Detection of elevated right atrial pressure using a simple bedside ultrasound measure.

Aims: Accurate assessment of right atrial pressure (RAP) often requires invasive measurement. With normal RAP, Valsalva increases right internal jugular vein (RIJV) cross sectional area (CSA) 20% to 30%. With high RAP, when venous compliance is low, we hypothesized that the increase in CSA would be blunted and could be detected non-invasively with bedside ultrasound.

Off-label use of stents: bare-metal versus drug-eluting stents.

Drug-eluting stents (DES) became the default strategy for percutaneous revascularization due to their improved intermediate-term outcomes when compared with bare-metal stents (BMS) in the pivotal randomized, controlled trials. The excellent results of DES in on-label or US FDA-approved indications led to extrapolation of the results to more complex situations that were excluded from initial pivotal trials; such as off-label indications. Safety concerns began to grow after reports of increased late thrombosis and possibly associated increased death and myocardial infarction with DES, especially in the off-label situations.

Pulmonary vein thrombosis in the setting of blunt chest trauma.

Pulmonary vein thrombosis has been associated with lung transplantation and lung resection. We report a case of right lower pulmonary vein thrombosis after blunt chest trauma.

Role of metabolically active hormones in the insulin resistance associated with short-term glucocorticoid treatment.

Background: The mechanisms by which glucocorticoid therapy promotes obesity and insulin resistance are incompletely characterized. Modulations of the metabolically active hormones, tumour necrosis factor alpha (TNF alpha), ghrelin, leptin and adiponectin are all implicated in the development of these cardiovascular risk factors. Little is known about the effects of short-term glucocorticoid treatment on levels of these hormones.

Relation of brachial artery reactivity to nitroglycerin and heart rate recovery following exercise in healthy male volunteers.

The parasympathetic nervous system facilitates peripheral arterial vasodilation and is also responsible for a decrease in heart rate immediately after exercise (heart rate recovery [HRR]). The relation among parasympathetic tone measured by HRR after exercise, endothelium-mediated vasodilation, and nitroglycerin-mediated vasodilation (determined with brachial artery ultrasound) was assessed in 25 healthy young men. One-minute HRR was nonsignificantly related to endothelium-mediated vasodilation (r = -0.

Effects of short-term glucocorticoids on hemostatic factors in healthy volunteers.

Objective: Increased circulating levels of hemostatic factors have been associated with arterial and venous thrombosis. Although in vitro evidence suggests that glucocorticoids may activate hemostasis and inhibit thrombolysis, no controlled in vivo studies have examined the effects of glucocorticoids on hemostatic factors. We hypothesized that a 5-day treatment course of dexamethasone would increase circulating levels of hemostatic and anti-fibrinolytic factors.

Effects of short-term glucocorticoids on cardiovascular biomarkers.

Context: Glucocorticoids are known to acutely increase blood pressure, suppress inflammation, and precipitate insulin resistance. However, the short-term effects of glucocorticoids on other cardiovascular risk factors remain incompletely characterized.

Objective: Our objective was to determine the effects of a short course of dexamethasone on multiple cardiovascular biomarkers and to determine whether suppression of morning cortisol in response to low-dose dexamethasone is correlated with cardiovascular risk markers in healthy volunteers.

Does altered glucocorticoid homeostasis increase cardiovascular risk?

The hypothalamic-pituitary-adrenal (HPA) axis, like the sympathetic nervous system and the renin-angiotensin-aldosterone (RAA) system, sustains life in stressful situations by increasing vascular tone and ensuring fuel availability. It also modulates inflammation and tissue repair processes. Untoward cardiovascular effects of chronic sympathetic and RAA activation are well recognized, illustrating that the short-term benefit of the physiologic stress response can be detrimental in the long term.

Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure.

Background: The diagnostic and prognostic values of plasma B-type natriuretic peptide (BNP) testing are established. However, the range of plasma BNP levels present in the setting of chronic, stable systolic heart failure (HF) is unclear.

Methods And Results: We followed up 558 consecutive ambulatory patients with chronic, stable systolic HF (left ventricular ejection fraction <50%) treated at a specialized outpatient HF clinic between November 2001 and February 2003.

Moricizine induced increase in pacing threshold.

A 72-year-old woman who was experiencing incessant ventricular tachycardia and recurrent automatic implantable cardioverter defibrillator (AICD) firing despite amiodarone therapy was referred to the Cleveland Clinic Foundation. Myocardial ischemia and infarction were ruled out by standard means. Several antiarrhythmic medications were tried previously without success.

The metabolic syndrome as a vicious cycle: does obesity beget obesity?

Most attempts at weight loss are frustrated by the body's propensity to maintain fat mass. There are genetic and environmental mechanisms behind this phenomenon, such as thrifty genes, sedentary lifestyle and abundant food resources. We will outline a physiologic mechanism that may perpetuate obesity once it develops.

The metabolic syndrome: a tug-of-war with no winner.

The metabolic syndrome may be viewed as a state of insulin-counterregulatory overdrive: counterregulatory hormones and fatty acids chronically duel with insulin, causing a cascade of biochemical interactions resulting in insulin resistance, hypertension, and dyslipidemia. Even before beta cells fail and type 2 diabetes ensues, the deadly quartet is quietly rehearsing.