No abstract

The QT-RR relation over a wide range of heart rates does not permit the use of one simple adjustment equation. A nomogram providing, for every heart rate, the number of milliseconds that the QT interval must be corrected gives excellent adjustment.

Pathological cardiovascular manifestations are reported in four male patients, who had taken massive amounts of anabolic steroids while undergoing many years of strength training. One patient was referred because of ventricular fibrillation during exercise, one because of clinically manifest heart failure, and one because of arterial thrombus in his lower left leg. The fourth patient was persuaded to attend for a check-up because of a long history of massive use of anabolic steroids. All four patients had cardiac hypertrophy. Two of the patients had symptoms and signs of heart failure, and one of these two had a massive thrombosis in both right and left ventricles of his heart. After cessation of the use of anabolic steroids in the other patient with heart failure, left ventricular wall thickness reduced quickly from 12 to 10.5 mm, and fractional shortening increased from 14% to 27%. Endomyocardial biopsy revealed increased fibrosis in the myocardium in two of the three cases. HDL-cholesterol was 0.58 mmol.l-1 and 0.35 mmol.l-1 in the two patients still using multiple anabolic steroids at the time of investigation. The cardiovascular findings described in the present paper should warn all physicians and athletes about the possible serious acute and long-term side effects of the massive use of anabolic steroids.

asthmatic patients in comparison to controls. The differences in miRNA expression were mainly similar in asthmatics with and without AR. With regard to asthma severity, a trend of increased miRNA expression in persistent asthma was seen, whereas the downregulation of certain miRNAs was most distinct in nonpersistent-asthma patients. Conclusions: Differences in miRNA expression in the nasal mucosa of subjects with long-term asthma and AR can be seen also when no markers of Th2-type inflammation are detected. Asthma severity had only a minor impact on miRNA expression.

Abstract. Reunanen A, Karjalainen J, Ristola P, Helio Èvaara M, Knekt P, Aromaa A (National Public Health Institute, Helsinki, Central Military Hospital, Helsinki, and Kvaerner Masa-Yards Helsinki New Shipyard, Helsinki, Finland). Heart rate and mortality. J Intern Med 2000; 247: 231±239.Objectives. Increased heart rate has shown to be associated with risk of mortality from cardiovascular diseases in some studies, but not in others. Increased heart rate has also been linked to causes of death other than cardiovascular. To clarify the role of heart rate as a predictor of death we studied its predictive value in a large population study. Design. A prospective population study with a follow-up time of 23 years. Subjects and methods. The study population comprised 5598 men and 5119 women 30±59 years of age on entry. Heart rate was measured from resting ECGs. Main outcome measure. Mortality from specified causes. Results. A total of 1848 men and 840 women died during the follow-up period. Increased heart rate was significantly associated with death from all causes, cardiovascular causes, and natural noncardiovascular, nonmalignant causes of death. Increased heart rate was associated with death from cancer in men with heart disease but not in men without heart disease on entry into the study. The increase in cardiovascular mortality with high heart rate was explained by the close association between heart rate and blood pressure. Adjustment for risk factors did not alter the significance of the association between increased heart rate and mortality from noncardiovascular causes. Conclusions. High heart rate is simple to observe clinically and a significant if nonspecific predictor of mortality. Increased risk of mortality from cardiovascular diseases can be explained by association with high blood pressure. The increased mortality risk associated with high heart rate related mainly to a group of diseases of noncardiovascular or nonmalignant origin.

Eruption of primary teeth has a great influence on the oral environment by providing suitable niches for bacterial colonization. The composition of oral gram-negative anaerobic microflora was investigated in 21 young children (mean age 32 months) with primary dentition. The bacterial findings of samples were compared with those of the same children collected at their edentulous infant period (mean age 3 months). During the primary period, 2 samples were collected from each child: a sample with dental floss from gingival margin of 2 teeth and stimulated saliva pooled with a mucosal swab sample. Both samples were cultured aerobically and anaerobically using nonselective and selective media. Prevotella melaninogenica, nonpigmented Prevotella spp., Fusobacterium nucleatum group and Capnocytophaga spp. were found in all children at the older age, whereas they occurred in edentulous mouth in 76%, 62%, 67% and 19%, respectively. The occurrence of Prevotella loescheii increased from 14% to 90%, Prevotella intermedia from 10% to 67%, Leptotrichia spp. from 24 to 71%, Campylobacter (Wolinella) spp. from 5 to 43% and Eikenella corrodens from 5 to 57%. Only the occurrence of Bacteroides gracilis and Veillonella spp. remained at about the same level. Species not isolated from the edentulous mouth, such as Prevotella denticola, Fusobacterium spp. other than the F. nucleatum group and Selenomonas spp. were now detected in 71%, 71% and 43% of the children. The stability of the colonizing P. melaninogenica strain(s) in the oral cavity was determined by using ribotyping; 1-2 isolates per child from the edentulous infant period of 9 children and 3-15 isolates per child from their primary dentition period were analyzed.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective-To evaluate the value of QT interval as a cardiac risk factor in middle aged people. Methods-The association between QT interval and cardiac risk factors and mortality in a middle aged Finnish population of 5598 men and 5119 women was evaluated over a 23 year follow up. To adjust the QT interval confidently for heart rate, a nomogram was constructed from the baseline electrocardiograms separately for men and women. Results-Nomogram-corrected QT interval (QTNc) prolongation was associated with elevated blood pressure and signs of cardiovascular disease; QTNC shortening was associated with smoking. Over 10% prolongation of QTNC predicted death in men with heart disease: adjusted relative risk (RR) was 2*17 (95% confidence interval 0.67-7-45) for sudden death; [2][3][4][5][6][7][8][9][10][11][12] (1-25-3.59) for total cardiovascular mortality; and 1-92 (1.23-3.00) for all cause mortality. In healthy men the increase in RR was not significant: sudden death, 1-48 (0-67-3.25); total cardiovascular mortality, 125 (0-92-1*70); al cause mortality, 1-21 (0-96-1-53). However, healthy men with long QTNC in the lowest heart rate quartile exhibited an KR of 2-75 (1-00-7*40) for sudden death. Over 10% shortened QTNC predicted cardiovascular death in men with heart disease who smoked; (1.45-9.54). Non-smoking men with short QTNC had low mortality risks irrespective of possible signs of cardiovascular disease. The trends in mortality risks were similar but weaker for women. Conclusions-In a middle aged population, prolonged QT interval predicts cardiac mortality in men with signs of cardiovascular disease. In women and healthy men this risk is weak and may reflect subclinical heart disease. A shortened QT interval predicts death in men with heart disease who smoke. (Heart 1997;77:543-548) Keywords: QT interval; cardiovascular mortality; cardiac risk factors; smoking The QT interval in the electrocardiogram reflects the time registered for depolarisation and repolarisation of the ventricular myocardium-that is, the summation of action potential durations in the ventricles.1 Theoretically, long and disparate duration of ventricular action potentials predispose to reentrant ventricular arrhythmias, which are harbingers of sudden death especially in cardiac patients.2 Short action potentials, on the other hand, reflect rapid electrical recovery enabling short cycle length in ventricular arrhythmias' and may predispose to ventricular fibrillation. Factors influencing action potentials change the QT interval; heart rate and autonomic tone are particularly important.4 For clinical and research purposes, QT intervals are corrected for heart rate. The most widely used method is based on Bazett's formula, despite the fact that this equation over corrects the QT interval at high heart rates and under corrects it at low heart rates.5Clinical studies in subjects with congenital or acquired long QT syndrome and in patients with acute myocardial infarction have shown that long QT intervals predispose to malignant ventric...

AimsThe incidence of myocarditis is uncertain as diagnostic criteria have been vague. We evaluated the incidence of myocarditis presenting in three well defined forms (mimicking myocardial infarction, presenting as dilated cardiomyopathy, and as a cause of sudden death) in young men in military service over a 20-year period. Methods and ResultsThe study population consisted of 672 672 Finnish men at a mean age of 20 years conscripted from 1977-1996. All those suspected of having myocardial disease were studied prospectively in the same institution. A clinical diagnosis of myocarditis mimicking myocardial infarction required ECG signs (ST-segment elevation followed by T-wave inversion) and a simultaneous detection of serum markers of acute myocardial injury (CK-MB and/or troponin T) in an infectious patient with chest pain. This form of myocarditis was diagnosed in 98 men, the incidence being 0·17 (95% CI 0·14-0·21) . 1000 manyears 1 . Causative microbes were those commonly infecting the conscripts, but Coxsackievirus aetiology could be confirmed in only 4% of the cases. Nine patients presented with dilated cardiomyopathy of recent origin (incidence 0·02 . 1000 man-years 1 ). None had histopathological evidence of myocarditis. Myocarditis caused one of the 10 sudden unexpected deaths (incidence 0·002 . 1000 man-years 1 ). ConclusionsThe usual presentation of acute myocarditis in young men mimicks alterations evoked by myocardial infarction but not those of dilated cardiomyopathy.(Eur Heart J 1999; 20: 1120-1125)