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ABSTRACT: Abnormal heart rate recovery (HRR) following exercise testing has been shown to be a predictor for adverse cardiovascular events. The actual maximum heart rate (MHR) attained during the exercise test does not however have a distinct significance in traditional HRR assessment. The objective of this study was to investigate the role of MHR in HRR.
This prospective study consisted of 164 patients (62% male, mean age 53.7 + or - 11.7 years) who were referred for a symptom-limited standard Bruce Protocol treadmill exercise test, based on clinical indications. The patients were seated immediately at test completion and the heart rate (HR) recorded at one and two minutes postexercise. A normal HRR was defined as a HR drop of 18 beats per minute or more at the end of the first minute of recovery. The HRR profile of patients who reached > or = 85% of their maximum predicted heart rate (MPHR) during peak exercise were then compared to HRR profile of those who could not.
One hundred twelve patients (Group A) achieved a MHR > or = 85% of MPHR during peak exercise whereas 52 patients (Group B) did not. Chi-square analysis showed a higher incidence of normal HRR in Group A compared to Group B (p = 0.029). Analysis of variance with repeated measures showed that group A had a greater HRR at the first minute F(1,162)= 6.98, p = <0.01) but not the second minute (F(1,162)=1.83, p = .18) postexercise.
There is a relation between the peak heart rate attained during exercise and the subsequent HRR. A low peak heart rate increases the likelihood of a less than normal HRR. Assessment of the entire heart-rate response seems warranted for more thorough risk-stratification.
Annals of Noninvasive Electrocardiology 01/2010; 15(1):43-8. · 1.10 Impact Factor
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ABSTRACT: Asymptomatic subclavian vein occlusion following insertion of a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) is not uncommon. We report a case of a dual-chamber PPM in a patient with an unrecognized left subclavian vein occlusion who developed massive left arm edema following ipsilateral implantation of an arteriovenous (AV) hemodialysis graft. We recommend that patients with pre-existing PPM or ICD leads who are in need of vascular access for hemodialysis should have the AV shunts placed in the contralateral arm. If this is unavoidable, then preoperative subclavian vein screening for patency should be mandatory, even in asymptomatic patients. Sonography is an appropriate initial test in such a situation.
Journal of Clinical Ultrasound 07/2008; 36(5):321-4. · 0.81 Impact Factor
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James Maher MD,
Abel Rivero MD,
Sina Zaim MD,
Peter J. Pappas MD,
Nicos Labropoulos PhD, DIC, RVT,
Marc Klapholz MD,
PhD Muhamed Saric MD,
James Maher,
Abel Rivero, Sina Zaim,
Peter J. Pappas,
Nicos Labropoulos,
Marc Klapholz,
Muhamed Saric
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ABSTRACT: Asymptomatic subclavian vein occlusion following insertion of a permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) is not uncommon. We report a case of a dual-chamber PPM in a patient with an unrecognized left subclavian vein occlusion who developed massive left arm edema following ipsilateral implantation of an arteriovenous (AV) hemodialysis graft. We recommend that patients with pre-existing PPM or ICD leads who are in need of vascular access for hemodialysis should have the AV shunts placed in the contralateral arm. If this is unavoidable, then preoperative subclavian vein screening for patency should be mandatory, even in asymptomatic patients. Sonography is an appropriate initial test in such a situation. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008
Journal of Clinical Ultrasound 05/2008; 36(5):321 - 324. · 0.81 Impact Factor
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ABSTRACT: We report the first case of witnessed sudden death of an Emery-Dreifuss muscular dystrophy (EDMD) patient with a properly functioning implantable cardioverter-defibrillator (ICD). This 38-yr-old woman with normal left ventricular function had a history of recurrent syncope and nonsustained ventricular tachycardia, for which a single-chamber ventricular ICD was implanted. She later collapsed suddenly and unexpectedly while at home, with witnesses present, and was found cyanotic with pulseless electrical activity by the emergency squad. This event took place in the setting of previously documented hypercapnic ventilatory insufficiency, for which she had refused the use of respiratory muscle aids to normalize alveolar ventilation. Subsequent interrogation of the ICD demonstrated normal function, with no evidence of ventricular tachycardia or ventricular fibrillation. In the hospital, her myocardial function was found to be normal by echocardiography. Further workup revealed that the patient had severe anoxic encephalopathy. She was eventually made "do not resuscitate," and she died on the sixth day of hospitalization. An autopsy was performed, and no obvious cause for the sudden death could be established. Review of the clinical presentation, with all the data available, suggests acute respiratory failure as the likely primary cause of this patient's sudden death, which then secondarily led to the observed pulseless electrical activity of the heart. The use of respiratory muscle aids--in particular, noninvasive mechanical ventilation to prevent chronic hypercapnia and cor pulmonale--is crucial for EDMD patients with symptomatic ventilatory insufficiency, for whom sudden deaths may not necessarily be of primarily cardiac origin.
American Journal of Physical Medicine & Rehabilitation 05/2008; 87(4):325-9. · 1.58 Impact Factor
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Journal of Cardiovascular Electrophysiology 05/2004; 15(4):496-500. · 3.06 Impact Factor
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Pacing and Clinical Electrophysiology 08/2002; 25(7):1146-8. · 1.35 Impact Factor
