PH is a strong short-term negative prognostic factor for patients with mitral regurgitation. The surgical procedure should be performed in the early stages of PH. Echocardiographic examination has useful, simple, and reproducible tools for classifying operative risks. An ischemic etiology and a need for concomitant CABG surgery are additional risk factors for patients with mitral regurgitation and PH.
Introduction: Ischemic stroke can lead to heart injury via dysfunction of the autonomic nervous system. QT intervals on electrocardiography (ECG) are susceptible to autonomic influences and their prolongation was associated with increased mortality after stroke. Aims: We aimed to study QT intervals in patients with ischemic stroke in chronic phase with and without cognitive impairment. Methods: ECGs were recorded in 50 patients with ischemic stroke. QT interval corrected for heart rate (QTc), QT dispersion (QTd), and QT interval variability (QTIV) were measured. The QTVI was calculated as the logarithm of the ratio between the variances of the normalized QT and RR intervals. Using Mini Mental State Examination and Hachinski`s ischemic scale we identified vascular dementia (VaD) in 17 patients. Twenty age-matched healthy subjects were examined for comparison. Results: We identified QTc, QTd prolongation in patients with ischemic stroke. Comparing patients with ischemic stroke vs. VaD, QTc (412 ±75.2 ms vs 456± 115 ms, p<0.01) and QTd (64±14ms vs 154±69 ms, p<0.0001) were more prolonged in VaD. QTVI were generally increased in ischemic stroke patients compared with healthy subjects (p<0.05) but the differences with high statistical significance level were found in VaD patients (p<0.001). We found correlation between QTd, QTVI, hypertension, diabetes, arrhythmia and cognitive impairment. Conclusion: Prolongation of QT intervals and increased QTVI occurs frequently after ischemic stroke but most significant changes were found in patients with cognitive impairment. Early detection of cognitive impairment in stroke patients provides better prevention of possible dementia.
Transcranial magnetic stimulation (TMS) is a non-invasive tool for electrical stimulation of nervous system. TMS is an effective technology with potential diagnostic and therapeutic uses in various diseases. TMS can be applied as single pulses of stimulation, paired-pulse, or in trains, repetitive TMS. In this survey we try to cover some important areas, such as biological effects, the safety issues, contraindications on TMS. According to available evidence, TMS could be an effective method for improving functional recovery of stroke patients. rTMS was able to improved motor function in the hemiplegic side, poststroke aphasia, manual dexterity and has a promising potential in neuromodulation of autonomic nervous system. Moreover repetitive TMS might become useful in the rehabilitation of patients with dementia in the attempt to restore impaired brain plasticity. The main deficiency of rTMS is that it has no long-lasting effect on motor function in patients with stroke. Creating a home device to deliver TMS can be an important step in rehabilitating the patients with stroke. All these are supported by the available studies, but more investigations are needed to establish the clinical indication as a diagnostic or therapeutic tool in any neurological or psychiatric disease.
Introduction: Magnesium is required in muscular contraction, neuromuscular conduction, heart functions, and vascular tone. Heart rate variability (HRV) is a non-invasive assessment method of the autonomic nervous system activity which regulates heart rate (HR). Time-domain, frequency-domain and non-linear analysis of the HRV can establish the autonomic tone balance. Objectives: The purpose of this study was to investigate the relationship between lower serum magnesium levels and HRV indices, and to observe if magnesium supplementation can corrected autonomic functions. Methods: We analyzed HRV parameters in 30 patients with hypomagnesaemia and 20 age-related healthy subjects. Results: In control group we found lower values for HR, LF nu and LF/HF ratio (p< 0.0002) and higher values for HF nu, SD1 when compare with patients with magnesium deficiency, resulting that in supine position there is an enhanced heart rate. In magnesium deficiency group we found increase LF nu, LF/HF ratio suggesting that the sympathovagal balance was affected with a sympathetic overactivity. After magnesium supplementation the HR, LF/HF ratio decrease and RMMSD, pNN50%, HF, SD1 increase in these patients. Conclusions: Findings from the current study suggest that Mg supplementation may enhance parasympathetic activity and therefore presenting a positive impact on cardiac autonomic function.
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