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Response to Nitro Not Diagnostic
For patients who present with acute, severe chest pain, response to nitroglycerin does not confirm a cardiac etiology, according to Deborah B. Diercks, M.D., of the University of California, Davis, Medical Center, and her associates.
Many emergency departments use the drug to diagnose coronary disease in those who present with chest pain, the investigators said (Ann. Emerg. Med. [Epub ahead of print] March 2005. DOI:10.1016/j.annemergmed.2004.12.009).
In their prospective study of 664 patients who presented with chest pain over the course of 1 year, patients who proved to have noncardiac pain showed the same response to nitroglycerin as those who turned out to have a cardiac etiology (68 with acute MI and 54 with unstable angina). Overall, 125 subjects (19%) reported no change in chest pain after taking nitroglycerin, 206 (31%) had a minimal reduction, 145 (22%) had a moderate reduction, and 188 (28%) reported significant or complete relief from chest pain.
Nitroglycerin may have relieved noncardiac chest pain by virtue of a placebo effect or its relaxing effect on smooth muscle, such as that lining the esophagus.
CPAP Lowers CV Risk
Risk for both fatal and nonfatal cardiovascular events is much higher in men with severe obstructive sleep apnea than in men with milder forms of the disorder or men who snore but don't have apnea, but treatment with continuous positive airway pressure (CPAP) normalizes this risk, according to Jose M. Marin, M.D., of Miguel Servet University Hospital, Zaragoza, Spain (Lancet 2005;365:1046-53).
They conducted a 10-year follow-up study of 667 men with severe obstructive sleep apnea (OSA), 409 with mild to moderate OSA, 389 with snoring but no OSA, and 277 healthy controls. Men with untreated severe OSA had 2.13 nonfatal and 1.06 fatal CV events per 100 person-years. In contrast, the rates were markedly lower for healthy men (0.45 and 0.30), snorers (0.58 and 0.34), and those with milder OSA (0.89 and 0.55).
Men with severe OSA who used CPAP had cardiovascular event rates that were comparable with those of snorers and men with milder apnea (0.64 and 0.35).
Waist Size and Insulin Resistance
Waist circumference is a simple and powerful predictor of a patient's risk for developing insulin resistance, reported Hans Wahrenberg, M.D., and his associates at Karolinska University Hospital, Stockholm.
They analyzed data collected from 2,746 healthy volunteers aged 18-72 years to determine whether different body measurements and biochemical markers could predict development of insulin resistance (BMJ [Epub ahead of print], April 2005. Article DOI 10.1136/bmj.38429.473310.AE. Available at
In this retrospective study, both men and women with a waist circumference of less than 100 cm were found to have zero risk for insulin resistance. A waist size less than 100 cm was the strongest predictor that insulin resistance would not develop, ahead of body mass index, waist-to-hip ratio, measures of total body fat, triglyceride level, HDL level, and blood pressure, they said.
Telephonic ECG After AF Ablation
Transtelephonic ECG monitoring is better than standard ECG and 24-hour Holter monitoring at detecting asymptomatic relapses in atrial fibrillation after patients have undergone radiofrequency catheter ablation, reported Gaetano Senatore, M.D., of Ospedale Civile di Cirie', Italy, and associates.
The down side of this improved detection of residual atrial fibrillation (AF) is that ablation now appears much less successful than clinicians had thought, Dr. Senatore and associates noted. In a study of 72 patients who underwent ablation for refractory AF, patients obtained 30-second readings on a transtelephonic ECG monitor every day, and whenever they felt palpitations, for 90 days. They also underwent standard ECG and Holter monitoring at 30 and 120 days postablation. The transtelephonic recordings documented AF recurrences in 20 patients (27.8%), compared with only 10 patients (13.9%) identified by the standard methods. Half of the affected patients had asymptomatic episodes of AF (J. Am. Coll. Cardiol. 2005;45:873-6).
The ablation procedure's success rate was 86% according to standard monitoring methods, but dropped to 72% with the more accurate method. Most published success rates for ablation have been based on the results of standard monitoring, and so are probably overestimated, Dr. Senatore and associates said. More importantly, “physicians usually consider AF as cured if sinus rhythm is documented on routine ECG or 24-hour Holter monitoring, and they often stop anticoagulation.” These results show that many such patients continue to have asymptomatic AF and should continue to receive anticoagulation.
Response to Nitro Not Diagnostic
For patients who present with acute, severe chest pain, response to nitroglycerin does not confirm a cardiac etiology, according to Deborah B. Diercks, M.D., of the University of California, Davis, Medical Center, and her associates.
Many emergency departments use the drug to diagnose coronary disease in those who present with chest pain, the investigators said (Ann. Emerg. Med. [Epub ahead of print] March 2005. DOI:10.1016/j.annemergmed.2004.12.009).
In their prospective study of 664 patients who presented with chest pain over the course of 1 year, patients who proved to have noncardiac pain showed the same response to nitroglycerin as those who turned out to have a cardiac etiology (68 with acute MI and 54 with unstable angina). Overall, 125 subjects (19%) reported no change in chest pain after taking nitroglycerin, 206 (31%) had a minimal reduction, 145 (22%) had a moderate reduction, and 188 (28%) reported significant or complete relief from chest pain.
Nitroglycerin may have relieved noncardiac chest pain by virtue of a placebo effect or its relaxing effect on smooth muscle, such as that lining the esophagus.
CPAP Lowers CV Risk
Risk for both fatal and nonfatal cardiovascular events is much higher in men with severe obstructive sleep apnea than in men with milder forms of the disorder or men who snore but don't have apnea, but treatment with continuous positive airway pressure (CPAP) normalizes this risk, according to Jose M. Marin, M.D., of Miguel Servet University Hospital, Zaragoza, Spain (Lancet 2005;365:1046-53).
They conducted a 10-year follow-up study of 667 men with severe obstructive sleep apnea (OSA), 409 with mild to moderate OSA, 389 with snoring but no OSA, and 277 healthy controls. Men with untreated severe OSA had 2.13 nonfatal and 1.06 fatal CV events per 100 person-years. In contrast, the rates were markedly lower for healthy men (0.45 and 0.30), snorers (0.58 and 0.34), and those with milder OSA (0.89 and 0.55).
Men with severe OSA who used CPAP had cardiovascular event rates that were comparable with those of snorers and men with milder apnea (0.64 and 0.35).
Waist Size and Insulin Resistance
Waist circumference is a simple and powerful predictor of a patient's risk for developing insulin resistance, reported Hans Wahrenberg, M.D., and his associates at Karolinska University Hospital, Stockholm.
They analyzed data collected from 2,746 healthy volunteers aged 18-72 years to determine whether different body measurements and biochemical markers could predict development of insulin resistance (BMJ [Epub ahead of print], April 2005. Article DOI 10.1136/bmj.38429.473310.AE. Available at
In this retrospective study, both men and women with a waist circumference of less than 100 cm were found to have zero risk for insulin resistance. A waist size less than 100 cm was the strongest predictor that insulin resistance would not develop, ahead of body mass index, waist-to-hip ratio, measures of total body fat, triglyceride level, HDL level, and blood pressure, they said.
Telephonic ECG After AF Ablation
Transtelephonic ECG monitoring is better than standard ECG and 24-hour Holter monitoring at detecting asymptomatic relapses in atrial fibrillation after patients have undergone radiofrequency catheter ablation, reported Gaetano Senatore, M.D., of Ospedale Civile di Cirie', Italy, and associates.
The down side of this improved detection of residual atrial fibrillation (AF) is that ablation now appears much less successful than clinicians had thought, Dr. Senatore and associates noted. In a study of 72 patients who underwent ablation for refractory AF, patients obtained 30-second readings on a transtelephonic ECG monitor every day, and whenever they felt palpitations, for 90 days. They also underwent standard ECG and Holter monitoring at 30 and 120 days postablation. The transtelephonic recordings documented AF recurrences in 20 patients (27.8%), compared with only 10 patients (13.9%) identified by the standard methods. Half of the affected patients had asymptomatic episodes of AF (J. Am. Coll. Cardiol. 2005;45:873-6).
The ablation procedure's success rate was 86% according to standard monitoring methods, but dropped to 72% with the more accurate method. Most published success rates for ablation have been based on the results of standard monitoring, and so are probably overestimated, Dr. Senatore and associates said. More importantly, “physicians usually consider AF as cured if sinus rhythm is documented on routine ECG or 24-hour Holter monitoring, and they often stop anticoagulation.” These results show that many such patients continue to have asymptomatic AF and should continue to receive anticoagulation.
Response to Nitro Not Diagnostic
For patients who present with acute, severe chest pain, response to nitroglycerin does not confirm a cardiac etiology, according to Deborah B. Diercks, M.D., of the University of California, Davis, Medical Center, and her associates.
Many emergency departments use the drug to diagnose coronary disease in those who present with chest pain, the investigators said (Ann. Emerg. Med. [Epub ahead of print] March 2005. DOI:10.1016/j.annemergmed.2004.12.009).
In their prospective study of 664 patients who presented with chest pain over the course of 1 year, patients who proved to have noncardiac pain showed the same response to nitroglycerin as those who turned out to have a cardiac etiology (68 with acute MI and 54 with unstable angina). Overall, 125 subjects (19%) reported no change in chest pain after taking nitroglycerin, 206 (31%) had a minimal reduction, 145 (22%) had a moderate reduction, and 188 (28%) reported significant or complete relief from chest pain.
Nitroglycerin may have relieved noncardiac chest pain by virtue of a placebo effect or its relaxing effect on smooth muscle, such as that lining the esophagus.
CPAP Lowers CV Risk
Risk for both fatal and nonfatal cardiovascular events is much higher in men with severe obstructive sleep apnea than in men with milder forms of the disorder or men who snore but don't have apnea, but treatment with continuous positive airway pressure (CPAP) normalizes this risk, according to Jose M. Marin, M.D., of Miguel Servet University Hospital, Zaragoza, Spain (Lancet 2005;365:1046-53).
They conducted a 10-year follow-up study of 667 men with severe obstructive sleep apnea (OSA), 409 with mild to moderate OSA, 389 with snoring but no OSA, and 277 healthy controls. Men with untreated severe OSA had 2.13 nonfatal and 1.06 fatal CV events per 100 person-years. In contrast, the rates were markedly lower for healthy men (0.45 and 0.30), snorers (0.58 and 0.34), and those with milder OSA (0.89 and 0.55).
Men with severe OSA who used CPAP had cardiovascular event rates that were comparable with those of snorers and men with milder apnea (0.64 and 0.35).
Waist Size and Insulin Resistance
Waist circumference is a simple and powerful predictor of a patient's risk for developing insulin resistance, reported Hans Wahrenberg, M.D., and his associates at Karolinska University Hospital, Stockholm.
They analyzed data collected from 2,746 healthy volunteers aged 18-72 years to determine whether different body measurements and biochemical markers could predict development of insulin resistance (BMJ [Epub ahead of print], April 2005. Article DOI 10.1136/bmj.38429.473310.AE. Available at
In this retrospective study, both men and women with a waist circumference of less than 100 cm were found to have zero risk for insulin resistance. A waist size less than 100 cm was the strongest predictor that insulin resistance would not develop, ahead of body mass index, waist-to-hip ratio, measures of total body fat, triglyceride level, HDL level, and blood pressure, they said.
Telephonic ECG After AF Ablation
Transtelephonic ECG monitoring is better than standard ECG and 24-hour Holter monitoring at detecting asymptomatic relapses in atrial fibrillation after patients have undergone radiofrequency catheter ablation, reported Gaetano Senatore, M.D., of Ospedale Civile di Cirie', Italy, and associates.
The down side of this improved detection of residual atrial fibrillation (AF) is that ablation now appears much less successful than clinicians had thought, Dr. Senatore and associates noted. In a study of 72 patients who underwent ablation for refractory AF, patients obtained 30-second readings on a transtelephonic ECG monitor every day, and whenever they felt palpitations, for 90 days. They also underwent standard ECG and Holter monitoring at 30 and 120 days postablation. The transtelephonic recordings documented AF recurrences in 20 patients (27.8%), compared with only 10 patients (13.9%) identified by the standard methods. Half of the affected patients had asymptomatic episodes of AF (J. Am. Coll. Cardiol. 2005;45:873-6).
The ablation procedure's success rate was 86% according to standard monitoring methods, but dropped to 72% with the more accurate method. Most published success rates for ablation have been based on the results of standard monitoring, and so are probably overestimated, Dr. Senatore and associates said. More importantly, “physicians usually consider AF as cured if sinus rhythm is documented on routine ECG or 24-hour Holter monitoring, and they often stop anticoagulation.” These results show that many such patients continue to have asymptomatic AF and should continue to receive anticoagulation.