: Pacemaker induced cardiomyopathy (PICM) is commonly defined as a reduction in left ventricular (LV) function in the setting of right ventricular (RV) pacing. This condition may be associated with the onset of clinical heart failure in those affected. Recent studies have focused on potential methods of identifying patients at risk of this condition, in addition to hypothesizing the most efficacious ways to manage these patients. Newer pacing options, such as His bundle pacing, may avoid the onset of PICM entirely.

Background The metabolic syndrome (MetSy), which is defined by the spectrum of obesity, insulin resistance and dyslipidaemia, is recognised as a major contributor to the overall risk of developing cardiovascular disease. Intermittent fasting (IF), which encompasses dieting plans with varying schedules of fasting, may be an effective method of reducing the burden of MetSy and the consequent cardiovascular events in the face of a worsening obesity epidemic in the contemporary society. Aims Despite the widespread public interest there is a serious lack of scientific understanding of the evidence base and the safe, optimal recommendations. This has created a level of public confusion that we endeavour to address by this narrative review of the published literature. Methods This narrative literature review summarises the current findings and suggests which regimens may be more effective and where future research in this area should be focused. Results Although the ideal regimen for IF remains unclear, there is promising evidence that alternate day fasting or modified fasting regimens, paired with or without continuous caloric restriction, may be more effective than continuous caloric restriction alone. Conclusion IF has been shown in the small number of human clinical trials discussed here to be an alternative to continuous caloric restriction in reducing the factors that contribute to the development of cardiovascular disease. Long-term randomised, controlled trials comparing continual caloric restriction and IF are required to objectively assess energy intake, energy expenditure, adherence, disease outcomes and metabolic factors.

No abstract

Background Giant cell myocarditis (GCM) is a rare and rapidly progressive disease associated with significant morbidity and mortality. Whilst patients more frequently present with acute heart failure, diagnosis is difficult due to heterogeneity in clinical presentations. Case Summary This case report presents a previously healthy 59-year-old Vietnamese woman who initially presented with syncope and a motor vehicle accident who developed rapid decline in left ventricular function. Her initial echocardiogram was suggestive of an infiltrative cardiomyopathy. GCM was confirmed on biopsy, and she received combined immunosuppression. Twenty-seven days following her initial presentation to hospital, she was unable to recover from severe multi-organ dysfunction and the patient was palliated and passed away. Discussion This case highlights the varied manner in which giant cell myocarditis may present. Even in the absence of cardiogenic shock at presentation, giant cell myocarditis should be considered in the evaluation of new cardiomyopathy of uncertainty aetiology. Diagnosis of this condition has distinct clinical implications on management and prognosis.

No abstract