简介：Takotsubosyndrome(TTS)isarecentlyidentifiedacuteheartsyndrome,characterizedbyregionalwallmotionabnormalitiesnotjustifiedbythepresenceofsignificantcoronaryarteryobstruction.Clinically,TTScloselyresemblesacutecoronarysyndromes(ACS)andthereforedifferentialdiagnosismaybeanimportantobstacleforitscorrectclinicalmanagement.TheprevalenceofTTSisestimatedtobearound2%ofacutemyocardialinfarctions,andthenumberofdiagnoseshasincreasedinrecentyears,possiblyreflectingourgrowingunderstandingofthiscondition.GiventhesimilaritiesbetweenTTSandACS,clinicalpresentationinthesepatientsisequivocal.However,numerouspeculiartraitshavebeenobserved,suchasthegreaterprevalenceinpostmenopausalwomenandthepresenceofstressfultriggers.ManypathogenetichypothesesforTTS,suchascatecholamineoverloadandmicrovasculardysfunction,havebeenproposed.Noneofthesehavebeencapableofindependentlyexplainingtheunderlyingmechanisms.ThediagnosticcriteriaproposedbytheHeartFailureAssociationoftheEuropeanSocietyofCardiologyrepresentanovelattempttointroducesemiquantitativeparameters,yetfurtherscientificvalidationisneeded.Contrarytopreviousopinions,TTSisnotalwaysbenign,consideringtherelativelyhighprevalenceofacutecomplications,anestimatedin-hospitalmortalitysimilartothatofacutemyocardialinfarction(1-8%),andasignificantrateofrecurrencesandpersistenceofsymptoms.ClinicalmanagementofTTShasbeenlargelybasedonempiricalexperiencerelatedtoACS,andthereforepharmacologicalstrategiesarepartiallyoverlapping.Anissueoftheutmostimportanceisthelackofrandomizedprospectivedatavalidatingdiagnosticcriteria,riskstratification,andspecifictherapeuticapproaches.

简介：Cardiologistswhoseepatientsonageneralcardiologyservicearebeginningtoseeanincreasingnumberofpatientswhohavereceivedaprimarypreventionimplantablecardiacdefibrillator(ICD)buthaveneverhaditfire.ThereareadditionallyanumberofpatientswhohaveinappropriatefiringofICDs.Inappropriateshocksoccurinupto40%ofpatientswithanICD.Themaincauseissupraventriculartachyarrhythmia,includingsinustachycardia,atrialfibrillation,andotherrapidsupraventriculararrhythmias.

简介：BackgroundThisstudytestedthehypothesisthatmoderatealcoholintakeexertsitscardioprotectiveeffectmainlythroughanincreaseintheserumlevelofhigh-densitylipoproteincholesterol.MethodsandResultsIntheCohortofNorway(CONOR)study,149729adultparticipants,recruitedfrom1994to2003,werefollowedbylinkagetotheCauseofDeathRegistryuntil2006.Atrecruitment,questionnairedataonalcoholintakewerecollected,andtheconcentrationofhigh-densitylipoproteincholesterolinserumwasmeasured.UsingCoxregression,wefoundthattheadjustedhazardratioformenfordyingfromcoronaryheartdiseasewas0.52(95%confidenceinterval,0.39-0.69)whenconsumingalcoholmorethanonceaweekcomparedwithneverorrarely.Theratiochangedonlyslightly,to0.55(0.41-0.73),aftertheregressionmodelincludedtheserumlevelofhigh-densitycholesterol.Forwomen,thecorrespondinghazardratioswere0.62(0.32-1.23)and0.68(0.34-1.34),respectively.ConclusionsAlcoholintakeisrelatedtoareducedriskofdeathfromcoronaryheartdiseaseinthefollow-upofalarge,population-basedNorwegiancohortstudywithextensivecontrolforconfoundingfactors.Ourfindingssuggestthattheserumlevelofhigh-densitycholesterolisnotanimportantintermediatevariableinthepossiblecausalpathwaybetweenmoderatealcoholintakeandcoronaryheartdisease.