Gross Structure of the Atriums: More Than an Anatomic Curiosity?

Despite the extensive literature concerning atrial arrhythmias, there are relatively few articles on the anatomy of the atrial chambers. Since electrophysiological mapping and interventional treatments of atrial arrhythmias involve entering the chambers, this article reviews the gross structures to provide a better understanding of the atriums, the septum, and the connecting great veins. In addition, based on the human heart, differences between porcine and canine hearts are highlighted. The right and left atriums are characterized by morphologically distinct appendages. The right atrium contains prominent muscular bundles and an extensive array of pectinate muscles. The distal ramifications of the terminal crest lead to the "flutter" isthmus. By contrast, the left atrium has relatively smooth walls. The atrial septum is limited to the valve of the oval fossa and its immediate muscular rim. Atrial musculature extends beyond the veno-atrial junctions to the outside of the pulmonary veins. The longest sleeves are around the upper pulmonary veins, and similar sleeves are seen around the superior caval vein. The structure of the atrium is more than an anatomic curiosity. It has practical implicationsfor mapping and interventional procedures.     

Fetal Lymphatic Malformations: More Variable Than We Think?

Lymphatic malformations are benign lesions that result from abnormal development of the lymphatic and venous systems. These lesions may be detected during routine prenatal ultrasound screening, and typically demonstrate imaging findings of a multiseptate cystic lesion lacking solid components, vascularity, and calcifications. We report 73 cases of prenatally detected lymphatic malformations and describe greater variability in their prenatal sonographic appearance than previously reported, including purely cystic lesions and mixed cystic and solid lesions with calcifications. Appreciation of this increased variability is important in providing accurate prenatal diagnosis, counseling, and management.     

Medication Overuse Headache in School‐Aged Children: More Common Than Expected?

Objective.— To investigate the prevalence of medication overuse headache (MOH) in a group of children and adolescents seen for headache in a third‐level center in Italy. Background.— Epidemiological studies indicate a prevalence of MOH in children and adolescents between 0.3 and 0.5%; no data are available for the Italian population. Methods.— We studied a group of first‐seen children and adolescents (118 patients, 43.2% male and 56.8% female, mean age: 11.9 years). A detailed history was taken, using criteria defined by Olesen et al to assess the presence of MOH. Statistical correlations between demographic and diagnostic variables were assessed. Results.— Eleven (9.3%) of our patients presented MOH; in the group with chronic daily headache, the prevalence raised to 20.8%. At follow up, after introduction of a more rationale treatment, most patients improved, but 2 of them reported a worsening of their headache. Conclusions.— We believe that a strong warning regarding medication overuse in headache therapy is essential for pediatricians and neuropsychiatrists.     

Stress ulcer prophylaxis in intensive care patients: an evidence-practice mismatch?

Prophylactic drugs are commonly used in intensive care units (ICUs) to decrease the risk of development of stress-related upper gastrointestinal tract lesions and bleeding. The aim of this article is to discuss history, incidence, risk factors, past and current research, and current evidence for usefulness of prophylaxis for this disorder. Currently, very good evidence suggests that most ICU patients do not benefit from the widespread application of prophylactic intervention.     

Stress in psychiatric nursing: fact or fiction?

Psychiatric nurses are not as stressed in their work as most research seems to indicate. The stress that does exist relates to organisational, rather than work-related matters. However, this study recommends that further investigations need to be conducted to address the needs of those who are reporting unacceptably high levels of stress.     

Cardiac Dysfunction in HIV‐1 Transgenic Mouse: Role of Stress and BAG3

Since highly active antiretroviral therapy improved long‐term survival of acquired immunodeficiency syndrome (AIDS) patients, AIDS cardiomyopathy has become an increasingly relevant clinical problem. We used human immunodeficiency virus (HIV)‐1 transgenic (Tg26) mouse to explore molecular mechanisms of AIDS cardiomyopathy. Tg26 mice had significantly lower left ventricular (LV) mass and smaller end‐diastolic and end‐systolic LV volumes. Under basal conditions, cardiac contractility and relaxation and single myocyte contraction dynamics were not different between wild‐type (WT) and Tg26 mice. Ten days after open heart surgery, contractility and relaxation remained significantly depressed in Tg26 hearts, suggesting that Tg26 mice did not tolerate surgical stress well. To simulate heart failure in which expression of Bcl2‐associated athanogene 3 (BAG3) is reduced, we down‐regulated BAG3 by small hairpin ribonucleic acid in WT and Tg26 hearts. BAG3 down‐regulation significantly reduced contractility in Tg26 hearts. BAG3 overexpression rescued contractile abnormalities in myocytes expressing the HIV‐1 protein Tat. We conclude: (i) Tg26 mice exhibit normal contractile function at baseline; (ii) Tg26 mice do not tolerate surgical stress well; (iii) BAG3 down‐regulation exacerbated cardiac dysfunction in Tg26 mice; (iv) BAG3 overexpression rescued contractile abnormalities in myocytes expressing HIV‐1 protein Tat; and (v) BAG3 may occupy a role in pathogenesis of AIDS cardiomyopathy.     

Left Ventricular Pacing in Right Ventricular Cardiomyopathy: Blessing or Blunder?

Arrhythmogenic right ventricular dysplasia (ARVD) predominantly involves the right ventricle, and myocardium is progressively replaced by fat and fibrous tissue in the apex, base, and outflow tract regions. This pathology, and the progressive nature of the disease, poses special challenges for implant and subsequent appropriate functioning of an implantable cardioverter‐defibrillator. This case report describes a solution to problems during lead placement in patients with ARVD.     

Cardiac fibroblasts in pressure overload hypertrophy: the enemy within?

Cardiac fibroblasts have been long recognized as active participants in heart disease; however, their exact physiological and pathological roles remain elusive, mainly due to the lack of specific markers. In this issue of the JCI, Moore-Morris and colleagues used a fibroblast-specific collagen1a1-GFP reporter to demonstrate that fibroblast accumulation after aortic banding in murine hearts arises almost exclusively from proliferation of resident fibroblasts originating from both the epicardium and a previously unrecognized source, the endocardium. Further characterization of fibroblast origin and function in different types and stages of heart disease could lead to development of improved fibroblast-targeted cardiac therapies.