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Holiday Inn Express Hotel & Suites SeaTac, SeaTac
- Free hot/cold buffet breakfast, free WiFi, and free parking
Main amenities
- 171 guestrooms
- Free airport shuttle
- Health club
- Business center
- 24-hour front desk
- Air conditioning
- Front desk safe
- Laundry service
- Meeting room
- Multilingual staff
- Free newspapers in the lobby
For families
- Microwave
- Refrigerator
- Premium TV channels
- Laundry facilities
- Iron/ironing board
- Hair dryer
What's around
- Seattle-Tacoma International Airport
- Angle Lake Park (0.2 mi / 0.3 km)
- Silver Dollar Casino (0.3 mi / 0.5 km)
- Tyee Valley Golf Course (1.3 mi / 2.1 km)
- Highline Community College (3.1 mi / 5 km)
- Des Moines Marina (3.4 mi / 5.4 km)
Holiday Inn Express Hotel & Suites SeaTac, SeaTac
Hotel Info: 855-239-9222from $179
- Group Rate
- One King Bed, Non-Smoking, Roll In Shower
- One Queen Bed, Smoking, Accessible
- Suite, 2 Queen Beds, Non Smoking
- Room, 1 Queen Bed, Non Smoking
- Suite, Accessible, Non Smoking
- Room, Accessible
- Room, 1 King Bed
- Suite, Accessible, Non Smoking
- Room, Accessible
- Room, 1 King Bed
- Room, 1 King Bed, Non Smoking
- Standard Room
- One Queen Bed, Non-Smoking, Accessible
- Suite, 1 King Bed, Non Smoking
- Room, 2 Queen Beds, Non Smoking
- One Queen Bed, Smoking
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 171 rooms
- This hotel is arranged over 5 floors
- Check-in time starts at 3 PM
- Check-out time is noon
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Pets allowed *
- Free WiFi in public areas
- Free WiFi in rooms
- Free airport shuttle (available 24 hours)
- Free self parking
- Free area shuttle
Nearby Two Star SeaTac hotels
In the hotel
- Free hot/cold buffet breakfast daily
- Health club
- Golfing nearby
- Business center
- One meeting room
- 24-hour front desk
- Dry cleaning/laundry service
- Laundry facilities
- Free newspapers in lobby
- Multilingual staff
- Elevator/lift
- Safe-deposit box at front desk
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Coffee/tea maker
- Iron/ironing board
- Hair dryer
- Premium TV channels
- Desk
- Free newspaper
- Free WiFi
- Free local calls
- Refrigerator
- Microwave
- In-room safe
Top SeaTac hotels
Recently reviewed hotels in SeaTac
- Motif SeattleFrom
"The hotel was in the heart of the city. It made it easy to walk to the Market Place, shopping, restaurants or to catch the light rail or metro. The staff were friendly and…"Jun 18, 2016
- Hawthorn Suites by Wyndham Kent/Sea-Tac AirportFrom
"Room was amazing. Booked a suite and it was much larger than expected. A master bedroom with a bath and a second bedroom upstairs with another full bath. Deck off living room and…"Jun 18, 2016
- Best Western LakewoodFrom
"An unplanned extended day led to their accomodating us, Very good location"Jun 17, 2016
- Hampton Inn & Suites Seattle DowntownFrom
"Seattle is great! People are friendly, food was great. We came specially for seafood and we loved. Not disappointed at all."Jun 17, 2016
Nearby hotels
Holiday Inn Express Hotel & Suites SeaTac, SeaTac's small print
Also known as
- Holiday Inn Express Hotel SeaTac
- Holiday Inn Express SeaTac
Optional extras
Pets are allowed for an extra charge of USD 50 per pet, per stay
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Excellent 4.0 /5 from 307 reviews
very good
This hotel was horrible. Holiday Inn Express has usually been a great place to stay, but this was a miserable stay, especially for the price paid.
This hotel was close to the Sea Tac airport...convenient for catching the light rail into Seattle to sightsee! Great shuttle service in the immediate area, as well
We got there pretty early from the boat and were allowed to check in but we had to wait for 1 1/2 hours for the rooms to be cleaned while seeing many leaving and others get rooms. The room was great once we got in. It was close to hotel and they provided transportation to lite rail and also to the airport. The airport shuttle did not drop us by the outside check-in so we had to wait in long lines b/c we didn't know about the outside check-in.
This Holiday Inn Express is a bit below the standards of the normal HIE Group. The entrance was great, and the staff were fine, but once on the floors, the hallways were not very tall, dark, and very hot. It was like being in a old, urban center hotel. A bit dank and dark. The room was not significantly better. Truly a surprise considering the consistency that HIE strives for. It seems this one was built with modular construction targeted to pack in as many rooms as possible. I will not stay there again.
Is the description of this hotel not correct? Tell us


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The house and the garden are very nice. The view looks like in Japan. Greetings, nguyentran
nguyentran, thank you for your visit. This garden was built in 1918 and was featured in the movie "Memoirs of a Geisha". Now, it is a park in the foothills of the Silicon Valley. David
Photo taken in Saratoga, CA, USA
Hakone Estate & Gardens

subset: commoncrawl


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Send Yun a message explaining your needs and you will receive a response shortly. Have you already emailed Yun or another tutor? If so, you have an account! Sign in now
If you select this option, WyzAnt will ask interested tutors to contact you by email if they are able to help. A maximum of five different tutors will email you and none of your personal information, including your email address, will be released.
Jiao tong university Xian
Jiao tong university Xian (Enrolled)
I offer Mandarin tutoring to all ages, to students just beginning to learn the language in school, or to adults who want to expand their knowledge and proficiency in Mandarin. I can tutor 1 on 1, or to small groups, up to normally no more than 5 students.
For my younger students I emphasize making learning fun, and engaging them with games and songs that let them learn without realizing it :) For adults continuing or starting to learn Mandarin, I zero in on problem areas, and customize my lesson plan to his or her specific needs.
I have a BA in Mandarin from Jiao-Tong University in China. I am a native speaker. I have 3 children of my own, so I understand a child's educational needs very well. I have nine years experience teaching and tutoring Mandarin, and I am currently teaching Mandarin at a private school. I am also currently enrolled in the Star Talk program teacher training program, which has given me additional exposure to new teaching methods. I offer Mandarin tutoring to all ages, to students just beginning to learn the language in school, or to adults who want to expand their knowledge and proficiency in Mandarin. I can tutor 1 on 1, or to small groups, up to
I also teach group children and adult lessons. Minimum 4 students. $20 per student.
Approved subjects are in bold.
In most cases, tutors gain approval in a subject by passing a proficiency exam. For some subject areas, like music and art, tutors submit written requests to demonstrate their proficiency to potential students. If a tutor is interested but not yet approved in a subject, the subject will appear in non-bold font. Tutors need to be approved in a subject prior to beginning lessons.
My major is Mandarin and I am native speaker in Mandarin. I am a teacher from a private school. And I have been teaching for 7 years. I like to use songs, games and pictures to teach my students. I have students from K - adult. I love to teach!
Native Mandarin Speaker; Experienced Private School Teacher


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Plants of the Rain Forest Rubric
|Worked together
|Group worked very well together and completed the assignment. They presented their work to the class in an interesting, clear manner.
|Group worked well together and completed their assignment. Their work could have been presented to the class in a more interesting manner.
|Group could have worked more efficiently, in both construction and presentation of their work to the class.
|Drew sketches of the assigned plants
|Sketches are accurate, artfully rendered, and informative.
|Sketches are accurate and well drawn.
|Sketches do not seem to be accurate and more time could have been spent drawing them.
|Identified uses of the assigned plants
|Three uses of assigned plants and a fact for each were identified.
|Three uses of assigned plants and a fact for each were identified in at least two of the three examples.
|There were not three uses and a fact identified for all assigned plants.
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text: Home Recipes Publication Simple Recipes Simple Appetizers Share: Simple Appetizers Find simple appetizers from our Simple and Delicious Magazine. Get easy to make, simple appetizers featured in our publication. Recipe Spotlight Best-Ever Stuffed Mushrooms Every Christmas Eve, I bring out a platter of my fresh-from-the-oven mushrooms. When you want a change, consider fixing the sausage and cream cheese filling all by itself—it's good spread on baguette slices and crackers. —Debby Beard, Eagle, Colorado Get Recipe More Simple Appetizers Previous Page ... 4 5 6 ... 68 Next Page Ham and Cheese Bagels Ham and Cheese Bagels "These bite-size bagel sandwiches are easy to fix for breakfast, lunch snacks and family get-togethers," writes Kristin Dallum of Vancouver, Washington. "Both combinations of toppings are as yummy as they are colorful." View Recipe Creamy Thyme Spread Creamy Thyme Spread Mary Steiner of West Bend, Wisconsin shares a make-ahead cracker spread that showcases thyme and garlic. "A neighbor who has an herb garden gave me the recipe," Mary writes. "It's simple to stir up and makes a special appetizer for company. It's also fun to serve at a party." View Recipe Coconut Fruit Dip Coconut Fruit Dip From Lakeville, Massachusetts, Nancy Tanguay shares this fruit dip that has a fun pineapple and coconut flavor. "I usually serve it with melon slices, strawberries and grapes, but you could use whatever fruit you have on hand. It's a big hit whenever I make it." View Recipe Advertise with us ADVERTISEMENT Spiced Hot Fruit Spiced Hot Fruit Irene Howard of Shanandoah, Iowa shares her recipe for a crowd-pleasing compote that takes advantage of convenient canned fruit. Its sweet, buttery sauce, spiced with ginger and cinnamon, makes a warm and wonderful addition to any breakfast buffet. View Recipe Ranch Garlic Bread Ranch Garlic Bread "I've worked as a manager of a fast food restaurant for 12 year," relates John Palmer of Cottonwood, California. "At home, I like to cook up different things using everyday ingredients." John gives a buttery loaf of French bread plenty of flavor simply with salad dressing mix and garlic powder. View Recipe Pineapple Appetizer Meatballs Pineapple Appetizer Meatballs Karen Mellinger Baker of Dover, Ohio blends a can of crushed pineapple into her meatballs to create a taste-tempting treat. Best of all, the sweet and tangy glaze that coats this big batch of bite-size snacks is a snap to prepare. View Recipe Turkey Nachos Turkey Nachos Chunks of leftover turkey are a tasty addition to this thick, cheesy dip that comes from Gayle Lewis of Winston, Oregon. "You'd never guess it has just three ingredients," she says. "This recipe can easily be doubled or tripled to satisfy a hungry crowd." View Recipe Curried Crab Quiche Curried Crab Quiche Curry and crab complement each other perfectly in this fuss-free quiche from Kathy Kittel of Lenexa, Kansas. With a sunny color and a rich taste, it's special enough for a holiday breakfast or brunch. View Recipe Hearty Broccoli Dip Hearty Broccoli Dip You'll need just five ingredients to stir up this no-fuss appetizer from Sue Cal. "People often ask me to bring this creamy dip to potlucks and parties," she remarks from her Beech Grove, Indiana kitchen. "I never leave with leftovers." View Recipe Bacon Biscuit Wreath Bacon Biscuit Wreath A Girl Scout leader in Denham Springs, Louisiana, Kathy Kirkland showed her troop how to make this pretty golden wreath. "The girls (and even some of their parents) enjoyed making and sampling the cheesy party appetizer. It's a snap to prepare with cheese spread and convenient refrigerated biscuits." View Recipe Spruced-Up Cheese Spread Spruced-Up Cheese Spread A neighbor, who's a wonderful cook, gave me the recipe for this zippy cracker spread. It's easy to shape into a Christmas tree for a festive occasion. —Judy Grimes, Brandon, Mississippi View Recipe Previous Page ... 4 5 6 ... 68 Next Page Advertise with us ADVERTISEMENT Advertise with us ADVERTISEMENT


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13Ds are filed with the Securities and Exchange Commission within 10 days of an entity's attaining a greater than 5% position in any class of a company's securities. Subsequent changes in holdings or intentions must be reported in amended filings. This material has been extracted from filings released by the SEC from Jan. 3 through Jan. 9. Source: InsiderScore.com
Activist Filings
Zix zixi 0.24096385542168675% Zix Corp. U.S.: Nasdaq USD4.16 0.01 0.24096385542168675% /Date(1469221200313-0500)/ Volume (Delayed 15m) : 123945 AFTER HOURS USD4.16 % Volume (Delayed 15m) : 4872 P/E Ratio 46.22222222222222 Market Cap 227165105.193024 Dividend Yield N/A Rev. per Employee 291500 More quote details and news » (ZIXI)
Meldrum Capital Management said that on Dec. 28 it had entered into an agreement with the company. Under the terms of the agreement, Zix will allow two Meldrum nominees to join the board, will nominate no more than seven directors to stand for election at the 2013 annual meeting, and will encourage the voluntary resignation or retirement of one director in order to reduce the size of the board to seven from eight.
Meldrum disclosed that it now owns 5,302,946 shares (8.7% of the total voting shares). It did not report buying or selling any shares in the past 60 days.
Increases in Holdings
Ferro FOE -0.7955449482895783% Ferro Corp. U.S.: NYSE USD12.47 -0.1 -0.7955449482895783% /Date(1469221321501-0500)/ Volume (Delayed 15m) : 459637 AFTER HOURS USD12.47 % Volume (Delayed 15m) : 4295 P/E Ratio 26.01168126825198 Market Cap 1037267089.16729 Dividend Yield N/A Rev. per Employee 224932 More quote details and news » (FOE)
Gamco Investors gbl 0.7988587731811697% GAMCO Investors Inc. Cl A U.S.: NYSE USD35.33 0.28 0.7988587731811697% /Date(1469221252561-0500)/ Volume (Delayed 15m) : 16086 AFTER HOURS USD35.33 % Volume (Delayed 15m) : 46 P/E Ratio 11.215873015873015 Market Cap 1052791389.67009 Dividend Yield 0.22643645626945938% Rev. per Employee 2165710 More quote details and news » (ticker: GBL) increased its holdings to 12,175,175 shares (14.1%) by purchasing 1,164,300 from Nov. 9 through Jan. 7 at prices ranging from $2.44 to $4.57 apiece. Gamco also disclosed that it had completed a sale of 370,273 shares from Nov. 8 through Jan. 7 at prices of $2.45 to $4.51 apiece.
Intermec (IN)
Gamco disclosed that it now owns 8,967,289 shares (14.9%) after buying 1,716,466 from Dec. 21 through Jan. 4 at prices ranging from $9.80 to $9.86 each. Gamco also reported selling 63,000 shares from Dec. 26 through Jan. 3 at $9.81 to $9.85 a share.
On Dec. 10, Intermec announced that it would be acquired by Honeywell HON -2.5703691218607787% Honeywell International Inc. U.S.: NYSE USD115.61 -3.05 -2.5703691218607787% /Date(1469221277019-0500)/ Volume (Delayed 15m) : 9120010 AFTER HOURS USD115.5 -0.11 -0.09514747859181731% Volume (Delayed 15m) : 47364 P/E Ratio 18.292721518987342 Market Cap 88108114486.1542 Dividend Yield 2.0586454458956838% Rev. per Employee 303147 More quote details and news » (HON) for $10 a share in cash. The offer was at a premium 25% above Intermec's prior closing price.
Decreases in Holdings
CNO Financial cno 1.3789299503585217% CNO Financial Group Inc. U.S.: NYSE USD18.38 0.25 1.3789299503585217% /Date(1469221321178-0500)/ Volume (Delayed 15m) : 757295 AFTER HOURS USD18.38 % Volume (Delayed 15m) : 4582 P/E Ratio 13.128571428571428 Market Cap 3291821222.07046 Dividend Yield 1.7410228509249184% Rev. per Employee 1111400 More quote details and news » (CNO)
Paulson & Co. decreased its stake to 21,511,400 shares (9.5%) by selling 2,127,489 from Dec. 18 through Jan. 8 at $15.00 to $16.07 apiece. Paulson also disclosed that its representative on the CNO board of directors, Charles Murphy, had resigned as of Dec. 31.
Commercial Metals CMC 0.8573178199632578% Commercial Metals Co. U.S.: NYSE USD16.47 0.14 0.8573178199632578% /Date(1469221321094-0500)/ Volume (Delayed 15m) : 1064913 AFTER HOURS USD16.47 % Volume (Delayed 15m) : 7506 P/E Ratio 39.214285714285715 Market Cap 1887939515.10155 Dividend Yield 2.914389799635701% Rev. per Employee 528337 More quote details and news » (CMC)
Icahn Associates trimmed its holdings to 5,805,986 shares (4.99%) by selling one million shares from Dec. 17 through Dec. 19 at prices that ranged from $9.48 to $9.49 per share.
Diebold DBD 1.9267822736030829% Diebold Inc. U.S.: NYSE USD26.45 0.5 1.9267822736030829% /Date(1469221321187-0500)/ Volume (Delayed 15m) : 509687 AFTER HOURS USD26.45 % Volume (Delayed 15m) : 837 P/E Ratio 7.015915119363395 Market Cap 1723138283.65097 Dividend Yield 4.3478260869565215% Rev. per Employee 158706 More quote details and news » (DBD)
Gamco owns 4,749,358 shares (7.5%), after selling 115,500 from Nov. 7 through Jan. 3 at prices ranging from $28.04 to $31.26 each. Gamco also reported buying 5,571 shares from Nov. 9 through Dec. 17 at $28 to $30.93 per share.
Interactive Brokers IBKR 1.0428736964078795% Interactive Brokers Group Inc. U.S.: Nasdaq USD34.88 0.36 1.0428736964078795% /Date(1469221200415-0500)/ Volume (Delayed 15m) : 1104876 AFTER HOURS USD34.88 % Volume (Delayed 15m) : 875 P/E Ratio 22.917214191852825 Market Cap 2231939820.99617 Dividend Yield 1.146788990825688% Rev. per Employee 1378100 More quote details and news » (IBKR)
Technology Crossover Management reduced its holdings to 4,202,540 shares (8.9%) by selling 800,000 from Dec. 19 through Jan. 7 at prices that ranged from $13.94 to $14.37 per share.
Gamco holds 2,571,645 shares (8.6%) after selling 69,314 from Nov. 8 through Jan. 7 at $5.54 to $8.84 apiece.
Online Resources (ORCC)
Discovery Equity Partnersreported that it owns 2,245,589 shares (7.2%), after selling 231,856 from Nov. 12 through Jan. 7 at prices that ranged from $2.09 to $2.30.
The Activist Spotlight
Michael Baker Corp. (ticker: BKR)
Business: Provides engineering, design and related consulting services
Stock-Market Value: $242 million ($25.04/share)
What's Happening: DC Capital Partners offered to acquire BKR for $24.25 per share. But Crescendo Partners threatened to commence a proxy fight if a special committee wasn't formed to explore a sale of the company to the highest bidder.
Key Numbers and Dates:
21: the number of boards that Crescendo has tried to get on.
19: the number of boards that Crescendo was successful in joining.
$28-to-$32: the per-share value that Crescendo believes a strategic investor would pay for BKR.
Dec. 13, 2012: the date on which BKR's CEO resigned.
Behind the Scenes: Crescendo Partners is a very effective activist. Crescendo believes that numerous parties would be interested in acquiring BKR and that a strategic buyer would pay a significant premium.
Crescendo believes that now is the time for a sale because: BKR's size and the current economic environment prohibit the company from achieving its true value by itself; the lack of a CEO makes executing a turnaround difficult; DC Capital's proposal effectively put the company in play, and its $24.25 offer should provide a floor price for a sale; and the low-interest-rate environment makes for an excellent time to sell cash-flow-generative businesses.
On Jan. 7, BKR announced that it had appointed a committee of independent directors to review strategic alternatives.
-- Kenneth Squire
The 13D Activist Fund, a mutual fund runby an affiliate of the author and not connected to Barron's, has no position in the securities mentioned here. In addition, the author publishes and sells 13D research reports, whose buyers may include representatives of participants in, and targets of, shareholder activism.
E-mail: email@example.com


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"Come a Little Closer," cries this billboard for a Funeral Services company. Over at Stop Geek, their comment is, "How far will advertisers go?" If advertising is just the art of invoking response, they've done well... But I'm not sure how much consideration they're going to trigger.
Implications - You really have to give this company credit for having a little bit of fun with their advertising. Instead of settling for morbidity and somber content, they instead appeal to the sense of humor of their consumers. This is definitely one eyebrow-raising campaign that will get people's attention. Whether or not it will be successful remains to be seen. Good luck!
Funeral Home Ad Encourages Passengers to "Come a Little Closer"
More Stats +/-
Top 30 Pets Ideas in July
Minimalist Celebrity Posters
Drag Racing Electric Cars
Meditative Puzzle Platforms
Tiny VR Cameras
Funeral Home Ad Encourages Passengers To "Come A Little Closer"
Dec 5, 2006 Updated: Apr 21 2011By: Jeremy Gutsche -
References: stopgeek
References: stopgeek


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Simple Definition of oven
: a piece of cooking equipment that is used for baking or roasting food
Examples of oven in a sentence
Preheat the oven to 350 degrees.
Please take the pizza out of the oven.
Origin and Etymology of oven
Middle English, from Old English ofen; akin to Old High German ofan oven and perhaps to Greek ipnos oven
First Known Use: before 12th century
Rhymes with oven
OVEN Defined for Kids
Definition of oven for Students
: a heated chamber (as in a stove) for baking, heating, or drying
Learn More about oven
Spanish Central: Translation of oven Nglish: Translation of oven for Spanish speakers Britannica English: Translation of oven for Arabic speakers Britannica.com: Encyclopedia article about oven
Seen and Heard
What made you want to look up oven? Please tell us where you read or heard it (including the quote, if possible).


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ELVIS' BIRTHDAY CELEBRATION W/KINGSIZED -- Didn't get that yummy Live in Las Vegas box set for Christmas? Not to worry, Kingsized delivers a mini-version of the "late Elvis" Vegas experience, complete with horn section, female backing singers and a grand finale "American Trilogy." Mike Gier's got the pipes, the songs and the loungy stage presence to make it all come alive, at least for an hour. Sequined white jump suit and free scarves not included. Star Bar (Horowitz)
Apache Cafe The Ave
Bayou Room In the Biz Night with 7 Sharp
Churchill Grounds Jazz Cafe Adebi
Darwin's Slim Fatz
Echo Lounge Rock and Roll High School - DJs spin your favorite punk, rock, goth and glam
Eclipse di Luna Trio Latino Band
Fat Matt's Rib Shack Rough Draft
Fuzzy's Place Donna Hopkins
Kaya House Arrest with DJs Kemit and Justin
McDuff's Irish Pub Open mic with Vicki Salz
Nomenclature Museum Food For The Distraught with rotating DJs Spearhead X, J-Sun, Boolicious and Hazeus
Northside Tavern Mountain Jam with Escape Vehicle
Olde Peculiar Public House Open-mic
Smith's Olde Bar David Ryan Harris & friends
Star Community Bar Elvis' Birthday Celebration w/Kingsized
Tasty World Ampathy, Mercury, G-305
Violette Jus Jazz w/ Dave Wallis, Eddie Taylor, Dan Coy, Shack Lewis, Rita Graham
Beck and Alabama Shakes...that's about it. I'm sure there's an unknown or two I would…
Well, this years Music Midtown sucks!
I'm pretty sure he was 19.
3 people apparently love handing over an extra 40% in fees for nothing in return…
Dang. I thought they would name some actual headliners.


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White hat hacker: Health care IT security tech easy, policy hard
An exclusive interview with white hat hacker Ralph Echemendia offers health care CIOs tips on how to shore up health care IT security.
This Article Covers
CAMBRIDGE, Md. -- Ralph Echemendia, an independent IT security contractor -- also known as a "white hat" or "ethical" hacker -- first learned the ins and outs of complex networking in a health care setting. Although he's gone on since then to work for large entertainment companies and a host of clients in other industries, he still works for health care organizations who give him very little information and challenges such as "here's the address of our office tower; find and get into our data center." The goal is to find holes in the organizations' health care IT security policies.
Download Our Guide: mHealth Security Best Practices
There's no doubt that mobile health technology improves patient care, engagement, and physician productivity. But, the security risks are vast. Learn how to protect your mHealth devices and data in this exclusive e-guide.
By submitting your email address, you agree to receive emails regarding relevant topic offers from TechTarget and its partners. You can withdraw your consent at any time. Contact TechTarget at 275 Grove Street, Newton, MA.
You also agree that your personal information may be transferred and processed in the United States, and that you have read and agree to the Terms of Use and the Privacy Policy.
Through clever technological and social engineering means, he's rarely thwarted, Echemendia told attendees at the HealthTech Council's fall meeting in Cambridge, Md. We sat down with him to discuss just what an ethical hacker does, and where he thinks health care CIOs and their compliance-officer peers should look to shore up vulnerabilities in their own privacy and security policies. His advice in a nutshell: Technology controls are easy for securing information; training all the humans to abide by the policies is hard.
Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.
Dig Deeper on Electronic health records security compliance
Find more PRO+ content and other member only offers, here.


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Annual Reports and Plans
Published: Jun 07, 2013
2012 IAASB Annual Report
The 2012 annual report highlights the IAASB's work in the public interest to enhance the quality and consistency of practice throughout the world, and thereby strengthen the public's confidence in the global auditing and assurance profession. It covers new and enhanced international standards issued by the IAASB during the year, and the board's progress on its current standard-setting projects and related initiatives. It also summarizes the IAASB's outreach activities to obtain input on its deliberations and to keep stakeholders informed of its activities.
Copyright © 2016 The International Federation of Accountants (IFAC). All rights reserved.
Related Resources
- 2015 Handbook of International Quality Control, Auditing, Review, Other Assurance, and Related Services Pronouncements
- IFAC Small and Medium Practices Committee Response to the IAASB's Invitation to Comment, Enhancing Audit Quality in the Public Interest: A Focus on Professional Skepticism, Quality Control and Group Audits
- Spanish Translation of IAASB's New and Revised Auditor Reporting Standards Now Available
- The IAASB's Work to Enhance Audit Quality
- The New Auditor's Report: A Comparison between the ISAs and the PCAOB Reproposal
Find more publications & resources related to:


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Hans Klok and his boyfriend Frank Gutteling - Hans Klok, his boyfriend Frank Gutteling Berlin, Germany - Aftershow-party for the TV show Willkommen bei Carmen Nebel at the Hotel Ellington Saturday 15th March 2008 (3 Pictures)
Hans Klok and His Boyfriend Frank Gutteling
Photo credit: WENN2#122#Caption Writer=HS
Hans Klok and His Boyfriend Frank Gutteling
Photo credit: WENN2#122#Caption Writer=HS
Hans Klok and David Garrett
Photo credit: WENN2#122#Caption Writer=HS
View All: Hans Klok and his boyfriend Frank Gutteling...
Next Hans Klok Slideshow: Planet Hollywod Resort's Grand Opening - Day 2 - Las Vegas, Nevada - Saturday 17th November 2007
The 1969 session, including the only known recording of 'Sunshine Woman' by the band, will be included on a re-issue of 'The Complete BBC Sessions'...
The 55 year old actor joined Chris Martin and co. on stage in New Jersey to perform 'Earth Angel' and 'Johnny B. Goode'.
Bjork Digital comes to London's Somerset House in September, along with a single live show at the Royal Albert Hall.
Kim Kardashian released an audio excerpt from a phone call between Kanye and Taylor Swift over the lyrics of 'Famous' - but if it was recorded...
There's very much a strength of conviction in remaining what you were, but arguably more so in becoming what you want to be.
The BBC drama starring Aidan Turner returns to BBC One on September 4th.
Guns N' Roses were detained at the Canadian border last week for gun possession but they're adamant the weapon didn't belong to them.


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Fitting a line to points. Linear regression. R-squared.
Even when there might be a rough linear relationship between two variables, the data in the real-world is never as clean as you want it to be. This tutorial helps you think about how you can best fit a line to the relationship between two variables.


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Welcome to Stanley, bringing warmth and comfort to your home for generations
An Irish company with a long and proud tradition, Waterford Stanley has been bringing you warmth and comfort to homes for generations, stretching back to when the first range cooker was made in Waterford in 1936.
Over 300,000 Irish households have already said yes to the control, efficiency and comfort that comes as standard with a Stanley Stove or range cooker. Follow your heart to Stanley, and if you need convincing, talk to somebody who already has one.
Our multi fuel stoves are available in free standing and insert room heater & central heating models.Stove Chooser
NewsView all news
New Course for sales and retail staff - Solid Fuel Awareness Training
HAI & METAC training have joined forces to promote new Solid Fuel Awareness training. The training has been developed in collaboration between METAC, Waterford Stanley, Bord na Móna and Grafton ROI.Read more >
Things to consider when purchasing a multi-fuel stove
Choosing and installing a high efficiency stove should not be a difficult process. Homeowners can save over 60% in fuel costs by installing a high efficiency stove as an alternative to an open fireRead more >


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American Music Awards 2012: The Performers
Barbara DeFranco
| November 16, 2012 - 4:53 pm
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Show your support for a school star
The Kent Teacher of the Year Awards were started to mark the vital contribution that teaching staff make to our community. The awards recognise the expertise and dedication that is the hallmark of an outstanding teacher.
Nominations open each January. Award categories include primary, secondary, newly qualified teacher, non teaching member of staff including dinner ladies and caretakers and a volunteer award, which includes members of the PTA and governors.
A panel of judges select winners from the local authority areas, Ashford, Bexley, Canterbury, Dartford, Dover, Gravesham, Maidstone, Medway, Sevenoaks, Shepway, Swale, Thanet, Tonbridge and Malling and Tunbridge Wells.
Winners will be announced at a ceremony in mid May at Leeds Castle, Kent.
The 2016 awards are supported by a number of community partners including Social Enterprise Kent, Kent Sport and Physical Activity Service, SELT, Project Salus, Medway Council, Kent County Council, CXK, Kreston Reeves, Loop CR Ltd, Three R's Teacher Recruitment, Canterbury Christ Church University, Leeds Castle, Marlowe Theatre and the following departments at the University of Kent: Politics and International Relations; Physical Sciences; Mathematics, Statistics and Actuarial Science; Biosciences; European Culture and Languages; and History.
The deadline to submit a nomination is 1 March each year.
Click here to download the Kent Teacher of the Year logo and pack to use within schools.
Nominations have now closed.
For more information on Teacher of the Year ring the team on 0844 264 0291.
Click HERE to view the photographs from the 2016 event
Click HERE to read news report and see full list of winners from 2016 event
Kent Teacher of the Year Awards is staged as a fundraising event to support the educational services delivered by the KM Charity Team in Kent schools. No charge is made to submit a nomination, but funds raised through corporate sponsorship and at the awards dinner are used to support our work.


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#27 - vortexrain
Reply 0(10/15/2013) [-]
Could you imagine being right next to this as it fell? No close enough to be hurt by any flying debris, but still close enough to be scared to see it falling.
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If a turbine falls and nobody sees it, is it still ******* terrifying?


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From Publishers Weekly
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.
"Excellent and imaginative and, similar to life itself, the book is full of surprises." (Nature)
"Lane lays out processes of dizzying complexity in smooth, nimble prose." (Kirkus Reviews)
"If Charles Darwin sprang from his grave, I would give him this fine book to bring him up to speed." (Matt Ridley, author of The Red Queen)


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15 Reviews
I've made this recipe over and over again. Each time it has gotten better and better. I'm posting again to share my new findings: I found that the recipe turns out even better if you don't over cook your mixture before adding the eggs. By not over cooking, you get a very silky texture.
I made this last year and it was wonderful. I am going to make it every year at Holidays. Not too sweet. All I can say is if you made it and it turned out wrong then maybe you should stick to frozen pies. It was the easiest pie to make! Yum. I used regular pie crust and one with oreo crust. Both were well liked. :)
Made this for my husband for Valentine's Day weekend. Unfortunately my pie wasn't so silky after having been refrigerated. I was looking for more of a mousse consistency and got a pretty hard, solid filling that I wasn't too thrilled about (the filling was beat until fluffy, as directed). While it still tasted good it wasn't what I was hoping for. I did swap the pie crust from a dough crust to a cookie crust and there were no complaints on that :). Good luck with the recipe!
VERY VERY yummy! Thanks for the great recipe!
If I could give you 10 stars for this recipe, I most certainly would! This was the most fantastic, smooth, rich chocolatey French silk pie I've ever tasted. Thank you so much for posting! Yum!
This was the biggest hit at my Thanksgiving dinner! Wow. It did take more than 20 minutes for my mixture to thicken, but other than that, everything turned out wonderful. Like someone else said, the taste is not exactly what I remembered as "french silk" pie - it was almost more chocolaty than I wanted (is that possible?!). Next time I might experiment with a mix of more than one type of chocolate.
This is a great recipe!! I'm glad I picked this recipe to try out.
This was a big hit at my husband's place of work. The guys he shared it with said it was better than Baker's Square French Silk pie.
Outstanding! Easy to make and delicious! Everyone raved about this pie and couldn't believe I made it myself. I used a store bought frozen pie crust and that was my husband's only complaint. He said it was just too thick for the pie. I'll try a homemade crust next time. The filling is rich and chocolaty, not too sweet. Thanks for sharing!
One word = AMAZING!!


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"Launched in March 2011, the Edge initiative is an effort driven by a coaliton of leading and local government organizations to develop public access technology benchmarks for public libraries. The Edge benchmarks, which will be piloted in summer 2012, will help libraries evaluate and continually improve their public technology services for their communities."
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Ultra-Compact Laser Radar
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Fibertek, Inc.
510 Herndon Parkway, Herndon, VA, 20170
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Francis Fitzpatrick
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Ralph Burnham
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Abstract"This program will develop a new approach for laser transmitters for ultra-compact space-based ladar systems. The technology proposed has the potential for reducing the size, weight and cost of the laser transmitter by an order of magnitude over existingdevices with the same average power. The laser design incorporates a novel multi-pass diode-pumped solid-state gain module that is optimized for efficiency and thermal management. This laser will find application as the transmitter for both short-pulsedirect-detection and coherent ladar systems. The novel solid-state laser technology to be developed will decrease the size, weight and cost of high-power diode-pumped lasers. These reductions will make affordable new applications including materialsprocessing and large area displays."
* information listed above is at the time of submission.
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Please join us for the annual spring OPEN HOUSE at the Happy Days classroom (Industrial Arts/ Band bldg at the high school) on THURSDAY MAY 12th from 6-7pm. Come and see the classroom with your kid(s), meet Mrs. Borchert, and learn more about the HD program. Reistration that night is possible too!
Current families, if you're on Facebook please send a request to the private Happy Days Preschool group!
Do you have a 3 or 4 year old not currently in Happy Days? 2016-17 Registration is underway! Print the forms (on the Right menu bar) and mail them in today!


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Ventricular Tachycardia
- Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD more...
Practice Essentials
Ventricular tachycardia (VT) or ventricular fibrillation (VF) causes most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with 3 or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from working ventricular myocardium, the distal conduction system, or both. See the image below.
Signs and symptoms
Symptoms of VT include the following:
Chest pain
Physical examination
During VT, the following may be observed:
Signs of diminished perfusion, including a diminished level of consciousness, pallor, and diaphoresis
High jugular venous pressure
Cannon a waves (if the atria are in sinus rhythm)
Variation in intensity of first heart sound, caused by loss of atrioventricular (AV) synchrony
After conversion, physical findings during normal sinus rhythm are related to any underlying structural heart disease.
VT can also result in sudden death. Patients in whom this occurs may first present with syncope.
See Clinical Presentation for more detail.
Electrocardiography (ECG) is the criterion standard for the diagnosis of VT. If the clinical situation permits, a 12-lead ECG should be obtained before conversion of the rhythm. In a patient who is hemodynamically unstable or unconscious, however, the diagnosis of VT is made from the physical findings and ECG rhythm strip only. Advanced cardiovascular life support (ACLS) protocols should be quickly followed. Laboratory tests should be deferred until electrical cardioversion has restored sinus rhythm and the patient is stabilized.
Assess levels of serum electrolytes, including the following, in all patients with VT:
Calcium (ionized calcium levels are preferred to total serum calcium levels)
Hypokalemia, hypomagnesemia, and hypocalcemia may predispose patients to either monomorphic VT or torsades de pointes.
Laboratory studies can also include the following:
levels of therapeutic drugs (eg, digoxin)
Toxicology screens (potentially helpful in cases related to recreational drug use)
Serum cardiac troponin I or T levels or other cardiac markers (to evaluate for myocardial ischemia or infarction)
VT post conversion
In patients with VT post conversion, diagnosis proceeds as follows:
Repeat the ECG after termination of VT
Include electrolyte levels in an acute evaluation
Perform toxicology screens for cocaine metabolites and tricyclic antidepressants, in accordance with the patient's clinical history
Check cardiac enzyme levels if clinical symptoms or signs of ischemia are present
Perform echocardiography and coronary angiography after conversion to sinus rhythm to assess for structural and ischemic heart disease
Electrophysiologic study
Diagnostic electrophysiologic study (EPS) requires placement of electrode catheters in the ventricle, followed by programmed ventricular stimulation using progressive pacing protocols. EPS is particularly relevant in patients considered to be at high risk for sudden death as a result of significant underlying structural heart disease.
See Workup for more detail.
Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic). Unstable polymorphic VT is treated with immediate defibrillation.
In stable patients with monomorphic VT and normal left ventricular function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide or sotalol
IV lidocaine is effective at suppressing peri-infarction VT but may increase the overall mortality risk
In torsades de pointes, magnesium sulfate may be effective if a long QT interval is present at baseline
For long-term treatment of most patients with left ventricular dysfunction, current clinical practice favors class III antiarrhythmics (eg, amiodarone and sotalol)
In patients with heart failure, the best proven antiarrhythmic drug strategies include the use of beta receptor–blocking drugs (eg, carvedilol, metoprolol, and bisoprolol); angiotensin-converting enzyme (ACE) inhibitors; and aldosterone antagonists
Implantable cardioverter-defibrillators
Multisociety guidelines recommend implantable cardioverter-defibrillator (ICD) therapy to augment medical management for the following[1] :
Most patients with hemodynamically unstable VT
Most patients with prior MI and hemodynamically stable sustained VT
Most cardiomyopathy patients with unexplained syncope
Most patients with genetic sudden death syndromes when unexplained syncope is noted
Radiofrequency ablation (RFA) via endocardial or epicardial catheter placement can be used to treat VT in patients who have the following:
Left ventricular dysfunction from prior MI
Bundle-branch reentry
Various forms of idiopathic VT
See Treatment and Medication for more detail.
Ventricular tachycardia (VT) refers to any rhythm faster than 100 (or 120) beats/min arising distal to the bundle of His. The rhythm may arise from ventricular myocardium, the distal conduction system, or both. (See Etiology.) VT can be classified as sustained or nonsustained, with a generally accepted cutoff of 30 seconds.
VT is further classified according to the electrocardiographic (ECG) appearance. If the QRS complex remains identical from beat to beat, as occurs when VT originates from a single focus or circuit, it is classified as monomorphic (see the first 2 images below). If the QRS morphology changes from beat to beat, the VT is classified as polymorphic (see the third image below). Further classification can be made on the basis of the substrate and the location of the earliest activation.
The most common setting for VT is ischemic heart disease, in which myocardial scar tissue is the substrate for electrical reentry. VT can also be seen in other conditions that create myocardial scar, such as the following (see Etiology):
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Arrhythmogenic right ventricular dysplasia (ARVD) or cardiomyopathy
Chagas disease [2]
Surgical incisions in the ventricle
VT may also occur in the absence of structural heart disease. VT in this setting may result from enhanced automaticity, which most commonly originates in the right ventricular outflow tract or from the fascicles of the cardiac conduction system. Bundle-branch reentrant VT occurs in patients with conduction system disease distal to the bundle of His. Finally, functional reentrant VTs can occur in structurally normal hearts, in patients with inherited channelopathies.[3]
VT can also be triggered by the following (see Etiology):
Electrolyte deficiencies (eg, hypokalemia, hypocalcemia, and hypomagnesemia)
Systemic diseases that affect the myocardium (eg, sarcoidosis, amyloidosis, systemic lupus erythematosus, hemochromatosis, and rheumatoid arthritis)
Sympathomimetic agents, including IV inotropes and illicit drugs such as methamphetamine or cocaine
Digitalis toxicity, which can lead to biventricular tachycardia
Drugs that prolong the QT interval (eg, class IA and class III antiarrhythmics, azithromycin, levofloxacin, and many others); these may cause torsades de pointes
Drugs that slow conduction velocity, particularly when underlying myocardial scar is present (eg, halothane and class IA and IC antiarrhythmics)
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea (see Presentation). It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death. (See Prognosis.)
ECG diagnosis of VT is generally straightforward but does require that this condition be distinguished from aberrantly conducted supraventricular tachycardia (SVT), which has a similar ECG pattern. ECG criteria for confirming the presence of a VT mechanism for a wide-complex tachycardia include the following:
Presence of atrioventricular (AV)—technically, ventriculoatrial—dissociation (in which the ventricles fire at a faster rate than the atria)
Fusion beats
Capture beats
Because AV dissociation, fusion, and capture beats occur in only a minority of VT tracings, additional 12-lead ECG criteria (the Brugada criteria[4] and the Vereckei criteria[5] ) have been derived to facilitate discrimination between VT and aberrantly conducted SVT. (See Workup).
Accelerated idioventricular rhythm, sometimes termed slow VT, is a variant of VT that produces a rate of 60-120 beats/min. It typically occurs in patients with underlying heart disease (ischemic or structural), is transient, and only rarely is associated with hemodynamic compromise or collapse. Treatment of the dysrhythmia itself usually is not required unless significant hemodynamic impairment develops.
Patients with frank hemodynamic compromise from acute VT require emergency management with electrical cardioversion. Although cardioversion treats VT, it does not prevent recurrence of VT, and patients may experience repeated episodes of recurrent VT after cardioversion; this phenomenon is termed VT storm. These patients additionally require acute antiarrhythmic therapy, ablation therapy, or both.
The mainstays of long-term treatment for clinically stable patients with VT are the various antiarrhythmic drugs. However, cardiologists are increasingly making use of interventional therapy with devices and ablation procedures designed to abort VT or to destroy arrhythmogenic tissue in the heart. (See Treatment.)
For information on VT in children, see Pediatric Ventricular Tachycardia .For patient education information, see the Heart Center, as well as Heart Rhythm Disorders, Supraventricular Tachycardia, and Palpitations.
At the cellular level, VT is caused by electrical reentry or abnormal automaticity. Myocardial scarring from any process increases the likelihood of electrical reentrant circuits. These circuits generally include a zone where normal electrical propagation is slowed by scar. Ventricular scar formation from a prior myocardial infarction (MI) is the most common cause of sustained monomorphic VT.
VT in a structurally normal heart typically results from mechanisms such as triggered activity and enhanced automaticity. Torsades de pointes, seen in the long QT syndromes, is likely a combination of triggered activity and ventricular reentry.[6]
During VT, cardiac output is reduced as a consequence of decreased ventricular filling from the rapid heart rate and lack of properly timed or coordinated atrial contraction. Ischemia and mitral insufficiency[7] may also contribute to decreased ventricular stroke output and hemodynamic intolerance.
Hemodynamic collapse is more likely when underlying left ventricular dysfunction is present or when heart rates are very rapid. Diminished cardiac output may result in diminished myocardial perfusion, worsening inotropic response, and degeneration to ventricular fibrillation (VF), resulting in sudden death.
In patients with monomorphic VT, mortality risk correlates with the degree of structural heart disease. Underlying structural heart diseases such as ischemic cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, Chagas disease, and right ventricular dysplasia have all been associated with degeneration of monomorphic or polymorphic VT to VF.[2] Even without such degeneration, VT can also produce congestive heart failure and hemodynamic compromise, with subsequent morbidity and mortality.
If VT is hemodynamically tolerated, the incessant tachyarrhythmia may cause a dilated cardiomyopathy. This may develop over a period of weeks to years and may resolve with successful suppression of the VT.[8] A similar course is occasionally seen in patients with frequent premature ventricular contractions or ventricular bigeminy, despite the absence of sustained high rates.[9]
Causes of VT include the following[3] :
Ischemic heart disease (most common)
Structural heart disease with disruption of normal conduction patterns (eg, nonischemic cardiomyopathy, ARVD or cardiomyopathy, and hypertrophic cardiomyopathy)
Congenital structural cardiac disorders (eg, tetralogy of Fallot) and associated surgical scar
Acquired channelopathies, most commonly from drugs that prolong the QT interval (eg, class IA and class III antiarrhythmics, phenothiazines, methadone, and many others); drugs that slow myocardial conduction (eg, flecainide, propafenone, and halothane) may also promote reentrant VT
Inherited channelopathies (eg, long QT syndrome, short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia)
Electrolyte imbalances (eg, hypokalemia, hypocalcemia, and hypomagnesemia
Sympathomimetic agents, including IV inotropes and illicit drugs such as methamphetamine or cocaine
Digitalis toxicity, which can lead to biventricular tachycardia
Systemic diseases causing infiltrative cardiomyopathy or scar (eg, sarcoidosis, amyloidosis, systemic lupus erythematosus, hemochromatosis, and rheumatoid arthritis)
Hypokalemia is an important arrhythmia trigger, followed by hypomagnesemia. Hyperkalemia may also predispose to VT and VF, particularly in patients with structural heart disease. Other triggers include sleep apnea and atrial fibrillation (AF), which can increase VT risk in patients with preexisting structural heart disease.
QT prolongation, which may be acquired or inherited, can lead to VT. Acquired QT prolongation is observed with certain potassium channel–blocking medications. Most of the causative drugs block the delayed rectifier cardiac potassium current, IKr. These agents include class IA and class III antiarrhythmics, azithromycin, and many others. Congenital long QT syndrome is a group of genetic disorders involving abnormal cardiac ion channels (most commonly, potassium channels responsible for ventricular repolarization).
In both acquired and congenital long QT syndromes, prolonged repolarization predisposes to torsades de pointes, a reentrant rhythm with a constantly varying circuit.[6] Other inherited ion channel abnormalities may cause idiopathic VF and familial polymorphic VT in the absence of QT prolongation.
Although the following syndromes have been described in most parts of the world, population groups in certain regions carry locally increased risk of genetically mediated heart disease. Examples include the Veneto region of Italy and the Greek island of Naxos (right ventricular dysplasia),[10] as well as northeastern Thailand (idiopathic VF/Brugada syndrome).[11] The risk for VT within populations varies primarily with the risk factors for atherosclerosis, however, rather than with ethnic differences per se.
Among patients younger than 35 years, the most common cardiac causes of sudden death, and presumably of VT, include the following[12] :
Hypertrophic cardiomyopathy
Right ventricular cardiomyopathy (ARVD)
Long QT syndrome
Congenital coronary artery abnormalities
Inherited long QT syndrome
Long QT syndrome is characterized by QT interval prolongation, T-wave abnormalities and polymorphic VT. Persons with this syndrome are predisposed to episodes of polymorphic VT. These episodes can be self-limited, resulting in syncope, or they may transition into VF and thus can cause sudden cardiac death.
Long QT syndromes have been identified by eponyms (ie, Romano-Ward syndrome, Jervell and Lange-Nielsen syndrome, Andersen-Tawil syndrome,[13] and Timothy syndrome[14] ). The form sometimes known as Romano-Ward syndrome is the most common type. However, current practice is moving away from using eponyms and toward denoting these syndromes as numbered types (eg, LQT1 through LGT12) on the basis of identified underlying mutations.
Mutations in the KCNQ1, KCNH2, SCN5A, KCNE1 and KCNE2 genes are known to be causative. Together, those 5 genes are responsible for virtually 100% of cases of inherited long QT syndrome.
Catecholaminergic polymorphic ventricular tachycardia
Catecholaminergic polymorphic VT (CPVT) is characterized by polymorphic VT that can be triggered by stress, exercise, or even strong emotional states. It can be induced by catecholamine administration. Patients may present with syncope or with sudden cardiac death if the dysrhythmia degrades into VF. Physical examination or ECG during rest will likely be normal.
CPVT may be caused by mutations in the CASQ2 or RYR2 genes.[15] An additional locus has been mapped to chromosome 7p22-p14. This disorder shares clinical characteristics with the bidirectional VT sometimes seen in digitalis toxicity.
Dilated cardiomyopathy
Dilated cardiomyopathy is a highly heterogeneous disorder that can predispose to ventricular tachyarrhythmias such as VT. Its genetic causes are myriad and involve mutations in genes coding for proteins that make up cardiac sarcomeres, including actin, myosin, and troponin. It is noteworthy that genes such as PSEN1 and PSEN2, which are responsible for early-onset Alzheimer disease, have also been implicated in dilated cardiomyopathy.
Most familial dilated cardiomyopathies are inherited in an autosomal dominant fashion. X-linked inheritance of dilated cardiomyopathy has been described in patients with mutations in the DMD gene (Duchenne muscular dystrophy) and the TAZ gene (Barth syndrome). Autosomal recessive inheritance has been described in mutations of the TNNI3 gene, which encodes troponin I.
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is usually inherited in an autosomal dominant fashion with incomplete penetrance. Mutations in 4 genes that encode sarcomeric proteins— TNNT2, MYBPC3, MYH7, and TNNI3 —account for approximately 90% of cases.[16] Most people with hypertrophic cardiomyopathy who have symptoms will experience them at rest. Less often, a person with this disorder will experience an initial episode of VT or VF with significant exertion.
Arrhythmogenic right ventricular dysplasia
ARVD (also known as right ventricular cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy) is characterized by replacement of the free wall of the right ventricle with fibrous tissue and the development of right ventricular hypertrophy. This disorder frequently results in sustained VT, which may degrade into VF.
The genetics of ARVD are extremely heterogeneous. Eight genes (TGFB3, RYR2, DSP, PKP2, DSG2,[17] TMEM43, and JUP) and 4 additional loci (14q12-q22, 2q32.1-32.3, 10p14-p12, and 10q22) have been implicated in the pathogenesis of this disorder, which is inherited in an autosomal dominant fashion with incomplete penetrance. Those 8 genes are believed to be responsible for approximately 40-50% of the total cases of ARVD.[17]
Brugada syndrome
Brugada syndrome is characterized by the specific ECG pattern of right bundle-branch block and ST-segment elevation in the early precordial leads, most commonly V1-V3, without any structural abnormality of the heart. It causes idiopathic VT or VF and carries a high risk for sudden cardiac death.[18]
Brugada syndrome can be caused by many genes. Currently, 8 genes are known to cause Brugada syndrome (SCN5A, GPD1L, CACNA1C, CACNB2, SCN1B, KCNE3, SCN3B, and HCN4), but they account for no more than 25% of cases. Brugada syndrome is inherited in an autosomal dominant fashion.
Familial ventricular tachycardia
Familial VT is characterized by paroxysmal VT in the absence of cardiomyopathy or another identifiable electrophysiologic disorder. Familial VT is rare; investigation of families with paroxysmal VT will frequently reveal disorders such as Brugada syndrome, long QT syndrome, or catecholaminergic polymorphic VT. In at least 1 case, however, these disorders were ruledout, and the patient was found to have a somatic mutation in the GNAI2 gene.[19]
VT and coronary artery disease (CAD) are common throughout most of the developed world. In developing countries, VT and other heart diseases are relatively less common.
The incidence of VT in the United States is not well quantified, because of the clinical overlap of VT with VF, but examination of sudden death data provides a rough estimate of VT incidence. Most sudden cardiac deaths are caused by VT or VF, at an estimated rate of approximately 300,000 deaths per year in the United States, or about half of the estimated cardiac mortality.[20]
A prospective surveillance study gave a sudden death incidence of 53 per 100,000 population, accounting for 5.6% of all mortality.[21] This is only a rough estimate of VT incidence, both because many patients have nonfatal VT and because arrhythmic sudden deaths may be associated with VF or bradycardia rather than with VT. In patients with ischemic cardiomyopathy and nonsustained VT, sudden death mortality approaches 30% in 2 years.
Morbidity from VT is associated with hemodynamic collapse. Resuscitated survivors may suffer ischemic encephalopathy, acute renal insufficiency, transient ventricular dysfunction, aspiration pneumonitis, and trauma related to resuscitative efforts.
Age-related demographics
VT is unusual in children but may occur in the postoperative cardiac setting or in patients with associated congenital heart disease. Tachydysrhythmias in children are more commonly due to paroxysmal SVTs (PSVTs).[22] The incidence of ischemic VT increases with age, regardless of sex, as the prevalence of CAD increases. VT rates peak in the middle decades of life, in concert with the incidence of structural heart disease. Idiopathic VT can be observed at any age.
Sex-related demographics
VT is observed more frequently in men because ischemic heart disease is more prevalent in men. Among patients with CAD in the Framingham Heart Study, male deaths were more common than female deaths (46% vs 34%, respectively).[23] It seems certain that as CAD becomes more common in women, the incidence of VT in women will increase.
Females with acquired or congenital long QT syndromes are at greater risk for sudden death. The opposite is true for ARVD (a 2-fold male predominance) and Brugada syndrome (an approximately 8-fold male predominance).
The prognosis in patients with VT varies with the specific cardiac process but is predicted best by left ventricular function. Patients with VT may suffer heart failure and its attendant morbidity as a result of hemodynamic compromise. In patients with ischemic cardiomyopathy and nonsustained VT, sudden-death mortality approaches 30% in 2 years. In patients with idiopathic VT, the prognosis is excellent, with the major risk being injury incurred during syncopal spells.
Appropriate treatment can significantly improve the prognosis in selected patients. Beta-blocker therapy can reduce the risk of sudden cardiac death from VT, and implantable cardioverter-defibrillators can terminate malignant arrhythmias.[24]
Prognosis does not always correlate with left ventricular function. Patients with long QT syndrome, right ventricular dysplasia, or hypertrophic cardiomyopathy may be at increased risk for sudden death despite relatively well preserved left ventricular function. These possibilities should be considered in any patient with a strong family history of premature sudden death.
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Jul 19, 2 pm, Oshtemo
Jokes about presidential candidates are just too easy this time around so I'm going to skip that part and get right to Aaron Reynolds new picture book President Squid. It is true that no giant squid has ever been president before, but this might be the right time. Squid wears a tie, lives in a big house (a sunken cruise liner), is famous (he's in a book), does all the talking, and likes to boss people around so he thinks he is perfect for the job. Will he be the fifth president carved into Mt. Rushmore? If you aren't already having enough fun during this year's presidential race, check out President Squid for even more laughs. ...
Posted by Steve, Jul 22, 2016 03:39:45 PM
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Here's a fun family activity for the summer: when you're preparing food together, write down the ingredients and steps together to make a family cookbook. A family cookbook doesn't have to be fancy. To me, the fun is in talking through the steps involved, the ingredients used, and the quantities. At any age, children benefit from this time spent together with you. There is so much hands-on learning that happens when kids and their adults think about an easy recipe (lemonade, anyone?) and write it down....
Posted by Bill, Jul 5/, 2016 12:24:20 PM
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