Cardiac Denervation and Cardiac Function

With respect to neural control of the heart, intrathoracic ganglia and their interconnections form the final common pathway for autonomic modulation of regional cardiac function. In this review, data are presented indicating that such ganglia that include those distributed on the heart contain afferent (sensory) and efferent (motor) neurons that intercommunicate via local circuit neurons. The intrathoracic reflexes involving these neurons function in a coordinated fashion with central neurons located in the spinal cord, brain stem, and supraspinal central neuronal regions to regulate cardiac output on a beat-to-beat basis. The focus of this review is the putative role that these various populations of intrathoracic neurons play in regulating normal cardiac function and, in particular, how their interactions can become altered following their decentralization or in the presence of altered regional cardiac function. It is proposed that a thorough understanding of the interactions that occur among the hierarchy of neurons within intrinsic cardiac and intrathoracic extracardiac ganglia is required in order to assess cardiac regulation in normal as well as diseased states.     

Primary Cardiac Angiosarcoma Accompanying Cardiac Tamponade

A de novo cardiac malignant tumor is rare and sometimes challenging to diagnose. We encountered a 67-year-old man without any medical history complaining of dyspnea on effort. On admission, his hemodynamics were deteriorated due to cardiac tamponade, which was improved by percutaneous drainage of 1,200 mL pericardial effusion, showing 11.0 g/dL of hemoglobin. We suspected primary cardiac malignancy following multidisciplinary tests, and a cardiac biopsy via sternotomy demonstrated the definitive diagnosis of primary malignant tumor (angiosarcoma) infiltrating the right atrial myocardium. We initiated weekly paclitaxel therapy. Further studies are warranted to establish the optimal diagnostic and therapeutic strategy for de novo cardiac malignancy.     

心律失常与心脏再同步化治疗无反应性的相关性

虽然基于肾素-血管紧张素-醛固酮抑制剂、β受体阻滞剂的药物治疗使心力衰竭治疗取得了很大进展,但心力衰竭患者的发病率及病死率仍居高不下.心脏再同步化治疗是近年心力衰竭非药物治疗上的重大进展.但是研究表明心脏再同步化治疗后,仍有约30%的心力衰竭患者对心脏再同步化无反应.现综述了心脏再同步化治疗无反应与心律失常之间的关系,并简要讨论对心脏再同步化治疗无反应的可能机制及预防策略.     

心脏核磁共振成像与心内电生理

透视介导的心脏内电生理术一个主要缺点为术中无法正确识别软组织及其与比邻结构关系,然而,心脏核磁共振成像介导的心内电生理术却弥补了这一缺陷.心脏核磁共振成像-心内电生理术不仅可精确地展示出心脏的三维空间形态结构,而且能直接识别心律失常病灶及观察射频消融的疗效,提高复杂心律失常手术成功率及减少并发症有重要作用.因而,心脏核磁共振成像被认为在心内电生理领域具有广泛运用前景.     

心源性晕厥或猝死的原因分析

分析 32例在入院时或入院后至少发生 1次或 1次以上心源性晕厥或猝死患者的原因及其发作时与发作前、后的常规 12导联心电图或持续心电监视心电图。结果 :引起心源性晕厥或猝死的基本原因可分为以下几种类型 :①冠心病急性或陈旧性心肌梗死 ;②长QT(U)综合征 ;③Brugada综合征 ;④扩张型和肥厚型心肌病 ;⑤特发性巨大异常J波 ;⑥其他原因。上述各种心源性晕厥或猝死患者有各自不同的心电学特征。结论 :心源性晕厥或猝死是由不同原因、不同心电学特征所致的非单一独立的临床实体     

Cardiac Amyloidosis

ABSTRACT. Two male patients with primary cardiac amyloidosis are described. Patient 1 presented with typical effort angina pectoris with no ischemic electrocardiographic changes and a normal coronary angiogram. At necropsy, a severe diffuse, intravascular amyloid deposition was observed in the intramural coronary arteries. In patient 2 the presenting symptom was congestive heart failure with echocardiographic evidence of asymmetric septal hypertrophy and pericardial effusion. Technetium-99m pyrophosphate scintigraphy showed diffuse myocardial uptake, and the diagnosis of cardiac amyloidosis was confirmed in the postmortem examination. The diagnostic and therapeutic problems associated with cardiac amyloidosis are discussed in the light of these case reports.     

Cardiac amyloidosis

Opinion statement No definitive therapy is available for cardiac amyloidosis. Treatment with alkylating agents such as melphalan has improved survival. Patients who do not respond to melphalan have benefited from high-dose chemotherapy with cyclophosphamide followed by peripheral stem cell transplantation. Most patients who have symptomatic cardiac involvement do not survive long enough to complete chemotherapy and therefore may not have the opportunity to show treatment benefit. Early diagnosis and treatment before the organ dysfunction has become irreversible are therefore essential to allow adequate duration of therapy. Lifesaving intervention with cardiac transplantation provides a window of opportunity in which other measures can be instituted.     

Cardiac Rupture

Journal of Thrombosis and Thrombolysis -     

Cardiac arrhythmias

This article presents an overview of common cardiac arrhythmias. Interventions for severe and potentially severe arrhythmias are discussed. Tips for recording and viewing the electrocardiogram as employed in polysomnography are presented. The focus is on arrhythmias, and as such the information revolves around rhythm, rate, and blocks. The reader is referred to other sources for discussion of topics such as axis, ischemia, and infarct.