One Friday evening, during routine work, I was called to the Children and Psychiatry Department to check a 17-year-old girl, with the diagnosis of anorexia nervosa (AN), because of bradycardia (heart rate (HR) of 38/min). A month later, a friend of mine asked me to check her 16-year-old daughter who has lost weight and has HR of 47/min. At that time, I realized that not all physicians (in hospitals, the community, or in the military service) are acquainted with the simple, easy to check physical sign of bradycardia in AN, and thus I became involved and decided to collect data concerning this issue.Eating disorders, and particularly AN, confer a long-lasting increase in morbidity and mortality especially among young adults. It is a life-threatening disorder, with a significant risk for sudden death (5 to 20%) due to severe cardiovascular complications. It is a generalized disorder that affects multiple organ systems, such as skeletal bones, linear growth, brain development, and fertility functions. Previous reports pointed out conflicting evidence concerning its reversibility upon treatment. 1-8AN carries the highest mortality rate of all psychiatric disorders, mostly due to sudden unexpected cardiac arrhythmic death.9,10 Studies have disclosed a mortality rate of up to 20%. 11 Cardiac arrest secondary to electrolytic disturbances, and QT c (QT corrected to HR) interval prolongation (secondary/primary) were recorded among AN patients. 12,13The mechanism of sudden death in AN is obscure and is attributed to sudden arrhythmic death. AbstractAnorexia nervosa (AN) is a life-threatening condition, with a significant risk for death, due to cardiovascular complications. It is characterized by abnormal eating behavior and has the highest mortality rate of all psychiatric disorders. It has been associated with bradycardia (a heart rate [HR] of less than 60 beats per minute) (up to 95%), hypotension, mitral valve prolapse, and heart failure. The diagnosis of AN can be elusive, and more than half of all cases are undetected. The purpose of this study was to raise and improve awareness to the possible diagnosis of AN in adolescent and young adult patients with weight loss displaying bradycardia and new cardiac disorders. Clinical characteristics, HR, and electrocardiographic data of 23 consecutive patients (20 females) with AN and of 10 young adults (8 females) without AN, between the years 2006 and 2009, were recorded and summarized. At presentation 16/23 (69.6%) showed HR < 50 bpm. The mean lowest HR of all patients was 44 AE 6 (range 26 to 68) bpm. No patient needed pacemaker therapy. Bradycardia in young adults, especially females with weight loss, should raise the possible diagnosis of AN, so it can be treated early in-time, and thus prevent premature death.

Cardiac device-related endocarditis (CDE) is a phenomenon for which incidence is on the rise; it presents difficult management problems to the clinician. On one hand, there is the patient who needs the implanted device, and the potential morbidity and mortality associated with its removal. On the other hand, there is the problem of a persistent infection - usually acquired during insertion of an electrical device - that is resistant to many antibiotics, has a high recurrence rate, and necessitates an extensive operation to remove the device if removal is delayed. Most studies recommend device and metal lead replacement if CDE occurs. The aim of the present review is to raise awareness of CDE among clinicians, and to provide an appropriate approach to its management.

Increased LF power reflects sympathetic cardiac activation. As the LF range accounts for regulation of blood pressure and baroreflex, several mechanisms may explain this activation. This in turn may predispose patients who suffer from cardiac disease to higher risk of developing ventricular arrhythmias, besides the possible adverse hemodynamic consequences of PPP.

The elimination of sympathetic predominance by helium PP indicates the central role of CO(2) in establishing this phenomena. Considering this information and its other known advantages, helium should be considered for use during prolonged laparoscopic procedures for high-risk patients.