No abstract

Thirty-two patients with atrial fibrillation and normal ventricular rates who complained of dizziness or loss of consciousness underwent 24-hour ambulatory electrocardiographic monitoring. A control group of 25 patients in atrial fibrillation but without symptoms of dizziness or loss of consciousness was likewise investigated. All patients remained in atrial fibrillation; periods of ventricular standstill (mean, 2.9; range, 1.8-8.0) were present in 31 symptomatic patients but in only three of the control patients (mean, 1.9 s; range, 1.7-2.4). Twenty-three symptomatic patients with pauses greater than or equal to 2.0 s received a demand pacemaker. Following pacing, nineteen became completely asymptomatic; four patients continued to have dizziness but three of these, who also experienced syncope, no longer did so (mean follow-up, 13 months; range, 6-30). It is suggested that ventricular standstill may commonly occur in patients with controlled atrial fibrillation who complain of dizziness or syncope and that the majority will benefit from permanent cardiac pacing.

A 43-year-old woman presented to her family physician with a two-year history of fatigue, diarrhea, and constant dull abdominal discomfort. Stools were described as normal in frequency and intermittently loose in consistency. In addition, she also experienced two to three episodes per month of non-bloody painless diarrhea, which was associated with a cramping abdominal pain. She attributed this pain, which radiated to the back and pelvis, to her menstrual cycle. During this period, she did not have any nausea or vomiting and did not notice any change in weight or appetite.

Background The renal resistive index (RI) measured using Doppler ultrasonography has been used as a diagnostic tool in the daily work-up of kidney diseases. A better understanding of its relationship with preclinical organ damage may help in determining overall cardiovascular risk in hypertensive patients. MethodsWe evaluated the association between RI and the presence and degree of target organ damage (TOD) in 415 (205 male) essential hypertensive patients. RI, carotid intima-media thickness, and left ventricular (LV) mass index were assessed by ultrasound scan. Albuminuria was measured as the albumin-to-creatinine ratio in three consecutive fi rst morning urine samples. ResultsBoth male and female patients with TOD showed signifi cantly higher RI as compared with those without TOD (presence versus absence of carotid wall thickening, p Ͻ 0.05; LV hypertrophy and albuminuria, p Ͻ 0.01, respectively). In both male and female patients, the severity of each TOD increased progressively from the lower to the upper RI tertile. Multiple logistic regression analysis found that each standard deviation (SD) increase in RI gave a 65% for male and 37% for female higher risk of having LV hypertrophy, and a 3.0-times for male and 1.8-times for female greater risk of having albuminuria. The occurrence of at least two signs of TOD also signifi cantly increased in parallel with elevation of RI (Odds ratio: 1.62 for male and 1.55 for female for 1 SD increase, p Ͻ 0.05, respectively). ConclusionsThese results strengthen the usefulness of RI as an independent, modifi able marker of cardiovascular damage in essential hypertension.Background The objective of this study was to determine the success rate of adrenal vein aldosterone sampling(AVS) on patients with documented primary hyperaldosteronism.Methods From October, 2005 to April, 2011 forty cases of adrenal vein aldosterone sampling were reviewed for success in accessing the adrenal veins. Blood was obtained from both adrenal veins and the inferior vena cava (IVC). The concentrations of aldosterone and cortisol were then measured. AVS was considered successful if the plasma level of cortisol in the adrenal vein was more than 10 times higher than that in the IVC (Funder et al, 2008).Results A total of 40 cases were reviewed with 18 (45%) cases being successful in accessing both adrenal veins. Twenty-two (55%) of the cases had adrenal adenomas. Within the 18 successful cases 5(12.5%) had the AVS repeated. Nine (50%) of the successful cases went on to have an adrenalectomy. There was 1 successful case that had a complication of bleeding into the right adrenal gland. The success rate of the two designated interventional radiologists was 61% and 20%.Conclusions On the basis of CT results alone 22 (55%) of the subjects would have been candidates for an adrenalectomy. Although the success rate for AVS was 45%, this success rate resulted in 18% of the subjects not inappropriately undergoing surgical intervention to treat their primary hyperaldosteronism. Although the overall success rate ...