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      High Altitude Arrhythmias

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          Abstract

          Objective: To investigate the cause and nature of palpitations occurring at high altitude. Methods: Implantable loop recorders were inserted subcutaneously in the left pectoral region of 9 healthy male volunteers. Subjects flew to Kathmandu (1,250 m) and then Lukla (2,800 m) before immediately commencing an identical ascent and descent profile to high altitude. The loop recorders were activated with any episode of palpitations and during exercise, rest and sleep. Arterial oxygen saturation was assessed concomitant with device activation. Results: Above 5,000 m all subjects reported palpitations during exercise. All subjects demonstrated sinus tachycardia and marked sinus arrhythmia; one subject demonstrated atrial flutter; one subject had non-conducted p waves, and a further subject had marked ST segment depression. Conclusions: Significant arrhythmias occur at high altitude. In view of the increased risk of sudden cardiac death at high altitude, and considering that the elderly account for 15% of the 100 million visitors to altitude annually, further investigation is required.

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          Most cited references 13

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          Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study.

          The underlying mechanisms and neuroanatomical correlates of theory of mind (ToM), the ability to make inferences on others' mental states, remain largely unknown. While numerous studies have implicated the ventromedial (VM) frontal lobes in ToM, recent findings have questioned the role of the prefrontal cortex. We designed two novel tasks that examined the hypothesis that affective ToM processing is distinct from that related to cognitive ToM and depends in part on separate anatomical substrates. The performance of patients with localized lesions in the VM was compared to responses of patients with dorsolateral lesions, mixed prefrontal lesions, and posterior lesions and with healthy control subjects. While controls made fewer errors on affective as compared to cognitive ToM conditions in both tasks, patients with VM damage showed a different trend. Furthermore, while affective ToM was mostly impaired by VM damage, cognitive ToM was mostly impaired by extensive prefrontal damage, suggesting that cognitive and affective mentalizing abilities are partly dissociable. By introducing the concept of 'affective ToM' to the study of social cognition, these results offer new insights into the mediating role of the VM in the affective facets of social behavior that may underlie the behavioral disturbances observed in these patients.
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            What Are You Feeling? Using Functional Magnetic Resonance Imaging to Assess the Modulation of Sensory and Affective Responses during Empathy for Pain

            Background Recent neuroscientific evidence suggests that empathy for pain activates similar neural representations as the first-hand experience of pain. However, empathy is not an all-or-none phenomenon but it is strongly malleable by interpersonal, intrapersonal and situational factors. This study investigated how two different top-down mechanisms – attention and cognitive appraisal - affect the perception of pain in others and its neural underpinnings. Methodology/Principal Findings We performed one behavioral (N = 23) and two functional magnetic resonance imaging (fMRI) experiments (N = 18). In the first fMRI experiment, participants watched photographs displaying painful needle injections, and were asked to evaluate either the sensory or the affective consequences of these injections. The role of cognitive appraisal was examined in a second fMRI experiment in which participants watched injections that only appeared to be painful as they were performed on an anesthetized hand. Perceiving pain in others activated the affective-motivational and sensory-discriminative aspects of the pain matrix. Activity in the somatosensory areas was specifically enhanced when participants evaluated the sensory consequences of pain. Perceiving non-painful injections into the anesthetized hand also led to signal increase in large parts of the pain matrix, suggesting an automatic affective response to the putatively harmful stimulus. This automatic response was modulated by areas involved in self/other distinction and valence attribution – including the temporo-parietal junction and medial orbitofrontal cortex. Conclusions/Significance Our findings elucidate how top-down control mechanisms and automatic bottom-up processes interact to generate and modulate other-oriented responses. They stress the role of cognitive processing in empathy, and shed light on how emotional and bodily awareness enable us to evaluate the sensory and affective states of others.
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              Gender differences in the mu rhythm during empathy for pain: an electroencephalographic study.

              Our recent magnetoencephalography study demonstrated that the mu rhythm can reliably indicate sensorimotor resonance during the perception of pain in others (Cheng, Y., Yang, C.Y., Lin, C.P., Lee, P.L., Decety, J., 2008b. The perception of pain in others suppresses somatosensory oscillations: a magnetoencephalography study. NeuroImage 40, 1833-1840). The current study further investigated the neurophysiological mechanism underpinning empathy for pain in relation with gender through the measurements of the electroencephalographic mu suppression in healthy female (N=16) and male (N=16) adults during the observation of body parts in painful or no-painful situations. The results demonstrate that both genders exhibited sensorimotor activation related to pain empathy. However, females showed stronger mu suppressions than males when watching the painful as well as the non-painful situations. Further, the mu suppression for pain empathy was positively correlated with the scoring on the personal distress subscale of the interpersonal reactivity index only in the female participants. The present findings suggest the existence of a gender difference in pain empathy in relation with the sensorimotor cortex resonance. The mu rhythm can be a potential biomarker of empathic mimicry.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2008
                October 2008
                23 April 2008
                : 111
                : 4
                : 239-246
                Affiliations
                aSchool of Clinical Medical Sciences, University of Newcastle and Royal Army Medical Corps, Army Medical Services, Newcastle upon Tyne, bSouthampton University Hospital, Southampton, and cCentre for Cardiovascular Genetics, University College London, London, UK
                Article
                127445 Cardiology 2008;111:239–246
                10.1159/000127445
                18434732
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 6, Tables: 1, References: 23, Pages: 8
                Categories
                Original Research

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