One century ago, the critical role of the Autonomic Nervous System (ANS) in health and disease was prophesized. In 1990, Heart Rate Variability (HRV =Sympathetic-tone [S] + Parasympathetic-tone [P]) was 1st used in clinical cardiology. Emphasizing the reduction in HRV was associated with a poor prognosis in all major cardiovascular illness. In 2000, HRV was included in Sudden Cardiac Death (SCD) risk stratification.

This publication presents the results of studies on biomineralization of “atherosclerotic plaque” forming in the coronary arteries of the heart. Obtained results were compared to studies of an artery unaffected by the process of atherosclerosis. Different types of artery biomineralization were marked, in terms of both mineral and chemical composition. Theories on the formation of crystallization centers where “atherosclerotic plaque” develops were also presented. Results of preliminary in vitro studies on dissolving cholesterol and phosphate mineralization in arteries were presented. The results were interpreted, and conclusions were offered.

Background: Over one billion people have Hypertension (HTN); mortality and morbidity are increasing. The Parasympathetic and Sympathetic (P&S) nervous systems prominently affect the onset and progression of HTN, yet P&S measures are not used to assist in management. Our objective was to determine the feasibility of HTN control using P&S-guided to JNC 8 HTN therapy. Methods: 46 uncontrolled HTN patients were randomized prospectively to P&S-assisted management, adjusting JNC 8 therapy using the ANX 3.0 Autonomic Monitor and adding (r) Alpha Lipoic Acid (Group 1) vs. JNC 8 (Group 2). Results: The two Groups were similar in: 1) age (mean 66 vs. 70 y/o for Groups 1 and 2, respectively; 2) initial resting home Blood Pressure (BP, Group 1 mean=162/90 mmHg vs. Group 2 mean=166/87 mmHg, 3) initial resting office BP Group 1 mean=151/75 mmHg vs. Group 2 mean=155/73 mmHg, and 4) ethnicity. Upon follow-up (mean=8.35 mo.): 1) mean resting home BPs were 145/77 mmHg (Group 1, 74% of patients at JNC 8 goal) vs. 155/83.5 mmHg (Group 2, 30.4% at JNC 8 goal), and 2) mean resting office BPs were 138/71 mmHg (Group 1) vs. 146/65 mmHg (Group 2). At the study’s conclusion, Group 1 Sympathetic tone was lower than that for Group 2 both at rest and upon standing, and Group 1 Parasympathetic tone was higher than that for Group 2 both at rest and upon standing. Conclusion: P&S-assisted HTN therapy is feasible, resulting in improved BP control, through healthier P&S tone on fewer prescription medications.

The posteroseptal accessory pathways often are associated with coronary sinus abnormalities. We report the case of a 15-year-old female, who had palpitations due to Wolff Parkinson White Syndrome and high risk posteroseptal accessory pathway associated with coronary sinus diverticulum. The accessory pathway was successfully ablated using radiofrequency catheter ablation into the diverticulum. These accessory pathways have a very short refractory period and are associated with a risk of sudden cardiac death during atrial fibrillation. Performing a coronary sinus venography and demonstrate diverticulum before ablation, substantially reduces failed ablation.

Chronic orthostatic hypotension (OH), affecting 10 to 30% of the elderly, is associated with falls, and increased morbidity and mortality. Current pharmacologic therapy can cause or worsen hypertension and ?uid retention. (r) a lipoic acid (ALA), a powerful natural antioxidant, avoids those complications and may assist management ofchronic neurogenic orthostatic hypotension (NOH). The purpose of this study is to demonstrate improvement in the symptoms of orthostatic dysfunction with r-ALA, including improved sympathetic (S) and blood pressure (BP) responses to head-up postural change (standing). A cohort of 109 patients with low S tone upon standing was detected using the ANX —3.0, Autonomic Monitor, ANSAR Medical Technologies, Inc., Philadelphia, PA. From the cohort, 29patients demonstrated NOH (change in (?) standing BP = —20/–10 mm Hg) and 60 patients demonstrated orthostatic intolerance (OI, ? standing systolic BP between –6 and –19 mm Hg). These 89 were given ALA orally: either 590 to 788 mg (r) ALA or 867 to 1,500 mg of the less expensive 50 to 50% mixture (r) ALA and inactive (s) ALA. Changes in their S- and P tone, and BPs, were compared with 20 control patients during mean follow-up of 2.28 years. Nineteen of 29 (66%) NOH patients responded with a ? standing BP from –28/–6 mm Hg to 0/þ2 mm Hg. Forty of 60 (67%) of patients with OI responded with a ? standing BP of –9/þ1 mm Hg to þ6/þ2 mm Hg. Although all patients treated with ALA increased S tone, the ? BP depended upon the pretreatment of S tone. Those with the lowest S tone responded the least well. The only treatment side effects were nausea, intolerable in only 5%. Nausea improved with routine gastrointestinal medica- tions. Glucose levels improved in the 28% of patients who were diabetic. Also, resting hypertension improved. Control patients had no ? BP and no increase in S tone. (r)ALA improves S-, and BP, responses to head-up postural change, and thereby NOH/OI, in a majority of patients without causing harmful side effects.