The needs to counsel patients with chronic medical conditions to understand their risk of driving or their potential legal eligibility to drive has become more and more important because patients are deterring from retirement due to social reasons and older drivers with higher prevalence of chronic illness will continue to drive while more younger patients at their working age developed chronic illness. Nonetheless, counseling would not be effective without a good understanding of the current legal requirements on medical fitness to drive although it has remained unchanged for the past few decades. The law statement is simple yet it is too broad and not specific enough to be applied in medical setting. To enhance patients' understanding of their own risk of driving with respect to their medical condition and to provide instruction on what to do, a return-to-drive counseling service has been developed in Tuen Mun Hospital for the past few years. In this workshop, the current legal requirement in Hong Kong will be explored and the approach on this issue in our daily practice and common challenges will be discussed. number of arrhythmia such as atrial fibrillation are known to include anxiety as a symptomatic manifestation. There is difficulty in making this diagnosis and some aspects should be considered. This includes the presence of a clear temporal association between the cardiovascular disorder and the anxiety symptoms, the presence of symptoms that are atypical of a primary anxiety disorder and the presence of evidence in the literature that the cardiovascular disorder causes anxiety. The anxiety or panic attacks must not be better explained by a primary anxiety disorder. The assessment could be performed using Cardiac Anxiety Questionnaire which is an 18-item self-report inventory that measures anxiety related to cardiac symptoms. As cardiac anxiety causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and anxiety exerts negative acute and long-term effects on the outcome of cardiac rehabilitation, medical treatment of cardiac anxiety is indicated. This involves a combination of pharmacological and psychological treatment. Regarding the pharmacological treatment of cardiac anxiety, the main categories of medications used are antidepressants, beta-blockers and benzodiazepines. Antidepressants include selective serotonin reuptake inhibitors and newer atypical antidepressants. Although beta-blockers do not affect the emotional symptoms of anxiety, they can relieve the physical symptoms of anxiety such as increased heart rate and trembling voice. Benzodiazepines provide relief of acute anxiety. They have physiological effects such as immediate lowering of the catecholamine level and decreasing coronary vascular resistance. Apart from pharmacological treatment, psychological treatment is also useful for cardiac anxiety. Psychotherapy such as cognitive behavioural therapy is a form of intervention which has a positive effect on the quality of life of patients with cardiac anxiety. There was evidence that mindfulness-based stress reduction program was useful. There the flight, evaluating the effect made by the aviation factors in aggravating the symptoms of the disease, introducing the flight limitations for the cabin crew and sick travelers and evaluating the function of automatic external defibrillation are the subjects that will be analyzed in this article. The and frail and cardiac patients need to start at with 1 set of 10-15 reps as the adaptation is The patients are instructed to raise weights with slow, controlled movements to full extension, exhale during exertion phase of the lift, avoid straining and Valsalva maneuver, minimize rest periods to increase endurance, stop exercise upon alarming signs or symptoms and avoid tight gripping of the weight handles. In this workshop we show all kinds of these exercises in practical type for cardiac patients. As a result all kinds of physical activities are recommended for cardiac patients in scientific and correct manners. Acute coronary syndrome (ACS) is usually caused by atherosclerotic plaque rupture resulting in thrombosis of coronary artery and myocardial necrosis. Lipid management is pivotal in primary and secondary prevention of ACS and statins have been shown to improve clinical outcome. However, despite modern revascularization technology, potent antiplatelet agents, neurohormonal modulation and statins, long term major cardiovascular event rate is still high. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a chaperone to destroy low density lipoprotein (LDL) receptor. A loss-of-function mutation of PCSK9 increases LDL receptors and markedly lower circulating LDL level translating into very low incidence of atherosclerosis. Numerous research have been performed in PCSK9 inhibition and monoclonal antibody to PCSK9 emerges to be an effective mean to reduce LDL level. Two PCSK9 inhibitors Alirocumab and Evolocumab approved for treatment in ACS patients who additional LDL lowering to reduce future cardiovascular risks. In multiple studies, they reduced LDL by 50- 70% with or without background treatment of statins. They also decreased coronary plaque volume and were effective in patients with familial hypercholesterolemia and statin intolerance. In clinical outcome studies involved more than 40,000 high cardiovascular risk individuals (including ACS), both agents reduced long term cardiovascular events. Treatment related adverse events were minimal. In the journey of lipid lowering therapy research, numerous studies confirmed the 'lower is better' theory of relationship between LDL and cardiovascular events. PCSK9 inhibitors emerge to be strong weapons for ACS secondary prevention. Nevertheless, as treatment cost is relatively high and hence identifying patients potentially derive maximum benefit becomes essential. Clinical risk factors (e.g. TRS2P score), baseline LDL and pathogenic genetic mutations are important for consideration. Future research may identify other potential factors such as biomarkers, proteomics, genomics etc for of PCSK9 inhibitors if not all patients with artery talk will focus on: - The importance of physical activity and exercise - Overview of current technology (with emphasis on wearables) in exercise promotion - Review of evidence (reliability, validity, effectiveness) Background: Empowering patients with coronary heart disease (CHD) to perform adequate physical activity is a main goal of cardiac rehabilitation (CR) programme. Self-efficacy, one's belief in his or her ability to perform and succeed in a particular situation, could influence the self-reported physical activity level. This study aims to examine the association between the exercise self-efficacy, objectively assessed physical level and exercise capacity of CHD patients participating in a CR programme. Method: We recruited 110 Chinese adults (age: 63.7 ± 10.4 years old) with clinical diagnosis of CHD and participating in a CR programme. The self- efficacy for exercise of participants was measured by the Cardiac Exercise Self-efficacy Scale. The physical activity level and exercise capacity was measured by an activity tracker and 10-metre incremental shuttle walk test, respectively. Multiple regression models were used to adjust covariates of physical activity level and exercise capacity. Results: The CHD patients walked a mean 9893 ± 4476 steps per day, in which 60.3% of them walked ≥ 7500 steps/day. Higher exercise self-efficacy was significantly associated with higher odds of adequate walking activity (OR = 2.30, 95% CI: 1.05 - 5.02) after adjusting for age, sex and body mass index. The CHD patients also completed a mean 512.0 ± 175.3 meters in the incremental shuttle walk test. After adjusting for age, sex, physical activity level and body mass index, the exercise self-efficacy was significantly associated with the exercise capacity of CHD patients (beta = 0.24, p<0.05). Exercise capacity is limited in patients with heart failure (HF). Limited exercise capacity is associated with disease severity and symptom, which is the NYHA functional class itself. Furthermore, it is an independent predictor for the prognosis of patients with HF. That is, the lower the peak oxygen uptake, the poorer the prognosis has been shown. Several factors including cardiac function pulmonary function, central hemodynamics, pulmonary circulation, and peripheral skeletal muscle function are associated with oxygen uptake. On the other hand, given that the pathology of HF leads to systemic organ damage, it is clear that oxygen uptake is a very good indicator of the condition of HF. Especially, skeletal muscle abnormalities rather than other factors play an important role on the reduced oxygen uptake. Various skeletal muscle abnormalities including abnormal energy metabolism, transition of myofibers from type I to type II, mitochondrial dysfunction, reduction in muscular strength, and muscle atrophy have been reported in patients with HF. However, the mechanism by which these abnormalities are caused has not been clarified. In this session, I will outline the importance and mechanism of skeletal muscle abnormalities in HF. It is well known that exercise tolerance is a prognostic factor of patients with heart failure (HF), and skeletal muscle indices are associated with exercise tolerance besides cardiac and pulmonary functions. Chronic HF is often accompanied with substantial skeletal muscle weakness, caused by immune activation, neuro-hormonal factors, decreased anabolic hormone activities, low physical activity, malnutrition and sarcopenia. Nutrition status in acute heart failure patients is more easily aggravated, compared with that in chronic heart failure patients. Nutrition therapy combined with cardiac rehabilitation could be more effective than nutrition therapy alone, and it should be carried out by a multidiscip

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OBJECTIVES Coronary stenting is associated with a high incidence of restenosis in patients with diabetes mellitus. Recent data suggest that diabetic patients treated with abciximab have a lower rate of target vessel revascularization (TVR). We sought to investigate whether abciximab can reduce in-stent restenosis after coronary stenting in diabetic patients. METHODS In this prospective double-blind trial, we randomly assigned 254 patients with type 2 diabetes mellitus undergoing nonurgent coronary stenting to receive abciximab with an initial heparin bolus of 50 U/kg (n = 128) or placebo with an initial heparin bolus of 70 U/kg (n = 126). All patients received aspirin and clopidogrel before the procedure. The primary endpoint was angiographic restenosis by quantitative coronary angiography at 6 months. The secondary endpoint was death, myocardial infarction (MI), or target lesion revascularization (TLR) at 6 months. RESULTS The clinical, angiographic, and procedural characteristics were matched between the 2 groups. Angiographic follow-up was completed in 226 patients (90%). Angiographic restenosis occurred in 29.1% of the abciximab group, and 24% of the placebo group (p = 0.30). The rates of the secondary endpoint were similar between the 2 groups (23.4% in the abciximab group versus 22.2% in the placebo group; p = 0.88). TLR was performed on 36 (18.4%) lesions in 29 (23.4%) patients of the abciximab group, and 26 (13.6%) lesions in 23 (18.3%) patients of the placebo groups, respectively (p = 0.21 and 0.35, respectively). CONCLUSIONS Abciximab does not reduce angiographic restenosis or TLR in type 2 diabetic patients undergoing nonurgent coronary stenting.

This article reviews the recent major developments in the field of rate adaptive pacing. Including, the improved instrumentation of existing sensors, the use of multiple sensors to enhance sensor specificity or sensitivity, and the automation of sensor calibration. The physiologic benefits and programming of rate adaptive pacing are reviewed.