TUESDAY, June 23 (HealthDay News) -- A slight abnormality in an electrocardiogram (EKG), until now thought to be insignificant, can be a warning sign of future cardiac problems and an increased risk of early death, a new study indicates.

Lengthening of what is called the PR interval, the right-hand portion of the jagged blip that records electrical activity as the heart contracts and expands, was associated with a doubled risk of developing the abnormal heartbeat called atrial fibrillation, three times the risk of needing a pacemaker, and one-and-a-half times the risk of early death, according to a report in the June 24 issue of the Journal of the American Medical Association.

"Historically, this has been viewed as benign," said study senior author Dr. Thomas Wang, associate director of heart failure and heart transplantation at Massachusetts General Hospital. "The main message of this paper is that there is an association between this EKG finding and future risk of heart rhythm abnormalities and death."

The PR interval records the time that the electrical activity of the heart moves across the atria, the two upper chambers of the heart that receive blood flowing from the body, into the ventricles, the lower blood-pumping chambers. EKG activity is recorded in thousandths of seconds, and a PR interval is said to be prolonged if it is greater than 200 milliseconds. Such a prolonged PR interval is generally seen in healthy adults, middle-aged and older, with the incidence increasing with age.

Analysis of EKGs of 7,500 participants in the Framingham Heart Study found a prolonged PR interval in 124 of them, and the increased risk was detected in a long-term follow-up.

"It is not known exactly why it happens," Wang said. "It could be scarring and other abnormalities in the electrical system of the heart."

When the abnormality is detected on an EKG, "there is no need to be panicked," Wang said. "But physicians should follow these patients more closely. There is no evidence that such patients should be treated differently, but future studies may show otherwise."

The 200-millisecond threshold was set rather arbitrarily, he said. The degree of risk seen in the study was directly associated with the length of the PR segment prolongation -- the longer the interval, the greater the risk.

And the amount of prolongation was directly associated with age -- the older the person, the longer a prolonged PR interval was likely to be. The association with age is no surprise, Wang said. It's also seen in those with cardiac risk factors such as high blood pressure.

"Lengthening of the PR interval is commonly seen on routine electrocardiograms, more often in older patients, and has been considered a relatively harmless finding," Dr. Susan Cheng, a cardiology fellow at Massachusetts General Hospital and Brigham and Women's Hospital and a member of the research team, said in a statement. "But our results indicate that PR interval prolongation is not as benign as previously thought."

The event rates seen in the study "are pretty low, even over 20 years of follow-up," said Dr. Daniel Lloyd-Jones, associate professor of preventive medicine and cardiology at the Northwestern University Feinberg School of Medicine.

"And from a clinician's point of view, I wouldn't do an electrocardiogram just to look for a prolonged PR interval," Lloyd-Jones said. "But we do electrocardiograms for all sorts of reasons, and it is reasonable to look for prolonged PR intervals because it is a modest marker of risk."

The most intriguing association is with the increased risk of atrial fibrillation, he added. "The atrial fibrillation study is really an interesting one," Lloyd-Jones said.

More information

The American Heart Association   provides an image of an EKG and explains what it means.

TUESDAY, June 23 (HealthDay News) -- A new method of repairing leaking mitral heart valves appears safe, a small study shows.

In the new study, researchers tested a reversible implant called the Percutaneous Transvenous Mitral Annuloplasty (PTMA) system, which is installed via a catheter.

In the heart, the mitral valve controls the flow of blood from the left atrium into the left ventricle (from the upper left chamber into the lower left chamber). A leaking mitral valve causes blood to flow back into the left atrium. This condition can worsen existing heart failure or cause congestive heart failure, according to a news release from the American Heart Association.

Currently, mitral valve repair requires opening the chest and putting the patient on a heart-lung machine. This method increases the risk of heart attack and stroke during surgery, as well as post-surgery risks such as lung problems, irregular heartbeat and infection, the news release noted.

The PTMA system changes the shape of the mitral annulus (a fibrous ring encircling the mitral valve) and prevents blood leakage by allowing the valve's two leaflets to close more tightly.

"Heart failure prevalence is worsening, and we know that the outcome of congestive heart failure is worse when mitral regurgitation is present," study author Dr. Stefan Sack, chief of cardiology, pneumology and intensive care at Schwabing Hospital in Munich, Germany, said in the news release.

The study included 27 patients, nine of whom received PTMA implants. However, four of those implanted devices had to be removed because of complications. While no deaths, heart attacks, stroke or emergency surgeries occurred among the 27 patients, four suffered at least one major adverse event, such as pneumonia, temporary kidney dysfunction, or accumulation of fluid around the heart. The researchers noted that the PTMA system will not be recommended for all patients due to various anatomic and disease-specific causes, and they stressed that more study is needed before the medical impact of the device can be determined.

The study, which appears in the June 23 online issue of Circulation: Cardiovascular Interventions, was funded by Viacor, which makes the PTMA system.

More information

The Society of Thoracic Surgeons has more about mitral valve repair  .

MONDAY, June 22 (HealthDay News) -- Loud music made hearts beat faster and blood pressure go up, while softer passages lowered both heart rates and blood pressure, a new study shows.

It's the latest word on how music affects the cardiovascular system, from researchers at Pavia University in Italy. Their earlier studies found that music with quicker tempos had people breathing faster, with increased heart rate and blood pressure, while slower tempos produced opposite effects.

The findings "increase our understanding of how music could be used in rehabilitative medicine," study author Dr. Luciano Bernardi, a professor of internal medicine at Pavia, said in a statement. The report appears in the June 22 online edition of Circulation.

It's a lesson that already is being put to medical use, said Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center, who has done his own research assessing the cardiovascular effects of music.

"The take-home message from this paper is now being employed at many hospitals, including ours," Miller said. "In the cardiovascular unit, we play music that is very soothing and quiet. On a subconscious level, it produces a decrease in blood pressure and heart rate."

The Italian and Maryland studies differ in important aspects. The Pavia researchers played classical music, including selections from Beethoven's Ninth Symphony, a Bach cantata, and arias from operas by Puccini and Verdi. They also measured the effects on the cardiovascular systems of two dozen volunteers in their mid-20s, half of whom were trained singers, who listened through headphones.

Readings from electrocardiograms and skin monitors showed that a crescendo, a swelling volume of music, was stimulating, while decrescendos had relaxing effects. The effects were modest but noticeable.

"In our studies, volunteers selected music that made them feel good or feel bad," Miller said. "Our belief is that cardiovascular reactions to music are amplified by emotional responses. Our results were not inconsistent with these findings."

The Italian study results were called "fascinating" by Barry A. Franklin, director of cardiac rehabilitation and exercise laboratories at William Beaumont Hospital in Michigan, and a spokesman for the American Heart Association.

"They were able to see modest changes in all variables," Franklin said. "As a clinician, one who works with people with cardiovascular disease, I ask, can we extrapolate or generalize to clinical populations? I see some potentially very exciting research and clinical applications to people with disabilities, where modest changes could have very significant salutatory effects. If they listen to music through headphones while they exercise, can we get better changes on such measures as oxygen flow and blood pressure?"

The people who Franklin works with now exercise on treadmills or stationary bicycles, without music. "I might implement a small pilot program on these subjects, not at rest but while they exercise," he said. "Are their responses altered by simultaneous music? These are debilitated coronary patients in whom small changes might be important."

"One logical next step would be to encourage interdisciplinary research with relevant clinical populations receiving specific music therapy interventions," said Al Bumanis, a spokesman for the America Music Therapy Association. The effects of music therapy are being tested in people in cardiovascular rehabilitation, brain-injured individuals and premature babies, among others, he said.

More information

Information on music therapy research is available from the American Music Therapy Association  .

SUNDAY, June 21 (HealthDay News) -- People having a heart attack for the first time are more likely to survive these days than they would have decades ago, researchers have confirmed.

But now doctors are trying to puzzle out why heart attacks have become more survivable -- what doctors, hospitals and individuals are doing right, and how to keep that trend headed in the right direction.

"There are several possible reasons why heart attacks are not killing as many people," said Dr. Merle Myerson, director of the cardiovascular disease prevention program at St. Luke's-Roosevelt Hospital in New York City. "We need to look at those and determine how we should train the next generation of health-care providers to continue this progress."

Myerson co-authored a study, published this year in Circulation, that reviewed more than 10,000 first heart attacks in four widely separated areas of the United States. Her team found only a marginal decrease in the heart attack death rate, from 5.3 percent in 1987 down to 3.8 percent in 2002.

But when they looked at 20 indicators of severity, they found that heart attacks today are not as damaging and deadly as in years past.

Part of the reason for that, Myerson figures, lies in the quality of care people are receiving at the hospital. There are better medications available, including anti-platelet and anti-coagulant drugs to help clear blockages. There also are better medical procedures available, with more doctors becoming skilled at performing angioplasty and bypass surgeries and implanting stents to open blocked arteries.

But Myerson thinks people also might be having less-severe heart attacks because of treatment they've been getting.

"People are getting better preventive care before they have a heart attack," she said. Doctors are doing a better job diagnosing and treating high blood pressure or high cholesterol, she said, and people are getting better at improving their diet, taking aspirin and exercising.

Yet despite the improvements, there are still ways to make heart attacks even less deadly. For example, Myerson's study found that people were taking as long as or longer to get to the hospital during a heart attack than they did 15 years ago, and the researchers ruled that out as something that might be contributing to the increased survivability.

Dr. Alice Jacobs, director of interventional cardiology at Boston Medical Center, said it was "disappointing" that so many people having heart attack symptoms still take two hours or more to get to a hospital.

"This represents an opportunity to focus on strategies that will reduce pre-hospital delay for patients who experience signs and symptoms of a heart attack," Jacobs said.

Myerson and Jacobs agree that public education is the best way to reduce that delay. "When someone has chest pain or chest discomfort, they need to activate the emergency response system as quickly as possible," Myerson said. "We need to educate people on the impending signs of heart attack.

"It might not be the classic crushing chest pain," she continued. "Sometimes it's acute shortness of breath, it's a left arm or jaw pain. It could be a feeling of indigestion. It's always better to go have it checked out."

Jacobs said that primary care physicians could take a leading role in this. "Patients, particularly those at high risk for an event, and their physicians should discuss the warning signs of a heart attack and a plan for how, when and where to seek medical attention," she said.

Another way to improve heart attack survivability would be to place even more of an emphasis on prevention. Myerson said that could be accomplished by having health insurers step up to cover the cost of preventive measures such as nutritional counseling and gym memberships.

"I think the key to better reimbursement for these is to put them on a par with getting a prescription for medication," she said. "We should be able to write a prescription for nutritional counseling and it would be treated the same as any other prescription."

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart attacks.