Risultati per: Incontinenza urinaria da stress o mista

Circulation, Volume 148, Issue Suppl_1, Page A14154-A14154, November 6, 2023. Myotonic dystrophy type 1 (MD1) is an autosomal dominant neuromuscular disease that can affect skeletal, smooth, and cardiac muscle. Patients often have cardiac involvement such as conduction diseases, ventricular arrhythmia, sudden cardiac death, cardiomyopathy and pulmonary hypertension. We describe a patient with MD1 who suffered recurrent takotsubo cardiomyopathy.Case:A 39-year-old female with history of myotonic dystrophy type 1, takotsubo cardiomyopathy with recovered ejection fraction (EF) 50-55%, gastroparesis and orthostatic hypotension presented with chest pain, nausea, vomiting, dyspnea, and diaphoresis. Initially she was hypotensive and tachycardic. The initial physical exam revealed intact mentation, cachexia, 4/5 muscle strength in all four extremities, lack of JVD, warm and well-perfused extremities without edema. Notable lab findings included a lactic acid of 2.3 mmol/L, high sensitivity troponin of 5000 ng/L and proBNP of 1520 pg/mL. Her initial ECG revealed first degree AV block, left anterior fascicular block, ST elevations in leads V2-V3and T wave inversions in lateral leads. She was admitted for further evaluation. A transthoracic echocardiogram (TTE) showed an EF of 20-25% with apical akinesis and ballooning, with a small apical mural thrombus. She was started on a heparin drip and ischemic work up was deferred given her normal coronary arteries three years prior. Serial TTEs showed improvement of her EF to 54% within two weeks. She was managed with gentle diuresis but she was unable to tolerate guideline directed medical therapy (GDMT) due to symptomatic hypotension. Improvement in her symptoms was noted with the EF recovery.Discussion:There is currently no known association between takotsubo cardiomyopathy and myotonic dystrophy type 1. To our knowledge there is one case in the literature that reported a recurrent takotsubo cardiomyopathy in MD1 patient, and this case is the second. These two cases highlight the possibility that MD1 patients may be at risk of recurrent takotsubo cardiomyopathy. We believe that additional research is needed to investigate a possible causative relationship between the two disease entities.

Circulation, Volume 148, Issue Suppl_1, Page A16823-A16823, November 6, 2023. Background:Adverse childhood experiences (ACEs), defined as abuse, household dysfunction, and neglect before age 18, increase the risk of depressive symptoms and cardiovascular disease (CVD). Fifty-two percent of people have reported 1 ACE with 6.2% reporting 4 or more. People in rural environments experience higher levels of stress and depressive symptoms, but little is known about the relationship of ACEs with stress and depressive symptoms in rural adults with CVD.Aim:To determine the prevalence of ACEs and the mediating effect of perceived stress on the relationship between ACEs and depressive symptoms in a sample of rural adults with CVD.Methods:We used Hayes PROCESS for SPSS (model 4) to determine the mediating effect of perceived stress (Cohen’s Perceived Stress Scale) in the relationship between ACEs (ACE questionnaire), and depressive symptoms (Patient Health Questionnaire-9) controlling for age, gender, financial status, and perceived control.Results:Of 210 rural adults with CVD (mean age 59 ± 13, ACE score 2.4 ± 2.5, and education 14 ± 3, 45.7% female, and 3.3% non-white) 20% reported 1 ACE with 30% reporting 4 or more. Adverse childhood experiences significantly predicted perceived stress (a = .2553,p= .001) and perceived stress significantly predicted depressive symptoms (b = .7419,p< .001). The total (c = .4881,p= .001) and direct effects (c’ = .2987,p= .038) of ACEs on depressive symptoms in this sample were significant, as was the indirect effect of perceived stress (ab = .4144, 95% CI [.2449 - .6231]).Conclusion:The prevalence of ACEs in this sample of rural adults with CVD was 5 times higher than reported in the general population. Perceived stress is a mediator of the relationship between ACEs and depressive symptoms in rural adults with CVD. Interventions to decrease depressive symptoms in rural adults with CVD should include an assessment of ACEs and address management of perceived stress.

Circulation, Volume 148, Issue Suppl_1, Page A12477-A12477, November 6, 2023. Introduction:Renovascular hypertension poses a significant risk for cardiovascular diseases, with endoplasmic reticulum (ER) stress playing a critical role in their development. However, the specific impact of ER stress-induced C/EBP homologous protein (CHOP) expression in endothelial cells on renovascular hypertension-induced cardiovascular complications remains unexplored. This study investigates the effects of disrupting ER stress CHOP in endothelial cells on microvascular dysfunction associated with renovascular hypertension.Hypothesis:We hypothesize that deleting ER stress CHOP in endothelial cells (EC) can mitigate renovascular hypertension-induced vascular endothelial dysfunction.Methods:Eight-week-old male and female mice (CHOPflx/flxand ECCHOP-/-) were divided into eight groups: control groups undergoing a sham operation for 4 weeks and renovascular hypertension groups subjected to 2-kidney-1-clip (2K1C) surgery for 4 weeks. Body weight, blood pressure, running performance, cardiac hypertrophy and fibrosis, lung edema, inflammation, vascular endothelial function, and signaling were assessed.Results:Male and female CHOPflx/flxmice subjected to 2K1C for four weeks exhibited hypertension, cardiac hypertrophy and fibrosis, lung edema, impaired running performance, and endothelium-dependent vascular relaxation dysfunction. In contrast, male and female ECCHOP-/-mice subjected to 2K1C for four weeks were protected against the pathogenesis of renovascular hypertension. Furthermore, mesenteric resistance arteries from CHOPflx/flxmice displayed reduced endothelial nitric oxide synthase (eNOS) phosphorylation, while ECHOP-/-mice showed no such effect.Conclusions:These findings emphasize the significance of targeting ER stress CHOP in endothelial cells of male and female mice to protect against the development and pathogenesis of renovascular hypertension.

Circulation, Volume 148, Issue Suppl_1, Page A16692-A16692, November 6, 2023. Introduction:Adverse childhood experiences, particularly early life stress (ELS), are associated with cardiovascular disease later in life but the underlying mechanisms remain elusive. Parental life experiences can have effects that are transmitted to the offspring suggesting a possible trans-generational transmission of ELS phenotypic traits.Hypothesis:ELS can impair cardiac function in exposed parents and their offspring.Methods:We used an ELS mouse model based on unpredictable separation of mouse pups (F1) from their mother (F0) each day for 3 hours from postnatal day 1 (PND1) to PND14 combined with dams exposure to an additional unpredictable stressor (forced swim in 18°C water for 5 minutes or 20-minute physical restraint in a tube) during separation. Control litters were raised normally. Echocardiography (Vevo 3100, Visualsonics) was performed at 6, 12 and 18 months in exposed animals (F0), their unexposed offspring (F1) and grand-offspring (F2). Both male and female mice were studied. Heart weight/tibia length was used to assess cardiac mass while Masson’s Trichrome was employed to detect fibrosis. Lung congestion was assessed as lung wet/dry weight ratio. Single-cell RNA sequencing (scRNAseq) was performed in MSUS and control hearts. A 6-week environmental enrichment (EE) program (cages containing running wheels, maze) was employed to test the possible rescue of ELS effects in adult males and their offspring.Results:Male and female MSUS mice (F1) displayed a time-dependent deterioration (from 6 to 18 months) of LV hypertrophy, diastolic function, myocardial fibrosis and lung congestion when compared to controls. ScRNAseq revealed dysregulation of genes controlling inflammation and metabolism (Cav1, Fabp4) in cardiomyocyte and endothelial cell clusters. MSUS F1 and F2 females and males had diastolic dysfunction and lung congestion at 12 and 18 months (no change at 6 months). Notably, EE improved diastolic function and lung congestion in MSUS mice.Conclusions:ELS induces heritable cardiac alterations which can be rescued by EE in fathers. These results shed light on the causal role of ELS on heart failure development and potential mitigation strategies.

Circulation, Volume 148, Issue Suppl_1, Page A14137-A14137, November 6, 2023. Stress-induced cardiomyopathy (SCMP) after permanent pacemaker (PPM) implantation is rare. Here, we report an additional case which was initially misdiagnosed as another disease due to atypical symptoms after PPM implantation.Case presentation:A 79-year-old woman with dizziness and dyspnea for one month visited Cardiology Department. She had a history of hypertension, dyslipidemia, diabetes-mellitus and stage IV chronic kidney disease. We confirmed complete atrioventricular block. Left ventricular ejection fraction (LVEF) was normal. PPM implantation was successfully performed without complications. The next day she felt very well with no symptoms. On the second day, she suddenly developed a fever and complained severe left neck pain. She had cough, sputum and general weakness without chest pain. C-reactive protein level increased and systolic blood pressure was decreased. We started antibiotics considering infection. We also checked implantation site, but there were no signs of infection. On the third day, echocardiography showed decreased LVEF (30%), akinesia of apical and medium segments of LV wall with preserved kinetics of basal segments without pericardial effusion (Figure 1). There was no significant stenosis on coronary angiography and we confirmed SCMP. After few days, her blood pressure and symptoms were improved. We prescribed sacubitril-valsartan, bisoprolol and furosemide. At 10 days after implantation, she was discharged with improved symptoms.Conclusion:Our case emphasizes that even successful implantation of PPM without complications can be a potential risk of SCMP. In the absence of typical cardiac symptoms after PPM implantation, a poor general condition may also be considered as a sign of SCMP. Therefore, it is necessary to monitor the patient for at least three more days after PPM implantation.

Circulation, Volume 148, Issue Suppl_1, Page A12142-A12142, November 6, 2023. Usual clinical testing rarely reveals persisting cardiac abnormalities in patients after hospitalization for Covid-19. Such testing may overlook residual changes responsible for increased adverse cardiac events seen post-discharge. To further elucidate patients’ long-term status, we performed exercise stress echocardiography (ESE) in 15 patients age 30-63 without myocarditis 3 to 31 months after hospital discharge. We compared patient outcomes to published data in healthy controls (HC) exercising according to the same protocol. Patients’ treadmill exercise (Bruce protocol), averaging 8.2 min, was halted by dyspnea or fatigue. Baselines before stress averaged the same in recovering patients (RP) and HC except for heart rate (HR): 81±13 bpm for RP and 63±8 for HC (p

Circulation, Volume 148, Issue Suppl_1, Page A17390-A17390, November 6, 2023. Introduction:Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID-19 pandemic (2020-2021) had an unknown impact on this intervention on perceived stress. The aim of this study was to determine whether the COVID-19 pandemic moderated the effects of RICHH on perceived stress for rural caregivers.Methods:This was a randomized controlled trial of a CVD risk reduction intervention that promoted self-care. Caregivers were randomized to usual care or the RICHH intervention. Data were collected at baseline, 4 and 12 months. Participants were grouped into two groups by COVID-19 timing: 1) the pre-pandemic group (n=145) completed the study before the pandemic; and 2) the pandemic group (n=114) completed the study during the pandemic. A piecewise linear mixed-effect model was used to evaluate the impact of the intervention and COVID-19 timing on perceived stress (Cohen’s Perceived Stress Scale).Results:The effect of the intervention on perceived stress in 259 participants (mean age = 55 ± 13 years, 78% female, 95% white, and 73 % married) was significant in the pandemic group (β= -.59, SE = .14, P < .001) but not in the pre-pandemic group (β = -.10, SE = .13, P = .45 [Figure1). The differences in perceived stress changes between the pre-COVID and during-COVID groups was significant, indicating a moderating effect of COVID (β = -.50, SE = .19, P = .009).Conclusion:The RICHH intervention helped to mitigate stress during the COVID-19 pandemic among those in the intervention group at the 4 months, however this effect was not sustained at 12 months. It remains unclear if the reduction in perceived stress during the pandemic was due to participation in the intervention or weekly contact with an interventionist.

Circulation, Volume 148, Issue Suppl_1, Page A16706-A16706, November 6, 2023. Introduction:Coronary vascular dysfunction (CVaD) is associated with major adverse outcomes, recurrent chest pain, and can be triggered by mental stress.Hypothesis:We hypothesized that women with CVaD have heightened emotional response and attenuated recovery compared to reference control (RC) women.Methods:Women diagnosed with CVaD (cases, n=57, age: 57±1 years) by abnormal adenosine or acetylcholine response during invasive coronary function testing were enrolled in Cardiac Autonomic Nervous System Study and compared to age-matched, asymptomatic RCs women (n=25, age: 56±3 years), free of cardiac or risk factor history. All underwent two 4-minute standardized mental stress tests – anger recall and mental arithmetic – followed by 15 minutes of recovery. Emotional arousal (tension, anxious, depressed) and chest pain were assessed via self-reported Likert scale at baseline, after stress, and after recovery. The difference between post-stress or post-recovery and baseline scores was used to evaluate stress provocation and recovery. Increased differences indicate more provocation or recovery attenuation. We utilized multivariate models adjusted for anti-anginal medications, statins, and aspirin or traditional cardiovascular risk factors and chest pain to assess associations between CVaD and chest pain or emotional arousal, respectively.Results:The two groups did not differ in hemodynamic response to mental stress (p >0.05). In multivariate models, CVaD status was associated with more stress-provoked chest pain (β 1.24 [0.1, 2.4], p=0.03) and more attenuated chest pain recovery (β 1.5 [0.6, 2.3], p=0.001) than RC. Similarly, after adjustment, cases were associated with more stress-provoked anxiety (β 1.2 [0.2, 2.2], p=0.02) and tension (β 1.2 [0.001, 2.4], p=0.05) while having more attenuated recovery of anxiety (β 1.1 [0.1, 2.0], p=0.02) and tension (β 1.1 [0.2, 2.0], p=0.02) compared to RC. There were no differences in feelings of depression between the two groups.Conclusions:Response to mental stress is heightened with attenuated recovery in women with CVaD. An improved understanding of mechanisms in stress response and CVaD is needed for potential therapeutic targets that may improve angina and quality of life.

Circulation, Volume 148, Issue Suppl_1, Page A18616-A18616, November 6, 2023. Introduction:Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy or “broken heart syndrome,” is a rare condition that predominantly affects postmenopausal women. The etiology of TCM is not entirely understood, but it is thought to be related to catecholamine-induced myocardial stunning. Clinical presentation typically mimics acute coronary syndrome. Left ventricular outflow tract obstruction (LVOTO) is an uncommon complication of TCM, with only a few cases reported in the literature.Case Presentation:A 78-year-old lady presented with chest pain that started a week ago. It was associated with exertion and resolved with rest. It was located substernally, pressure-like, and was 7/10 in intensity. EKG revealed diffuse inferolateral ST segment depression. Her initial troponin was 0.2 which climbed up to 5. She was diagnosed with NSTEMI and was started on IV heparin. Cardiac catheterization revealed no significant CAD. Echocardiography revealed wall motion abnormalities suggestive of Takutsubo Cardiomyopathy (apical ballooning syndrome) with apical hypokinesis and hypercontractile basal segment of the left ventricle. She also had LVOTO with a peak and mean gradient of 80 and 48 mmHg respectively. Her LVEF was calculated to be 40 %. There also was accompanied systolic anterior motion of the mitral valve leaflet. Given the above findings, she was started on a beta blocker along with an angiotensin receptor blocker. Patient’s chest pain resolved with this and was discharged in a stable condition on day three. Follow up appointment at the clinic showed complete resolution of her HOCM and LVOTO.Discussion:The key to managing patients with TCM is to identify LVOTO early, and avoid inotropes and vasodilators. Beta blockers are seen as the cornerstone of treatment. Fortunately, this is a self-resolving condition and the prognosis is excellent with resolution of echocardiographic abnormalities and symptoms within a few weeks’ time.

Le donne di mezza età a rischio maggiore aterosclerosi carotidea

Various forms of psychological intervention have proven to be powerful in the treatment of posttraumatic stress disorder (PTSD). Two of the best-studied interventions, prolonged exposure (PE) and cognitive processing therapy (CPT), have strong support for their efficacy and have been extensively disseminated by Veterans Affairs, while a third intervention, eye movement desensitization and reprocessing, also is efficacious and widely practiced. Each of these treatments requires considerable therapist training, typically involves numerous sessions over several months, and is variably tolerated by patients. These limitations of extant psychotherapies for PTSD have hastened the demand for therapies that might provide alternatives that are less burdensome for therapists and patients.

This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.

Introduction
Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.
Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).
Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection.

Methods and analysis
The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).
The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique.

Ethics and dissemination
Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.
Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022.

Trial registration number
NCT05364203.

Giorlandino, ‘obesità dopo il parto è una sfida clinica e di salute pubblica’

Objectives
The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

Design
A longitudinal study with follow-ups from 42 days to 6 months after delivery.

Settings and participants
A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

Methods
Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

Results
Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p

Higher use was not associated with improved outcomes.