Congenital heart disease (CHD) patients tend to exercise less than their peers without heart disease. These patients often have exercise hesitancy or are not appropriately encouraged to exercise by their primary cardiologists. Regular exercise in the CHD population has been shown to increase fitness and lessen the incidence of obesity. There are positive psychosocial benefits of regular exercise including decreased mood disorders, improved academic performance, and ultimately improved quality of life. As physical activity is increasingly emphasized, a purposeful approach utilizing cardiopulmonary exercise testing for risk stratification and establishment of a baseline level of fitness is often helpful. Once exercise testing is complete, cardiopulmonary rehabilitation has been shown to improve measures of physical and mental fitness and should be considered in CHD patients in need of assistance with exercise.

The pathology of aortic dilatation is still not fully understood. Increased aortic dimensions are found in patients with hypertension, bicuspid aortic valve or various elastopathies, most commonly with Marfan syndrome. In general, there is only a mild adaptation of the aortic root to physical activity. Although there is no clear evidence that physical activity significantly influences aortic root size, individuals with thoracic aortic disease (TAD) are generally discouraged from engaging in sports activities. Most of them resign from sports and moves toward sedentary life with all of its consequences such as obesity, hypertension, and worsening lipid profile. There are also many sedentary individuals with TAD who had never even started any physical activity for the same reasons. Athletes who survived aortic dissection may also be stressed about regaining sports activity. On the other hand, there is mounting data on the potentially beneficial influence of mild-to-moderate exercise in patients with TAD. Therefore, a design of a comprehensive, monitored, cardiac rehabilitation program for patients with TAD, presented in the current manuscript, is highly warranted. It is based on an available data and should help both doctors and patients with TAD to overcome restrictions regarding the safety of sports activity. If proven successful, it may be used in the future for exercise prescription in patients with TAD in the community setting.

Background: Heart rate variability (HRV), the change in the time intervals between successive pairs of heartbeats, is influenced by interdependent regulatory systems operating over different time scales to adapt to psychological challenges and environmental demands. Low ageadjusted HRV is predictive of upcoming health challenges in healthy people as well as a wide range of diseases in patients and correlates with allcause mortality. 24h HRV recordings are considered the “gold standard” and have greater predictive power on health risk than shortterm recordings. However, it is not typically costeffective or practical to acquire 24h HRV recordings. This has led to the growing use of shortterm recordings in research and clinical assessments. Objective: The first study examined the correlations between a 10min restingstate period, a 1min paced deep breathing protocol, response to handgrip, and 24h HRV measures in 28 healthy individuals. Based on the results of the initial study, the primary study examined the correlations between the 1min paced deep breathing assessment and 24h measures in a general population of 805 individuals. Results: The highest correlations for the HRV variables were with the vagally mediated sources of HRV. The 1min paced deep breathing was positively correlated with 24h highfrequency power (r = 0.60, P < 0.01), root mean square of successive difference (r = 0.62, P < 0.01), lowfrequency (LF) power (r = 0.64, P < 0.01), veryLF power (r = 0.57, P < 0.01) total power (r = 0.42, P < 0.01), standard deviation of normaltonormal interval (SDNN) index (r = 0.59, P < 0.01), and SDNN (r = 0.41, P < 0.01). Conclusions: The findings from this study suggest that the 1min paced deep breathing protocol is an ideal shortterm assessment that can be used in a health risk screening context. When low values are observed, it is recommended that a 24h assessment be conducted.

Background: Previous research on bipolar disorder demonstrates greater-than-expected vascular dysfunction later in the course of illness, proportionate to the cumulative burden of mood symptoms. However, little is known about the effect of acute mood states on vascular function. Here, we examine the relation between vascular function and mood state in individuals with bipolar disorder. Materials and Methods: This prospective study followed forty individuals with bipolar disorder for up to 6 months. The participants were assessed for mood state and vascular function at baseline, 2 weeks, and 6 months. Mood state was determined using the clinician-administered Montgomery–Šsberg Depression Rating Scale and Young Mania Rating Scale. Vascular function was assessed by flow-mediated dilation (FMD) of the brachial artery, forearm vascular resistance (FVR), and arterial stiffness. Results: The participants had a mean age of 30.1 years, and 75% were male. Primary outcome measures such as FMD and nitroglycerine-mediated dilation were not found to have statistically significant associations with depressive or manic symptoms. In unadjusted models, higher manic symptoms were significantly associated with increased FVR nitroprusside-mediated dilation and diastolic blood pressure. In adjusted models, higher depressive symptoms were significantly associated with increases in augmentation index adjusted for heart rate of 75 bpm, and higher manic symptoms remained associated with increases in diastolic blood pressure. Conclusion: FMD may have limited sensitivity as a biomarker for measuring short-term effects of mood state. Long-term prospective studies are needed to clarify the temporal relation between chronic mood symptoms and vascular function in bipolar disorder.

Background: A recent scientific statement from the American Heart Association included ST-segment elevation in the absence of chest pain in the definition of early repolarization (ER). ST-elevation at J-point termination (Jt)-point was not taken into account in previous heritability studies. The relevance of ST-elevation at Jt point (especially in inferior leads) is not evident enough. Our aim was to assess the heritability of ER with ST-elevation in inferior leads among offspring of such patients and patients' follow-up results. Materials and Methods: A prospective study of 16 consecutive patients with inferior ST-elevation at Jt ≥0.1 mV, who have arrived to outpatient department most often due to chest pain not associated with coronary stenosis according to multislice computed tomography angiography, started in 2013. Repeated cardiologist evaluation included their 12 children in 2017. Comparisons were made with 16 age- and gender-matched control patients' rest 12-lead electrocardiograms (ECGs) from the outpatient department of year 2018. Impact of ST-elevation's localization and sex on heritability were assessed by odds ratio (OR) with 95% confidence interval (CI). Results: There were no significant changes of patients' (all men) health and ECGs during follow-up. Eight (66.7%) of their children were ECG-positive versus 1 (6.2%) control patient,P = 0.001. All siblings (from the same father) of 5 (62.5%) ECG-positive children were ECG-positive. Two of the 5 (male and female) underwent detailed evaluation, including cardiac magnetic resonance, without abnormalities. In cases of only inferior father's ST-elevation, OR, 3.00; 95%CI, 0.24-37.7, and for male children, OR, 7.00; 95%CI, 0.400-23, for presenting with this pattern. Conclusions: Constant inferior ST-elevation, even in cases of chest pain, maybe ER, heritable without structural abnormalities. Heritability may be greater for male offspring and in cases of only inferior father's ST-elevation. Longer studies are necessary to confirm that it is benign. We suggest the term “a constant ST-segment elevation (at Jt)” instead of “ST-segment elevation in the absence of chest pain,” with adding that it is possible latent, depending on the heart rate.