The Heart

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What is torsades de pointes?

Torsades de pointes is an uncommon type of ventricular tachycardia, or disturbance of the heart's rhythm.

It is a complication of the rare condition called long-QT syndrome or LQTS, and it can be life-threatening.

In this article, learn about the symptoms and treatment of torsades de pointes.

What is torsades de pointes? EKG of torsades de pointes. Image credit: Jer5150, (2012, June 3)
Torsades de pointes is a form of tachycardia that shows up as a ribbon-like EKG pattern.
Image credit: Jer5150, (2012, June 3)

Problems that occur with the heart's rhythm are known as arrhythmias.

When the heart beats faster than usual, as in a case of torsades de pointes, it is called tachycardia.

Torsades de pointes is French for "twisting of points" and refers to when the heart's two lower chambers or ventricles, beat faster than the upper chambers, which are known as the atria.

Most cases of torsades de pointes resolve on their own without treatment. However, it can develop into ventricular fibrillation, which can lead to cardiac arrest and may even be fatal.

Thank you for supporting Medical News Today Symptoms and diagnosis A person can develop torsades de pointes without any warning. Symptoms may vary depending on the individual and the length of the episode. Symptoms of torsades de pointes include: heart palpitations dizziness nausea cold sweats chest pain shortness of breath rapid pulse low blood pressure In more serious cases, torsades de pointes can cause lack of consciousness, known as syncope, or even a cardiac arrest, which can lead to death. It is crucial to accurately diagnose torsades de pointes and distinguish it from other forms of ventricular tachycardia. Torsades de pointes can sometimes be diagnosed by assessing a person's calcium, magnesium, and potassium levels. However, a diagnosis is usually made using an electrocardiogram or EKG. EKG An ECG demonstrating the irregular rhythm of torsades de pointes.
An EKG may be used to diagnose and monitor torsades de pointes.
Image credit: CardioNetworks, (2010, April 10) An EKG measures the electrical activity of the heart. Electrical signals control the heart, starting at the top in the atria, and working their way down into the ventricles. This process makes the heart pump blood around the body. An EKG tracks the electrical signals during this cycle and displays them as wavy lines that a doctor can read. In cases of torsades de pointes, these lines will form a distinctive shape, much like a party ribbon that has been twisted. Thank you for supporting Medical News Today Causes Torsades de pointes is more common in women than men, but anyone can develop the condition. It is usually a complication of LQTS, which can be drug-induced or congenital, meaning the person is born with it. LQTS causes sudden and uncontrollable changes or arrhythmias in a person's heart rate in response to stress or exercise. These arrhythmias can be very dangerous. There is also a range of conditions and medications that cause or influence the development of torsades de pointes. These include: antiarrhythmic drugs, including quinidine, procainamide, and disopyramide antipsychotics or tricyclic antidepressants methadone, erythromycin, and ketoconazole intracranial bleeding, or bleeding inside the skull electrolyte disturbances, such as hypokalemia, hypomagnesemia, and hypocalcemia acute myocardial infarction, or a blockage in a coronary artery kidney injury liver failure toxins from heavy metals or insecticides anorexia malnutrition In cases where there is no known cause, the condition is known as idiopathic torsades de pointes. Treatment Stethoscope on EKG measuring heart rate and rhythm.
In some cases, torsades de pointes will just be monitored rather than treated. Torsades de pointes can have life-threatening complications, so immediate treatment is vital. Treatment will vary, depending on the individual's symptoms and the cause of the abnormal heart rhythm. People without syncope, ventricular tachycardia, or a family history of the condition may only be monitored by a doctor rather than receive treatment. The first thing a doctor will do after diagnosing torsades de pointes is check the person's calcium, magnesium, and potassium levels. If the levels of any are low, then supplements will be given. Magnesium can also be an effective treatment in people who already have normal magnesium levels. If torsades de pointes is found to have an underlying medical cause, this will be treated first. If a medication is causing the condition, a doctor may recommend an alternative treatment. For people with a congenital form of LQTS, treatment includes: beta-adrenergic antagonists, such as propranolol beta-blockers pacemakers implantable cardioverter defibrillator in rare cases For people with acquired torsades de pointes, specific treatment is not usually needed. This is because the arrhythmia should disappear once the underlying condition is treated. Thank you for supporting Medical News Today Outlook Torsades de pointes is a serious arrhythmia that can lead to sudden cardiac death in some cases. However, the outlook for people managing the condition with the appropriate treatment is excellent. Arrhythmias are common but can be very serious, so an abnormal heartbeat should always be reported to a doctor. People who have a history of torsades de pointes in their family may wish to be screened for the condition as a precaution.
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Heart failure risk might depend on your neighborhood

The risk of developing heart failure is highly dependent on diet, lifestyle, and genetics. A new study, however, suggests that where we live may also play a key role.
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Researchers suggest that our neighborhoods play a role in our risk of heart failure.

Researchers discovered that people who lived in deprived areas were more likely to develop heart failure than individuls who resided in wealthier areas.

Co-senior study author Dr. Elvis Akwo, who is a postdoctoral research fellow from Vanderbilt University Medical Center in Nashville, TN, and colleagues note that previous research has shown that a person's individual socioeconomic status can have negative health implications.

But the team says that this new study shows that the socioeconomic status of one's neighborhood can also affect heart failure risk.

The researchers recently published their findings in the journal Circulation: Cardiovascular Quality and Outcome.

Heart failure occurs when the heart is no longer able to pump enough oxygen-rich blood to aid the functioning of other organs. According to the Centers for Disease Control and Prevention (CDC), it affects around 5.7 million adults in the United States.

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While there is currently no cure for heart failure, lifestyle changes, medications, and surgery are some of the treatments that can help to prolong survival. Still, around 50 percent of people with heart failure die within 5 years of being diagnosed.

As such, it is important to identify all risk factors for heart failure, as this guides us toward strategies that can help to prevent the condition.

From their study, Dr. Akwo and his colleagues believe that they have identified a person's place of residence as a risk factor for heart failure.

In order to reach their findings, the researchers analyzed the data of 27,078 adults aged 40–79. All subjects were part of the Southern Community Cohort Study, which is a health study of adults across 12 states in southeastern America, between 2002 and 2009.

Around 69 percent of the participants were African-American, and around 63 percent were women.

The team divided the subjects into three groups, ranging from those who lived the least-deprived neighborhoods to those who lived in the most deprived.

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Highest heart failure incidence in poor areas

Subjects were followed-up for a median of 5.2 years. During this time, a total of 4,300 participants developed heart failure.

The researchers found that adults who lived in the most deprived areas had the highest incidence of heart failure, at 37.9 per 1,000 person-years, compared with 28.4 per 1,000 person-years for those who lived in the least-deprived areas.

After adjusting for participants' age, sex, race, and lifestyle and clinical factors, the scientists found that each tier jump in neighborhood deprivation — from the least deprived to the most deprived — was associated with a 12 percent increase in heart failure risk.

Overall — after further adjustment for subjects' education and income — the team calculated that a person's place of residence accounted for 4.8 percent of their heart failure risk.

"There is existing evidence," notes co-senior study author Loren Lipworth, an associate professor of epidemiology at Vanderbilt University Medical Center, "suggesting strong, independent associations between personal socioeconomic status — like education, income level, and occupation — and risks of heart failure and many other chronic diseases."

"But what this study adds," she explains, "is evidence suggesting that characteristics of your place of residence, actually also play a significant role in influencing the risk of heart failure over and above the role of your own individual socioeconomic characteristics."

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Neighborhood 'predicts risk of heart failure'

The researchers note that because their study mainly focused on middle-aged individuals with low income, the results cannot be generalized to other populations just yet.

Still, they hope that their results will encourage community-based interventions that can help individuals to reduce their risk of heart failure.

"Public policy professionals need to pay attention to the neighborhood, not just the individuals, because your place of residence does predict your risk of heart failure. Improved community-level resources may ultimately reduce the risk of heart failure in these communities."

Dr. Elvis Akwo

"These are merely suggestions on what could have some impact," Dr. Akwo goes on to explain. "We hope that our study will open the door for experimental studies for interventions and what kinds of measures can be tested to improve the cardiovascular health of entire communities," instead of, he says, "just one person at a time."

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Heart failure risk could be reversed with exercise program

If they start in time, middle-aged people could reduce or reverse their risk of heart failure from years of sedentary living with a 2-year program including high- and moderate-intensity aerobic exercise.
middle aged woman cycling
For sedentary middle-aged people, heart failure risk can be reduced or reversed with a 2-year exercise program.

This was the conclusion of a recent study, led by researchers from the University of Texas Southwestern in Dallas and published in the journal Circulation, that revealed that exercise can reverse damage to aging hearts.

However, the cardiologists who carried out the research emphasize that the exercise must be done at least four to five times per week.

The team had shown in an earlier study that two to three times per week is not enough to protect against heart failure.

"Based on a series of studies performed by our team over the past 5 years," explains senior study author Benjamin D. Levine, who is a professor of internal medicine at the University of Texas Southwestern, "this 'dose' of exercise has become my prescription for life."

He urges people to exercise as "part of their personal hygiene," similar to showering and brushing teeth.

Heart failure

Heart failure is a serious condition in which the body's cells do not receive a sufficient amount of oxygen and nutrients because the heart muscle is too weak to pump enough blood.

This leads to symptoms such as fatigue, shortness of breath, coughing, and difficulty carrying out everyday things such as climbing stairs, walking, and carrying shopping.

Heart failure can be ongoing, or chronic, or it can be acute and develop suddenly. Although it can affect younger people as well, it is one of the most common reasons that people aged 65 and over are admitted to hospital.

Estimates made in 2016 suggest that there are around 5.7 million people living with heart failure in the United States, and only around half of those with the condition survive for longer than 5 years following diagnosis.

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Ejection fraction

The heart has four chambers that pump blood in an organized way: a left and right upper chamber, or atrium, and a left and right lower chamber, or ventricle.

Blood depleted of oxygen comes in from the rest of the body into the right atrium and then goes out to the lungs through the right ventricle. The lungs enrich the blood with oxygen and it travels back to the heart, entering the left atrium. This oxygen-rich blood is then pumped back out to the rest of the body through the left ventricle.

One of the measures that is used to diagnose heart failure is the ejection fraction, or the amount of blood that the left ventricle pumps out with each heartbeat.

Ejection fraction is considered normal if it is in the range of 50–70 percent. This means that 50–70 percent of the total volume of blood in the left ventricle is pumped out each time the heart beats.

An ejection fraction of 40 percent or less might be evidence of heart failure. If it is 41–49 percent, it might indicate borderline heart failure, but not necessarily; other conditions, such as a heart attack, can also reduce ejection fraction.

However, you can still have heart failure if your ejection fraction reading is normal — this is called heart failure with preserved ejection fraction (HFpEF).

In their study paper, the researchers note that HFpEF is often preceded by a loss of heart muscle elasticity. This increased "cardiac stiffness" is also associated with poor physical fitness in middle age.

Stiffened heart muscle

In earlier research, cardiologists from the University of Texas Southwestern had found that middle-aged people who do not exercise and are unfit often have a smaller, stiffened left ventricle that does not pump blood very well.

In contrast, they observed that this is not the case in very fit athletes and even in non-athletes who exercise on 4 to 5 days per week over decades. Instead, their heart chambers remain large and elastic.

In other research, Prof. Levine had found significant improvement in "cardiac compliance," or reduction in heart muscle stiffness, from a year of exercise training in young people, but no such improvement in people aged 65 and over.

Therefore, in the new study, the team wanted to find out whether or not more intense, prolonged aerobic exercise can restore elasticity in stiff heart muscles of middle-aged people whose lives have been largely sedentary.

They recruited 53 participants aged from 45 to 64 who were healthy but largely sedentary — that is, they spent a lot of time sitting and did not exercise very much.

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A program with high-intensity 'four-by-fours'

The investigators randomly assigned the participants to one of two groups — the exercise group or the control group — in which they undertook 2 years of exercise and underwent various tests of heart function.

The control group participants completed 2 years of regular balance training, yoga, and weight training on 3 days per week.

The exercise group participants undertook a 2-year progressive exercise program comprising high- and moderate-intensity aerobic exercises on 4 to 5 days every week.

The progressive exercises included working up to doing "four-by-fours," during which the heart rate is monitored. These exercises consist of four sets of 4-minute exercises wherein the heart works at 95 percent of its maximum heart rate, followed by 3 minutes of "active recovery," during which the heart rate is 60–75 percent of its maximum.

The scientists defined maximum, or peak, heart rate as the level of heart rate measured when the participant was working as hard as they could while still able to complete the 4-minute exercise.

At the end of the study, the results showed that overall, the exercise group became fitter. They increased the amount of energy that they used during exercise — measured as the volume of oxygen uptake — by 18 percent.

There was also a noticeable reduction in cardiac stiffness.

There were no such improvements in the control group. It appears that exercising only two or three times per week was not enough to protect the heart against the effects of aging, says Prof. Devine.

"But," he adds, "committed exercise four to five times a week was almost as effective at preventing sedentary heart aging as the more extreme exercise of elite athletes."

'Exercise 4–5 days per week' to stay healthy

Prof. Devine says that they also found that the time to start exercising is in late middle age, "when the heart still has plasticity."

"I recommend that people do 4 to 5 days a week of committed exercise as part of their goals in preserving their health," he urges.

He suggests a similar program to the one that the participants undertook in the study. This should include:

at least one long session per week lasting around an hour of cycling, walking, tennis, or aerobic dancing one high-intensity aerobic session per week, such as four-by-four interval training one session of strength training per week two or three sessions of moderate-intensity exercise per week

Moderate-intensity exercise is that which still causes you to perspire but is not so intense that you cannot carry on a conversation.

Because the study included mostly white volunteers who wanted to take part and were physically able to do so, the findings may not apply to the population in general or to other racial groups, explain the researchers.

"The key to a healthier heart in middle age is the right dose of exercise, at the right time in life."

Prof. Benjamin D. Levine

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What are the best diets for 2018?

When it comes to New Year's resolutions, eating better is at the top of our list. But which diet plan is the best? A panel of health experts — on behalf of U.S. News & World Report — reveal the top-rated diets for 2018.
Apples with 2018 engraved
U.S. News & World Report reveal the best diets for 2018.

It is estimated that around 45 million people in the United States go on a diet each year, with weight loss being the primary goal.

However, whether you're dieting to lose weight or simply to improve overall health, sticking to a specific eating plan can be challenging. With so many diets to choose from, how can you tell which one will work for you?

U.S. News & World Report put together a panel of health experts every year to evaluate the most popular diets in the U.S.

This year, the experts assessed 40 diets, ranking them from lowest to highest in seven categories, including the best diets for weight loss, diabetes, and heart health. So, we take a look at some of the key results.

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The best diets for weight loss

For the majority of dieters, weight loss is the ultimate goal, but losing weight and keeping it off is far from easy.

Research suggests that approximately 30–35 percent of weight lost from dieting is regained within 1 year. But it is possible to maintain weight loss. It's just a matter of finding the right eating plan.

The U.S. News & World Report panel of experts evaluated 40 popular diets for their effects on both short- and long-term weight loss, noting that some people want to lose weight quickly, while others want to maintain their weight loss for years to come.

The health experts rated Weight Watchers as the best diet on both accounts, scoring 4 out of 5 for short-term weight loss, and 3.5 out of 5 for long-term weight loss.

One of the longest-running, well-known commercial diets, Weight Watchers incorporates a points system, wherein foods and beverages are assigned points based on their nutritional values, and dieters are assigned a daily points allowance.

According to U.S. News & World Report, the expert panel "appreciated the program's support system, which helps dieters keep the pounds off."

The Volumetrics Diet came in at second place for best weight loss diet, scoring 3.8 out of 5 for short-term weight loss and 3.3 out of 5 for long-term weight loss.

Designed by Barbara Rolls, who is a professor of nutrition working at Pennsylvania State University in Centre County, the Volumetrics Diet focuses on putting foods with low-energy density, such as low-fat milk, grains, and non-starchy fruits and vegetables, at the forefront of one's diet, as well as limiting foods with high-energy density.

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The best diets for heart health

Heart disease is the leading cause of death for men and women in the U.S., killing around 610,000 people in the country every year.

A poor diet can increase the risk of heart disease, because eating food high in fat can lead to high blood pressure, high cholesterol levels, and obesity, which are major risk factors for the condition.

But which eating plan is best for a healthy heart? For this category, the health experts analyzed each of the 40 diets and gave them average heart-health ratings.

The Dietary Approaches to Stop Hypertension (DASH) diet took first place in this category.

Developed by the National Heart, Lung, and Blood Institute — a part of the National Institutes of Health (NIH) — the DASH diet is high in fruits, vegetables, whole grains, fish, poultry, and low-fat dairy, but it limits foods high in sugar and saturated and trans fats.

The DASH diet was also ranked the best overall diet.

The Mediterranean diet — which emphasizes consuming fish and seafood at least twice weekly, alongside regular consumption of fruits, vegetables, legumes, and whole grains — took joint second place for best heart-healthy diet, alongside the Ornish diet.

With the Ornish diet, fat is limited to 10 percent of daily calories, and foods are divided into five groups, from the least to most healthful.

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The best diets for diabetes

The Mediterranean diet not only ranked highly for one of the best heart-healthy diets, but it also took the crown for the best diabetes diet, scoring 3.7 out of 5.

It is estimated that around 30.3 million people in the U.S. are living with diabetes, wherein blood glucose levels become too high due to the body's inability to produce or effectively use insulin.

Although eating a healthful diet is important for all of us, people with diabetes need to be extra cautious; skipping meals or eating the wrong foods may lead to problematic highs and lows in blood glucose levels.

According to the panel, "The Mediterranean diet is a great option for preventing or controlling diabetes. [...] Some research has shown that diabetics on a Mediterranean diet may improve their levels of hemoglobin A1C, a measure of blood sugar over time."

The DASH diet makes yet another appearance here, ranking second in the best diabetes diet category, with the experts noting that "its menu looks a lot like widely accepted nutritional guidelines for those with the condition."

Whichever eating plan that you decide is best for you, it's important to note that physical activity is just as important as the foods you eat.

Current guidelines recommend that adults should engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity every week.

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Common anti-smoking drug may raise stroke, heart attack risk

Anyone thinking of giving up smoking as a New Year's resolution should think carefully about what quitting aids they should use to help achieve this — particularly if the results of a new study are anything to go by.
a man breaking a cigarette in half
Researchers say that the anti-smoking drug varenicline may increase the risk of cardiovascular events.

Research published in the American Journal of Respiratory and Critical Care Medicine suggests that a commonly prescribed drug to help those who smoke to quit, called varenicline (brand name Chantix), may raise the risk of having a cardiovascular event.

Cardiovascular events are heart problems such as heart attack, stroke, arrhythmias, or irregular heartbeats, and unstable angina, in which the heart does not receive enough blood and oxygen.

Commenting on the reasons why the researchers conducted the study, lead author Dr. Andrea S. Gershon — an associate professor of medicine at the University of Toronto in Canada, explains, "Previous studies regarding the safety of varenicline have been conflicting and most examined people with relatively similar characteristics and backgrounds in highly controlled settings."

"We wanted to study varenicline among all kinds of people in the real world."

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Cardiovascular event risk increased

The team analyzed the health records of 56,851 people in Ontario, Canada, who had begun using varenicline between 2011 and 2015. Specifically, the researchers looked at the health data for a year prior to and a year following these people taking the drug for 12 weeks.

The analysis showed that, during the studied periods, 4,185 of the people experienced a problem with their hearts that required hospitalization or an emergency room (ER) visit.

There were 3.95 cardiovascular events per 1,000 varenicline users in the study that "could be attributed to the drug." From this, the authors calculated that people prescribed varenicline were 34 percent more likely to be hospitalized or visit the ER due to a heart problem while taking the drug.

However, among people taking varenicline who had not previously had a problem with their heart, there was only a 12 percent increased risk of a cardiovascular event.

Study 'should help make informed decisions'

This type of study is called an observational study and it cannot determine cause and effect. Thus, based on these results, it is not possible to say for sure whether it is varenicline that increased risk of heart problems in these patients. The study can only report that there is a link between taking varenicline and being at increased risk of having a heart problem.

The authors also say that their study was limited by not including information about whether the subjects quit smoking or whether they also took other drugs to help them give up smoking.

Previous studies have found that varenicline "triples the odds" of a person who smokes quitting. The authors behind the new study say that this health benefit needs to be considered when weighing up any potential risks associated with taking the drug.

"Our findings should not be used to suggest people not take varenicline," explains Dr. Gershon. "The findings should be used to help people make an informed decision about whether they should take varenicline based on accurate information about its risks as well as its benefits."

She adds that the results of this study suggest that doctors should monitor patients closely if they are taking varenicline, in order to catch any potential heart problems early.

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