[Was that something?]

My defi has now saved my life several times in the past. On the other hand it has also often given me a shock in situations which from a medical point of view were not absolutely necessary. In particular it is the coping with this shock which brings me to contradict the standard phrase"Don't be afraid you are protected by the defibrillator!". But I am afraid because my quality of life is substantially impaired not only by the high number of shocks suffered. Each new defi shock triggers in me a series of recurring reaction patterns. There is a tendency to observe by me that with every new shock the restoration of a rudimentary emotional equilibrium always takes longer. However, I want to be able to appear in public again without being accompanied every step of the way by the notion of collapsing in public or to twitch like an electric eel. I can't get used to the idea of an existence as a ticking time bomb.

Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

OBJECTIVES

Palpitations can generate feelings of anxiety and decrease quality of life (QoL) due to fear of a cardiac abnormality. Continuous event recorders (CERs) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety. The aim is to determine anxiety and health-related (HR)-QoL and evaluate the burden of carrying a CER in general practice populations.

STUDY DESIGN AND SETTING

Patients (n=244) participated in a randomized trial. One group (n=127) carried a CER during 4 weeks. One hundred and seventeen patients formed the usual care (UC) group. State-Trait Anxiety Inventory (STAI) and the Short Form-36 (SF-36) were administered at study inclusion, after 1, 6 months.

RESULTS

At baseline, patients reported greater anxiety and lower QoL than healthy populations. The CER group had three times more cardiac diagnoses than the UC group. No differences were found between CER group and UC group at 6 weeks. At 6 months, the UC group showed QoL improvement and less anxiety compared to the CER group. Type of diagnosis had influence, but did not fully explain these differences.

CONCLUSION

A CER does not negatively influence anxiety or QoL. Better outcomes in the UC group might be attributed to less cardiac diagnosis and more emphasis on psychological well-being.

Connecting with others in the midst of stressful upheaval on September 11, 2001

This study was originally planned from September tenth through twelfth to assess concurrent use of three real-time data sources during a usual day. When the World Trade Center towers collapsed, the plan expanded to describe 24-hour blood pressure and heart rate, natural environment word use, television viewing/radio listening, and self-reported diary feelings for six undergraduate students in the midst of stressful upheaval. Heart rate, "we" word-use and television viewing/radio listening increased over time. Higher negative and lower positive feelings/emotions occurred during morning hours on September 11. Students connected with others and shared good thoughts. Measurement with real-time data sources was informative.

[Factors influencing policy of examination of patients with stable angina pectoris]

The study was made to evaluate the rate of application of different diagnostic methods in patients with stable effort angina (SEA) treated in the cardiological department; influence of various factors (social, demographic, risk factors, clinical course of ischemic heart disease, associated diseases, internal picture of the disease) on choice by the attending physician of the diagnostic policy. The trial included 49 patients (44 male and 5 female aged 42-73 years, median 63 years) without contraindications to stress tests and without mental diseases. Choice of diagnostic tests (bicycle exercise only, Holter ECG monitoring only, bicycle exercise + ECG monitoring, none of the two) was made by attending physicians. Information on social, demographic, risk factors, clinical features of IHD and associated diseases was obtained in the course of semistructured interview 2-5 days before the discharge from the hospital. The internal picture of the disease was studied by psychometric testing using "Reaction to the Disease Questionnaire". The results were the following: only bicycle exercise, only Holter ECG monitoring were performed in 15 (30.6%) and 19 (38.8%) patients, respectively (95% confidence interval was 17.2-44.0% and 24.6-52.9%, respectively). None of the tests was made in 15 (30.6%) patients (95% confidence interval was 17.2-44.0%). The choice of the physician was significantly influenced by two factors: obesity and internal picture of the disease. The physicians preferred to avoid bicycle exercise conduction in obese patients and patients with hypernosognosia who consider ischemic heart disease a catastrophe and suffer of vital fear and helplessness.

Symptomatic myocardial ischemia and everyday life: implications for clinical use of interactive monitoring

In coronary heart disease (CHD), pathological myocardial ischemic changes do not always occur with the symptom of heart pain. Methodological problems make it difficult to examine the factors that influence silent and symptomatic myocardial ischemia in everyday life. This study uses a computer-assisted monitoring system with an interactive Holter ECG, an actometer, and an electronic diary. Self-report measurements indicate that symptomatic patients tend toward increased neuroticism, whereas asymptomatic patients engage in beneficial and active coping skills more frequently. The results of the monitoring study demonstrate the same degree of ischemia in silent and symptomatic episodes. However, these episodes show differences in certain psychological context variables. Symptomatic episodes are linked to high subjective strain and severe tension. Because angina pectoris is not a reliable warning signal of myocardial ischemia, the use of the interactive monitoring system is recommended for educating CHD patients on how to cope with excessive strain in everyday life.

Influence of social support on cardiac event rate in men with ischaemic type ST segment depression during ambulatory 24-h long-term ECG recording. The prospective population study 'Men born in 1914', Malmö, Sweden

Three-hundred and ninety-four 68-year-old men, representing 60.3% of a cohort of men born in 1914, were examined with ambulatory ECG during 24 h in 1982-83. Ninety-eight (24.8%) men had one or more episodes of ischaemic type ST segment depression (greater than or equal to 0.10 mV), 79 of whom had no history of previous ischaemic heart disease (IHD). During 63 months follow-up, 17 of the 98 suffered a cardiac event, i.e. fatal or non-fatal myocardial infarction (MI) or death due to chronic IHD. The objective of this study was to assess the influence of psychosocial factors, such as social network and social support, on cardiac event rate in men with ischaemic ST segment depression. A higher risk was found among men with little material and informational support (i.e. access to practical services and material resources and access to guidance, advice and information (crude relative risk 4.8; 95% CI; 1.6-14.8) and men with low availability of emotional support (i.e. opportunity for care, encouragement of personal value and feelings of confidence and trust) (crude relative risk 4.3; 95% CI: 1.4-13.3). This association was independent of history of IHD and other known risk factors for myocardial infarction (MI).

Heart rate reactivity to laboratory tasks and ambulatory heart rate in daily life

This study investigated relationships between laboratory task-related heart rate reactivity and ambulatory heart rate responses and variability during daily life. Sixty-two healthy, young men completed one laboratory session consisting of pretask rest, reaction time, video game, and mental arithmetic, and one 24-hour ambulatory heart rate monitoring day. After controlling for ambulatory physical activity, laboratory reactivity measured as basal-to-task increase correlated significantly with ambulatory minimum, mean, and maximum increases from basal during wakefulness and with awake mean square successive difference. After controlling for ambulatory physical activity, laboratory reactivity measured as pretask-to-task increase correlated significantly only with awake mean square successive difference. These results support the hypothesis that individual differences in heart rate responses to laboratory tasks reflect similar differences in heart rate responses and variability during daily life. Results are compared in their degree of support for two theoretical models describing the generalization of individual differences in laboratory reactivity to reactivity during daily life.

Cardiovascular effects of social support in the work place: twenty-four-hour ECG monitoring of men and women

Psychosocial work characteristics, such as work demand, work control, and social support at work, have been shown to be related to the development of coronary heart disease in epidemiological studies. However, the mechanisms which mediate the social and psychological effects on the cardiovascular system are not known. We have studied the direct cardiovascular effects of psychosocial work environment characteristics in 148 working men and women, representing seven different occupational groups (physicians, teachers, musicians, policemen, train engineers, prison personnel, and saw mill workers). Besides standardized measures of work demand, work control, and social support, ambulatory 24-hour monitoring of electrocardiograms in the customary work and home environment was performed. Systolic and diastolic blood pressure were measured as well as other standard physiologic risk factors for coronary heart disease. Mean heart rates were found to be significantly higher in persons reporting low social support at work. This effect was maintained during working hours as well as during leisure time and rest. Of the other related physiologic risk factors, systolic, but not diastolic blood pressure was found to be higher in persons reporting low social support. Smoking, alcohol consumption and relative body mass index were not related to social support at work. Controlling for age, sex and physical strain at work, strengthened the association of low social support with elevated heart rates.