creatinine phosphokinase (CPK) were used to estimate infarct size. Epicardial and pericardial fat were measured by echocardiography. We used univariate and multivariate analyses to assess whether obesity was associated with infarct size. Correlations between BMI, WC and cardiac fat with cardiac biomarkers were also performed. Results: Mean age was 62±12 years, and 55% were men. Obesity was diagnosed in 69%. On multivariate analysis, obesity was associated with greater infarct size in non-ST elevation MI (p=0.02). A positive correlation was observed between BMI and peak troponin I (rho=0.24, p=0.03), and both, BMI and WC had a positive correlations with CPK levels (rho=0.28, & rho=0.28, both p=0.02). However, in ST elevation MI, obesity was associated with smaller infarct size (p=0.05). Epicardial fat + pericardial fat had a negative correlation with peak CPK levels (rho=-0.36, p=0.05). Conclusions: We observed an opposite association between obesity and infarct size depending on the type of MI. These results were unexpected and may provide insight into the pathophysiology of the obesity paradox

Primary cardiac tumors.

Primary cardiac tumors are a rare entity compared to tumors that metastasize to the heart. Patients with such tumors may be asymptomatic. Many cases are found incidentally during evaluation of an unrelated medical condition. It is important for the clinician to have a high index of suspicion when evaluating a patient presenting with signs and systemic symptoms concerning possible malignancy, plus cardiac specific symptoms or complications. These can include new onset dyspnea, congestive heart failure, arrhythmias or murmurs varying with body positions. Imaging, particularly the use of echocardiography, remains the cornerstone of diagnosis, and may be combined with new imaging modalities of cardiac CT and MRI. The aim of this paper is to describe the epidemiology and pathophysiology of the various benign and malignant primary cardiac tumors

Meditation: should a cardiologist care?

Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals. Religious and spiritual associations are common but are not requisite for meditation practice and it should be recognized that the basis of many if not all practices is the training of the brain and body, a process that appears to have profound effects on both structure and function. In recent decades there has been interest regarding the effects of these ancient practices on the cardiovascular system, as meditation has intuitive appeal for benefit in this area. Though there is a relative shortage of quality data, available evidence suggests that meditation may exert beneficial effects on autonomic tone, autonomic reflexes, and decrease blood pressure acutely and after long term practice. In addition, meditation has the potential to positively influence the cardiovascular system through the mind-heart connection and the anti-inflammatory reflex. There is limited but promising data to suggest that meditation based interventions can have beneficial effects on patients with established cardiovascular disease. More high quality and unbiased studies of meditation practices on relevant endpoints in cardiovascular disease are needed, including the effects of such practices on inflammation, baseline heart rate variability, arrhythmias, myocardial infarction, and cardiovascular mortality

Dyssynchrony in obese subjects without a history of cardiac disease using velocity vector imaging

Abstract Aim: To examine the occurrence of intra-left ventricular (LV) dyssynchrony in obese versus non-obese subjects without known cardiac disease using velocity vector imaging (VVI). Methods: One hundred ninety consecutive subjects with no known cardiac disease had their echocardiograms analyzed using VVI after excluding subjects with QRS duration \u3e120ms or LV ejection fraction (LVEF) \u3c55%. Study subjects were divided into two groups based on body mass index (BMI): obese (BMI \u3e30 kg/m2) and non-obese (BMI \u3c30 kg\u3e/m2). Results: The final cohort included 136 subjects (74 were obese), 32% female and mean age 55 + 16 years. Occurrence of intra LV dyssynchrony was higher in the obese compared to non-obese group. Conclusions: There was an increased prevalence of intra LV dyssynchrony in obese subjects, especially longitudinal and radial dyssynchrony. This dyssynchrony may signal a mechanism by which obesity predisposes to the development of heart failure

Heart failure and the holidays.

INTRODUCTION: Studies suggest increased cardiac morbidity and heart failure exacerbations during winter months with a peak around the holiday season. Major sporting events and intense encounters in sports have been shown to affect cardiovascular outcomes amongst its fans. METHODS: All patients admitted to Einstein Medical Center between January 1, 2003 and December 31, 2013 with a diagnosis of congestive heart failure were included in the study. They were included on the basis of the presence of an ICD-9CM code representing congestive heart failure as the primary diagnosis. Comparisons were made between the rates of heart failure admissions on the holiday, 4 days following the holiday and the rest of the month for 5 specific days: Christmas day, New Year\u27s day, Independence day, Thanksgiving day and Super Bowl Sunday. RESULTS: Our study included 22,727 heart failure admissions at an average of 5.65 admissions per day. The mean patient age was 68 ± 15 years. There was a significant increase in daily heart failure admissions following Independence day (5.65 vs. 5; p = 0.027) and Christmas day (6.5 vs. 5.5; p = 0.046) when compared to the rest of the month. A history of alcohol abuse or dependence did not correlate with the reported+ rise in heart failure admissions immediately following the holidays. The mean number of daily admissions on the holidays were significantly lower for all holidays compared to the following 4 days. All holidays apart from Super Bowl Sunday demonstrated lower admission rates on the holiday compared to the rest of the month. CONCLUSION: Christmas and Independence day were associated with increased heart failure admissions immediately following the holidays. The holidays themselves saw lower admission rates. Overeating on holidays, associated emotional stressors, lesser exercise and postponing medical around holidays may be among the factors responsible for the findings

Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample.

INTRODUCTION: Primary hyperparathyroidism (pHPT), most commonly caused by solitary parathyroid adenomas, leads to mobilization of calcium and is known to result in nephrolithiasis and osteoporosis. To date, studies of pHPT and cardiovascular risk factors and events have produced discrepant findings, likely due to small sample sizes and enrolling populations with varying disease severity. HYPOTHESIS: We utilized a national registry, hypothesizing an association between pHPT and cardiovascular risk factors and events. METHODS: Patients \u3e18years with a diagnosis of pHPT were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Diseases code 252.01. Demographics, risk factors, and cardiovascular event rates were collected and compared to general population data. RESULTS: pHPT was present in 0.1% (n=37,922) of hospital admissions. There was a significant increase in the prevalence of most cardiac risk factors including hypertension (HTN), diabetes mellitus, hyperlipidemia, obesity, and chronic kidney disease. The rates of heart failure (HF) and coronary artery disease (CAD) were higher in the pHPT population. However, after performing multivariate regression for age and cardiac risk factors, pHPT did not independently predict HF or CAD. The risk of HTN, however, was independently predicted by pHPT (OR 1.3; p\u3c0.001). CONCLUSIONS: Primary hyperparathyroidism independently predicted the risk of hypertension in a patient population from a large national database. Despite significant differences in univariate analysis of cardiac risk factors and events, pHPT did not independently predict risk of HF or CAD after multivariate regression analysis. Future studies should explore potential mechanisms relating hypertension to pHPT