Regional wall-motion abnormalities on post-stress electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomography imaging predict cardiac events.

Background: The global left-ventricular (LV) ejection fraction (EF) is a powerful predictor of cardiac death (CD). There are limited data on the prognostic value of regional LV function. We examined the role of visually assessed regional wall motion in risk stratification for future cardiac events.

Intraoperative hypothermia increased defibrillation energy requirements.

We describe two patients with newly implanted automatic implantable cardioverter-defibrillators that had excessive defibrillation thresholds associated with hypothermia at intraoperative defibrillation threshold testing. Normal defibrillation threshold levels were obtained during postoperative non-invasive electrophysiology testing in an electrophysiology laboratory when the patients were normothermic. We hypothesize that inadvertent intraoperative hypothermia during device implantation may increase the defibrillation threshold.

Implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava.

A persistent left superior vena cava was discovered in a 66-year-old man with heart failure undergoing implantation of a biventricular pacing and defibrillator device. An active fixation right ventricular defibrillator lead was placed through a curved guiding catheter. A sub-selection catheter and a guidewire allowed the engagement of a posterior-lateral branch of the coronary sinus, performance of an angiogram without an occlusive balloon, and optimal lead placement.

The congenital long QT syndrome and implications for young athletes.

The congenital long QT syndrome (LQTS) is caused by cardiac ion channel mutations, which predispose young individuals to sudden cardiac death often related to exercise. The issue of LQTS and sports participation has received significant publicity due to reports of sudden death in young competitive athletes. This article reviews the pathophysiology, clinical characteristics, and management of LQTS in the physically active and athletic population.

Acute resting myocardial perfusion imaging in patients with diabetes mellitus: results from the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial.

Background: Resting myocardial perfusion imaging (MPI) improves the triage of patients presenting to the emergency department (ED) with symptoms suggestive of acute cardiac ischemia (ACI). In the ED setting the presence of diabetes mellitus (DM) is a predictor of ACI and hospitalization, but the role of resting MPI in patients with DM is unknown.

Methods And Results: A secondary data analysis of a prospective, multicenter, randomized, controlled trial of ED evaluation strategies in patients with symptoms suggestive of ACI and normal or nondiagnostic electrocardiograms was performed.

Cardiac tamponade as a result of Mycobacterium avium-complex pleural effusion.

Patients with advanced AIDS are prone to opportunistic infections, including disseminated disease from Mycobacterium avium-complex (MAC). We describe the first reported case of MAC related pleural effusion causing cardiac tamponade.

Pharmacologic radionuclide myocardial perfusion imaging.

Pharmacologic stress testing with myocardial perfusion imaging has enabled patients who cannot complete adequate exercise to undergo diagnostic and prognostic evaluation for coronary artery disease. Pharmacologic stress agents belong to two groups: vasodilators (such as adenosine and dipyridamole), and inotropes (such as dobutamine). All have similar sensitivity (89%-91%) and specificity (78%-86%) for the diagnosis of coronary disease.