In hospitalized patients with ACS who received continuous, intensive nurse counseling about smoking cessation, bupropion did not increase the rates of smoking abstinence.

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Objectives: Brain natriuretic peptide (BNP) levels correlate with prognosis in patients with cardiac disease and may be useful in the risk stratification of cardiac patients undergoing noncardiac surgery (NCS). The objective of this study was to examine whether BNP levels predict perioperative events in cardiac patients undergoing NCS. Methods: Patients undergoing NCS with at least 1 of the following criteria were included: a clinical history of congestive heart failure (CHF), ejection fraction <40%, or severe aortic stenosis. All patients underwent echocardiography and measurement of BNP performed using the ADVIA-Centaur BNP assay (Bayer HealthCare). Clinical endpoints were death, myocardial infarction or pulmonary congestion requiring intravenous diuretics at 30 days of follow-up. Results: Forty-four patients were entered into the study; 15 patients (34%) developed cardiac postoperative complications. The mean BNP level was 1,366 ± 1,420 pg/ml in patients with events and 167 ± 194 pg/ml in patients without events, indicating a highly significant difference (p < 0.001). The ROC area under the curve was 0.91 (95% CI 0.83–0.99) with an optimal cutoff of >165 pg/ml (100% sensitivity, 70% specificity). Conclusions: BNP levels may predict perioperative complications in cardiac patients undergoing NCS, and the measurement of BNP should be considered to assess the preoperative cardiac risk.

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Intravenous immunoglobulins (IVIgs) are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4–6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI). The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization). This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.

Background The cardiac ryanodine receptor type 2 (RyR2) is a large homotetramer, located in the sarcoplasmic reticulum (SR), which releases Ca 2+ from the SR during systole. The molecular mechanism underlying Ca 2+ sensing and gating of the RyR2 channel in health and disease is only partially elucidated. Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT1) is the most prevalent syndrome caused by RyR2 mutations. Methods and Results This study involves investigation of a family with 4 cases of ventricular fibrillation and sudden death and physiological tests in HEK 293 cells and normal mode analysis (NMA) computation. We found 4 clinically affected members who were homozygous for a novel RyR2 mutation, G3118R, whereas their heterozygous relatives are asymptomatic. G3118R is located in the periphery of the protein, far from the mutation hotspot regions. HEK293 cells harboring G3118R mutation inhibited Ca 2+ release in response to increasing doses of caffeine, but decreased the termination threshold for store‐overload‐induced Ca 2+ release, thus increasing the fractional Ca 2+ release in response to increasing extracellular Ca 2+ . NMA showed that G3118 affects RyR2 tetramer in a dose‐dependent manner, whereas in the model of homozygous mutant RyR2, the highest entropic values are assigned to the pore and the central regions of the protein. Conclusions RyR2 G3118R is related to ventricular fibrillation and sudden death in recessive mode of inheritance and has an effect of gain of function on the protein. Despite a peripheral location, it has an allosteric effect on the stability of central and pore regions in a dose‐effect manner.

Objectives: To assess competency and confidence in ECG interpretation in medical students across years of medical school and evaluate the associations of various factors, a curriculum change, and student confidence with ECG competency. Methods: Four hundred and fourteen (414) third-to sixthyear medical students participated in this cross-sectional study conducted in 2019 in the Hebrew University of Jerusalem, Israel. A voluntary response sample of participants answered a validated, web-based questionnaire, composed of eight ECG strips. Participants were also asked about confidence and sources for ECG education and exposure. Competency and confidence across medical school years were compared using the ANOVA and chi-square tests. Results: Competency was low overall (mean score, SD (standard deviation) 3.23±1.81 out of 8), and higher in sixthyear students compared to third-, fourth-and fifth-year students (4.37±1.69 vs. 2.90±1.82, 2.90±1.54, 2.50±1.56, respectively, F(3,337)=24.425, p<0.0001). There was no difference between students before and after the curriculum change. Work experience in medicine was associated with competency (odds ratio (OR), 7.97; 95% confidence interval (CI), 4.03-15.77, p<0.0001). The reported confidence level was low (median 2 out of 5) and was found to be correlated with the total score achieved (r(332)=0.5, p<0.0001). Conclusions: Student competency was shown to be insufficient throughout medical school. Competency and confidence in ECG interpretation seem to be significantly improved by increased and repetitive exposure to ECG. Thus, strategies to facilitate better ECG skills should involve an extended focus on ECG in the undergraduate and graduate curricula and include competency-based educational programs.