The Risk of Fatal Arrhythmias Associated With Sertraline in Patients With Post-myocardial Infarction Depression

Congestive Heart Failure and Arrhythmias Among Hospitalized Patients With Carcinoid Syndrome

Introduction Carcinoid syndrome (CS) represents the most common functional syndrome in patients with neuroendocrine tumors which may be in an advanced tumor state. The pathophysiology of congestive heart failure (CHF) and arrhythmia in CS is poorly understood; however, chronic exposure to excessive circulating serotonin is considered one of the most important factors contributing to increased morbidity and mortality in this population. Despite recognition, international consensus guidelines specifically addressing the diagnosis and management of CHF and arrhythmia in CS are lacking. This study focused on hospitalized patients once they represent more severe disease states requiring intensive management, thereby providing a clearer understanding of factors influencing adverse clinical outcomes.  Methods This retrospective cohort study utilized the Healthcare Cost and Utilization Project National Inpatient Sample to identify predictors of congestive heart failure and arrhythmia in hospitalized CS patients from 2016 to 2018.  Results Initially, a total of 1,859 patients were included. After stratification, 606 patients had CHF and arrhythmia diagnosis with variables analyzed using multivariate logistic regression. Among 606 patients, 360 had CHF with advanced age, male sex, non-Hispanic Black race, Medicare insurance, and prolonged hospital stays, all of which were identified as significant predictors. Similarly, 246 patients diagnosed with arrhythmias were more prevalent in older and male patients and were associated with increased mortality and prolonged hospitalization. Conclusion These results highlight critical patient-related factors influencing mortality in CS patients with CHF and arrhythmia. Strategies aimed at early recognition, including clinical scoring systems, and biomarker assessment, could improve risk stratification and patient outcomes. Our findings underscore the importance of early risk stratification and targeted interventions to mitigate cardiac complications in CS patients. Additionally, incorporating our data into clinical practice has the potential to improve early recognition, promoting timely interventions for CS patients with CFH and arrhythmia. Developing consensus guidelines for managing CS-related cardiac complications, based on these insights, will further standardize care and improve patient outcomes.

Depression and coronary heart disease: mechanisms, interventions, and treatments

Coronary heart disease (CHD), a cardiovascular condition that poses a significant threat to human health and life, has imposed a substantial economic burden on the world. However, in contrast to conventional risk factors, depression emerges as a novel and independent risk factor for CHD. This condition impacts the onset and progression of CHD and elevates the risk of adverse cardiovascular prognostic events in those already affected by CHD. As a result, depression has garnered increasing global attention. Despite this growing awareness, the specific mechanisms through which depression contributes to the development of CHD remain unclear. Existing research suggests that depression primarily influences the inflammatory response, Hypothalamic-pituitary-adrenocortical axis (HPA) and Autonomic Nervous System (ANS) dysfunction, platelet activation, endothelial dysfunction, lipid metabolism disorders, and genetics, all of which play pivotal roles in CHD development. Furthermore, the effectiveness and safety of antidepressant treatment in CHD patients with comorbid depression and its potential impact on the prognosis of CHD patients have become subjects of controversy. Further investigation is warranted to address these unresolved questions.