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Which Test is Best for Pain in the Chest?

R I Med J (2013)

February 2025

Professor of Medicine, Clinician Educator, Warren Alpert Medical School, Brown University; Associate Chief, Cardiology, Brown University Health Cardiovascular Institute, Providence, Rhode Island.

Chest pain is one of the most common chief complaints seen in both the emergency department (ED) and primary care settings.1,2 It is estimated that 20-40% of the general population will suffer from chest pain at some point throughout their lives.3 Interestingly although obstructive coronary artery disease (CAD) prevalence has declined, chest pain as a presenting symptom has become increasingly common over the last decade.

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Severe bradycardia in patients with obstructive sleep apnoea and good early response to CPAP.

Sleep Breath

January 2025

Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80, Kraków, 31-202, Poland.

Background: Obstructive sleep apnoea (OSA) may lead to heart rhythm abnormalities including bradycardia. Our aim was to ascertain clinical and echocardiographic parameters in patients with OSA in whom severe bradycardia was detected in an outpatient setting, as well as to evaluate the efficacy of CPAP therapy on heart rate normalization at the early stages of treatment.

Methods: Fifteen patients mild, moderate or severe OSA and concomitant bradycardia were enrolled.

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This analysis assessed the relationship between the plasma concentrations of loperamide and its N-desmethyl loperamide meta- bolite (M1) and the potential QT interval prolongation at therapeutic and supratherapeutic doses. The exposure-response analysis was performed using the data from healthy adults participating in a randomized, double-blind, single-dose, four-way (placebo; loperamide 8 mg [therapeutic]; loperamide 48 mg [supratherapeutic]; moxifloxacin 400 mg [positive control]) crossover study. The electrocardiographic measurements extracted from 12-lead digital Holter recordings were time-matched to pharmacokinetic sampling of loperamide/M1.

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In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3-5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care.

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The trained heart adapts through geometric changes influenced by concentric and eccentric hypertrophy, depending on the predominance of the isometric or dynamic components of the exercise performed. Additionally, alterations in heart rhythm may occur due to increased vagal system activity. Cardiological evaluation with an electrocardiogram (ECG) aims to identify cardiac conditions that could temporarily or permanently disqualify an athlete from competition.

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