of cardiac risk among profe ssional drivers. Scand J Work Environ Health 1994;20:73-86.This literature review indicates that professional drivers have excess cardiac risk that is not fully explained by standard risk factors. The contributi on of occupation is suggested by two independent methods and by psychophysiological studies during on-the-job driving. Driving has been conceptualized as a threat-avoidance task. Stimuli encountered in traffic are not inherently aversive but become so by association with driving experie nce, a formulation corroborated by laboratory studies in which stimuli such as car headlights elicit cardiovascular hyperreactivity and electroencephalographic signs of arousal in professional drivers. More-advanced neurophysiological methods (event-related potentials) show higher cortical electrone gativity to imperative signals among professional drivers than among nondriver referents. These data are viewed in light of reports of possible associations between event-related slow potentials and cardiac risk. A clinically and ecologically relevant neurocardiological model is proposed, and preventive strategies, including workplace interventions, are suggested.K EY TERMScardiova scular disease, event-related potentials, glare, neurocardiology, professional drivers, review, work stress.Of the numerous studies performed in va rious countries on cardiovascular disease and professional driving over a sp an of almost three de cades, ne arly all have shown an exce ss ri sk of cardiovascular di sease among professional drivers. Despite rigorous se lection against these disorders at hiring and during periodic medical foll ow-up ( 1-4), a risk of hyp ertension, ventri cu lar arrhythmias, myocardial infarction, and other ischemic heart disease ha s been ob served in 28 of the 32 reports found to consider thi s question (1-32). (No ns ig nifica nt findings have be en reported in references 13, 18, 19, and 23.) Of particular note in many of these studies is the close relation between the number of work years as a driver and the untowardly yo ung ag e at which these ev e nts occur (l , 5, 7, 9 17, 26, 29, 32). For example, in studies of young myocardial infarct ion patients, fo r whom profession was determined, an unexpectedly high percentage (up to 40 %) comprised professional dri vers (9,17,26,29,32). While standard ri sk-factor status tends to be high in thi s population, these fa ctors have not been clearly shown to distinguish professional drivers from other lo wer ri sk groups (1 , 15, 16,33-35) (tab le I). Rece ntly , Ro sengren and her co-workers (27) demonstrated that the excess risk of coronary he art disease among middle-aged bus and tram drivers occurred independently of sta ndard ri sk-factor status .Thus the quest ion ari ses as to how this excess cardiac risk oc curs for professional drivers. A growing co nse ns us indicates that occupational factors must be gi ven ca reful consideration (1-3). A focus on neural mech anisms pr omises to offer meaningful insig hts into the problem (3,36,37). In...
A total of 46 patients with syncopal episodes after VVI pacemaker implantation were studied. Of these, 92% had one to three syncopal episodes and 8% more than three. All underwent a thorough clinical examination, which included chest X ray, echocardiogram, neurological exam, and the following protocol: 24-hour Holter monitoring, EEG, blood pressure (BP) measurement in three positions, Doppler exam of the carotid vessels, fasting blood glucose, and head-up tilt table test (60 minutes, 60 degrees). Holter monitoring showed exit block in two patients (4.3%) and failed sensing in one (2.1%). In two patients there was unilateral slowing on EEG. Orthostatic hypotension was found in four patients (8.6%), and hypoglycemia in three insulin-dependent diabetics. An occlusive atherosclerotic plaque in the carotid artery was found in three patients (6.5%). Syncope was induced in 17 patients (36.9%) by the tilt table test, after a mean standing time of 47 +/- 11 minutes. The mean resting systolic BP of these patients was 140 +/- 24 mmHg, and fell to a mean level of 56 +/- 8 mmHg (mean systolic BP drop was 79 +/- 8 mmHg). Sixteen of these 17 patients with positive tilt table were being paced at the time of syncope and one had a spontaneous heart rate of 73 beats/min. In 14 cases (30.4%) the cause of syncopal episodes after this extensive workup remained unexplained. These results indicate that pacemaker dysfunction is not a major cause of syncopal episodes in pacemaker patients and that these are most often due to vasovagal syncope. Long-term follow-up is warranted to determine the prognostic significance of various types of syncope in pacemaker patients.
A considerable amount of data supports a 1.8-7.4-fold increased mortality associated with Cushing’s syndrome (CS). This is attributed to a high occurrence of several cardiovascular disease (CVD) risk factors in CS [e.g. adiposity, arterial hypertension (AHT), dyslipidaemia and type 2 diabetes mellitus (T2DM)]. Therefore, practically all patients with CS have the metabolic syndrome (MetS), which represents a high CVD risk. Characteristically, despite a relatively young average age, numerous patients with CS display a 'high' or 'very high' CVD risk (i.e. risk of a major CVD event >20% in the following 10 years). Although T2DM is listed as a condition with a high CVD risk, CS is not, despite the fact that a considerable proportion of the CS population will develop T2DM or impaired glucose tolerance. CS is also regarded as a risk factor for aortic dissection in current guidelines. This review considers the evidence supporting listing CS among high CVD risk conditions.
A total of 1,431 patients (mean age 63.4 +/- 14.1) with pacemakers (96.2% VVI) primoimplanted between 1967 and 1985 were followed for a mean duration of 78.2 +/- 40 pacing months, with 0.6% loss to follow-up. Cumulative survival for 1, 3, and 10 years was 0.9427, 0.9136, and 0.7536, respectively. There was no significant difference in survival between atrioventricular block (AVB) and sick sinus syndrome (SSS) patients. In addition to age and gender, factors existent prior to implantation that independently affected prognosis included manifest coronary heart disease (CHD), congenital/acquired heart lesions, heart failure, noncardiac internal disease, syncope, and generalized fatigue. After implantation, the most important factor was generalized fatigue, then age, stroke, myocardial infarct (MI), gender (male), heart failure, and syncope. Patients with no underlying disease showed an extremely high cumulative survival (0.9173 at 10 years). Compared to the general population of Yugoslavia, the pacemaker patients showed a similar yearly mortality rate until 1981. After that, elderly males (70+) had a significantly lower yearly mortality than the matched population. Thus, in this large series of pacemaker patients followed into the most recent period with an extremely low loss to follow-up, short- and long-term survival was very high. Pacemaker patients of any age who are otherwise in good health have an excellent prognosis.
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