The prognostic influence of many risk factors, such as hypertension or hypercholesterolemia, in several cardiovascular disorders has been widely proved. It has appeared, growing knowledge about the role of resting s (HR) and its association to other known cardiovascular risk factors. Resting HR takes an important place in cardiovascular physiopathology. Oxygen supply-demand balance, endothelial function, atherosclerosis development and vascular stress leading to plaque disruption are all directly influenced by increasing resting HR. Information obtained from recent trials, specially performed in heart failure patients, demonstrate the great benefits of decreasing resting HR. In this field, every increase in baseline beats per minute (bpm) is associated to increasing mortality rates and elevated risk of adverse cardiovascular outcomes. This shows the role, not only as risk marker but also as important risk factor, in cardiac diseases. Furthermore there is no optimal and homogeneous cut-off value of baseline HR for the different cardiovascular disorders. Despite of this, it seems desirable to maintain patient HR as lower as possible, below 70 bpm, in order to minimize risk of adverse events. So lowering baseline heart rate is a target to achieve,to improve prognosis.

We describe a woman who presented in her third trimester of pregnancy with progressive dyspnea. Physical exam showed a hyperdynamic right ventricular impulse and a widely split fixed S2. Echocardiography showed moderately enlarged right sided chambers and linear insertion of the atrioventricular valves. This echocardiographic finding is typically consistent with a partial atrioventricular septal defect (AVSD). However further imaging with cardiac MRI revealed a large ostium secundum atrial septal defect (ASD), with a pulmonary to-systemic flow ratio of 2.4. This appears to be the first documented case in the literature of a secundum ASD presenting with linear insertion of the atrioventricular valves. In conclusion, we describe an unusual case of secundum atrial septal defect in pregnancy presenting with dyspnea and linear insertion of the atrioventricular valves.

Acute Decompensated Heart Failure (ADHF) is one of the most common causes of hospital admission and is associated with poor outcome. More than often, currently available treatments including high-dose loop diuretics don’t provide patients with adequate decongestion due to either worsening renal function or diuretic resistance resulting in high readmission rate and early mortality. Moreover, the recent trials studying newer strategies such as the mechanical ultrafiltration, low dose dopamine or nesiritide have demonstrated no benefit over diuretic regimens in terms of volume removal or elevation of creatinine leaving no further choice for management of diuretic resistant ADHF patients. Patients with heart failure share the same pathophysiology of decreased effective arterial blood volume as patients with cirrhosis; because of splanchnic vasodilatation in cirrhosis and decreased cardiac output in heart failure with resultant stimulation of the renin-angiotensin-aldosterone system. Hyperaldosteronism plays a major role in the pathogenesis of ascites and contributes to resistance to loop diuretics. Therefore, the use of high doses of aldosterone antagonist (spironolactone up to 400 mg/day) is the main therapy to produce a negative sodium balance in cirrhotic patients with ascites. However, similar approach has not been adopted in ADHF patients to achieve negative sodium balance. This article reviews the pathophysiology of worsening renal function and diuretic resistance associated with the use of loop diuretics, mechanical ultrafiltration and other vasodilator therapies in ADHF patients and identifies the potential role of an old therapy, i.e. aldosterone antagonists in the high dose for management of these patients.

The short QT syndrome (SQTS) is a cardiac channelopathy associated with a propensity for cardiac arrhythmias in persons with a structurally normal heart [1-3]. Although victims of sudden cardiac death (SCD) tend to fit in certain categories, the cause of SCD may be sometimes completely unpredictable. Herein, we present the case of a young man with a history of succesfully resuscitated SCD and recurrent syncopal attacks with unknown etiology. A 20-year-old man presented to our cardiology out-patient clinic due to several episodes of transient loss of conciousness not associated with emotional stress or exercise during the last 6 months. The patient was afebrile with blood pressure of 110/70 mmHg, heart rate of 60 bpm, and oxygen saturation of 99% by pulse oximetry. Cardiac examination showed a regular heart rhythm with no murmurs. The rest of the physical examination was unremarkable. Electrocardiography (ECG) demonstrated a sinus rhythm, 55 bpm; PR interval: 132 ms; QRS duration: 85 ms; QTc: 313 ms (Bazzet formula); and J-point to T-wave-peak interval: 140 ms (Figure 1).

Cardiovascular Disease (CVD) is now the most common cause of death in the 20th century and driven by industrialization, urbanization and associated lifestyle changes, it is taking place in every part of the world among all races, ethnic groups and cultures. In India CVD has increased in an alarming rate and has accounted for 32% deaths in 2000. According to the World Health Organization (WHO) 60% of the world’s cardiac patients will be Indian by 2010 [1]. Ischemic Heart Disease (IHD), to a large extent, is preventable. This is evident from studies in some countries where incidence of heart attacks and strokes has come down by over 25% by an aggressive approach on preventive aspects like avoiding smoking, doing more physical exercise, control over eating (especially fats, cholesterol rich foods and refined sugars), mental relaxation and effective control of high blood pressure, preferably by non-drug measures [2] Nutrients as dietary supplementation like vegetables and fruits decreasing the risk of development of various diseases including cardiovascular disease (CVD) [3]. Huge amount of antioxidants present in the vegetables and fruits may protect the myocardium either by inhibition of development of atherosclerosis or by inhibiting the oxidation process of Low Density Lipoprotein (LDL) [4]. Polyphenolic compounds are majorly present in the fruits, vegetable and other plant sources like oils with possible cardio protective and other medicinal properties [5]. Various researchers proved the antioxidant, antithrombotic effect of flavonoids and also inhibiting the cellular oxidation process [6-8]. Apples, Onions, tea, various cooking oils, broccoli and red wine are rich in flavonoids and most of the population in the western countries like USA, Europe and North America including these in their diet, but effect of these nutrients in CVD not well documented [5].