Nonsustained wide QRS tachycardia during an exercise ECG stress test

The evaluation of a nonsustained wide QRS tachycardia in a life insurance applicant's exercise test presents a special challenge to the medical director because of the unpredictable and potentially lethal nature of these arrhythmias. Ventricular tachycardia accounts for up to 80% of wide QRS tachycardias in unselected populations and more than 95% of cases with a prior myocardial infarction. Malignant ventricular arrhythmias usually occur in the presence of significant structural heart disease. In this setting, ventricular arrhythmias carry a high risk of sudden cardiac death. Less commonly, ventricular tachycardia occurs in hearts that appear normal. In many such cases, however, the heart is in fact not normal, but rather has less visible abnormalities including derangements of cardiac ion channels or structural proteins. In these individuals, ventricular arrhythmias also carry a high risk of sudden cardiac death. There are, however, some ventricular tachycardia syndromes which occur in normal hearts that have a more benign prognosis.     

The challenge of inferior Q waves

The presence of unexpected Q waves in an applicant's electrocardiogram poses a diagnostic dilemma for the medical director. On the one hand, the Q waves may be the remnants of a previously unsuspected "silent" myocardial infarction. Conversely, unexpected Q waves may represent a normal or positional variant, or an important noncoronary type of heart disease. This case study illustrates some of the pitfalls in interpreting applicants' electrocardiograms containing Q waves in the inferior leads.     

Cognitive fitness

Recent neuroscientific research shows that the health of your brain isn't, as experts once thought, just the product of childhood experiences and genetics; it reflects your adult choices and experiences as well. Professors Gilkey and Kilts of Emory University's medical and business schools explain how you can strengthen your brain's anatomy, neural networks, and cognitive abilities, and prevent functions such as memory from deteriorating as you age. The brain's alertness is the result of what the authors call cognitive fitness -a state of optimized ability to reason, remember, learn, plan, and adapt. Certain attitudes, lifestyle choices, and exercises enhance cognitive fitness. Mental workouts are the key. Brain-imaging studies indicate that acquiring expertise in areas as diverse as playing a cello, juggling, speaking a foreign language, and driving a taxicab expands your neural systems and makes them more communicative. In other words, you can alter the physical makeup of your brain by learning new skills. The more cognitively fit you are, the better equipped you are to make decisions, solve problems, and deal with stress and change. Cognitive fitness will help you be more open to new ideas and alternative perspectives. It will give you the capacity to change your behavior and realize your goals. You can delay senescence for years and even enjoy a second career. Drawing from the rapidly expanding body of neuroscience research as well as from well-established research in psychology and other mental health fields, the authors have identified four steps you can take to become cognitively fit: understand how experience makes the brain grow, work hard at play, search for patterns, and seek novelty and innovation. Together these steps capture some of the key opportunities for maintaining an engaged, creative brain.