Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life.

Background: Takotsubo cardiomyopathy (TTC), also known as takotsubo syndrome (TTS) or broken heart syndrome, is an acute reversible cardiac disorder characterized by transient left ventricular dysfunction that mimics acute myocardial infarction. First described in Japan in 1990, TTS is increasingly recognized as a model of psychosomatic cardiovascular disease. However, the mechanisms linking psychological stress with myocardial dysfunction remain incompletely understood. Objectives: This narrative review summarizes current evidence on the relationship between psychological stress and the onset, clinical course, and prognosis of TTS, with emphasis on neuroendocrine and autonomic mechanisms. Methods: A structured literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, covering publications from 1990 to 2025, including original research, reviews, meta-analyses, and guidelines addressing psychological stress, neuroendocrine pathways, and psychiatric comorbidities in TTS. Results: Acute stress triggers a catecholamine surge two- to threefold higher than in myocardial infarction, causing sympathetic overstimulation and cardiomyocyte toxicity. Apical vulnerability reflects increased β2-receptor density, while hypothalamic-pituitary-adrenal (HPA) axis activation may enhance adrenergic sensitivity via cortisol. Anxiety and depression affect up to 56% and 48% of patients, respectively. Women, particularly postmenopausal, account for over 90% of cases and appear especially vulnerable due to estrogen-related alterations in sympathoadrenal regulation. Conclusions: TTS represents a psychosomatic cardiovascular syndrome in which emotional stress manifests as acute cardiac dysfunction. Integrated psychocardiac management combining cardiac care, psychiatric assessment, and psychological support may improve outcomes and reduce recurrence risk.

Background: Mitral annular disjunction (MAD) is a structural abnormality of the mitral valve apparatus characterized by atrial displacement of the leaflet hinge point away from the left ventricular myocardium. Once considered an incidental finding, MAD is now recognized as a component of the arrhythmic mitral valve prolapse phenotype and a potential substrate for ventricular arrhythmias and sudden cardiac death, particularly in physically active individuals. Objectives: To summarize current evidence regarding the anatomy, epidemiology, arrhythmogenic mechanisms, multimodality imaging, risk stratification, and management of MAD, with emphasis on its relevance in athletes. Methods: A narrative review of the literature was performed using PubMed/MEDLINE and major cardiology and sports medicine journals. Publications from 1999 to 2024 were reviewed using the terms “mitral annular disjunction”, “arrhythmic mitral valve prolapse”, “athlete”, “exercise”, “sudden cardiac death”, “eligibility”, and “return to play”. Priority was given to recent guidelines, expert consensus documents, systematic reviews, large cohort studies, and landmark publications. Results: Physiological cardiac remodeling in athletes may obscure the diagnosis of MAD, while exercise-related hemodynamic and autonomic changes may facilitate ventricular arrhythmias in susceptible individuals. Current recommendations support individualized risk assessment and shared decision-making rather than universal sports restriction. Conclusions: MAD should be considered during cardiovascular evaluation of athletes with bileaflet mitral valve prolapse, unexplained ventricular arrhythmias, or a family history of sudden cardiac death. Further studies are needed to establish athlete-specific risk stratification and long-term management strategies.

Background: Epilepsy affects approximately 50 million individuals worldwide and represents a major contributor to global neurological morbidity. Despite increasing evidence supporting the safety and benefits of exercise, physical activity remains underutilized in this population. Individuals with epilepsy are consistently less active than the general population, largely due to persistent safety concerns and limited clinical guidance. Aim: This narrative review aims to examine the relationship between epilepsy and physical activity, including epidemiology, underlying physiological mechanisms, potential benefits, associated risks, and clinical recommendations. Materials and methods: A structured literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, including studies published between 2008 and 2025. Eligible sources included original research articles, systematic reviews, and clinical guidelines addressing physical activity in individuals with epilepsy. Results: The available evidence indicates that moderate-intensity physical activity does not increase seizure frequency in most patients and may, in some cases, contribute to seizure reduction. Proposed mechanisms include upregulation of brain-derived neurotrophic factor (BDNF), reduction of neuroinflammation, and improved autonomic regulation. Exercise is also associated with improvements in quality of life, mood, and physical fitness, which are often inadequately addressed by pharmacological treatment alone. The International League Against Epilepsy (ILAE) classification of sports according to seizure-related risk provides a practical framework for individualized recommendations. Conclusions: Current evidence supports the incorporation of physical activity into epilepsy management, provided that recommendations are tailored to the individual patient.

Background Performance anxiety is a well-documented phenomenon in competitive sport with established behavioural and psychological consequences; however, its physiological correlates - particularly with respect to cardiovascular autonomic regulation - remain insufficiently integrated within sport medicine and cardiology literature. Objectives This narrative review aims to synthesize current evidence on the relationship between performance anxiety and cardiovascular autonomic function in athletes, with particular emphasis on heart rate variability (HRV) as a non-invasive biomarker of autonomic balance. Methods A structured literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, including studies published from 1996 to 2026, with selected seminal works published prior to this period. Eligible sources comprised original research articles, systematic reviews, meta-analyses, and clinical guidelines addressing heart rate variability, performance anxiety, and autonomic nervous system regulation in athlets. Results Converging evidence indicates that elevated anxiety is associated with reduced HRV, reflecting sympathetic dominance and reduced parasympathetic activity. This imbalance may negatively affect athletic performance, recovery, and cardiovascular health. Activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) appears to link psychological stress with physiological dysregulation. Conclusions Performance anxiety may contribute to autonomic imbalance characterized by sympathetic dominance and reduced HRV, leading to impaired performance and recovery. These findings support the use of psychophysiological monitoring and targeted psychological interventions in athlete health management.