1,721,148 research outputs found
The cardiologist and myocardial and pericardial diseases: a cultural, clinical, organizational challenge
No full textThe cardiologist and myocardial and pericardial diseases: a cultural, clinical, organizational challeng
Dieci quesiti in tema di miocardite eosinofila [Ten questions about eosinophilic myocarditis]
No full textEosinophilic myocarditis is a rare form of myocardial inflammation characterized by interstitial infiltration by eosinophils. Clinical presentation may vary from complete absence of symptoms to fulminant myocarditis with cardiogenic shock, to chronic heart failure due to progression to restrictive cardiomyopathy. The main causes of eosinophilic myocarditis are hypersensitivity reactions secondary to drug exposure, eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome and infections. Antibiotics and agents acting on the central nervous system are the most frequently reported drugs capable of causing hypersensitivity myocarditis. Infections are usually due to intestinal parasites. Imaging techniques together with clinical and laboratory data help rising the suspicion of eosinophilic myocarditis. However, the definite diagnosis is made by endomyocardial biopsy. The evidence of eosinophilic infiltrate among myocytes allows to start an immunosuppressive treatment, usually based on corticosteroids, that are the cardinal therapy for eosinophilic myocarditis. Anticoagulation should be undertaken in case of endoventricular thrombosis, which frequently complicates eosinophilic myocarditis, mainly those cases associated with hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis. In this focused review, we will try to provide answers to the most common questions on the causes, presentation, diagnosis, treatment, and outcomes of eosinophilic myocarditis
Active implanted cardiac devices and magnetic resonance: Results of a survey among cardiologists of Piedmont
No full textThe recent introduction of Magnetic Resonance-conditional implantable cardiac device has abolished the previous absolute or relative contraindications to magnetic resonance scan also in patients implanted with such devices. The present survey aimed at investigating the level of knowledge of terms and conditions for a well-tolerated use of Magnetic Resonance-conditional devices prior, during and after magnetic resonance scan among cardiologists in Piedmont (Italy). A questionnaire consisting of 32 questions was distributed to 256 cardiologists and 73 responded to the survey. The interviewed considered loop recorders (18%), pacemakers (13%), implantable cardiac defibrillators (23%), and joint prostheses (20%) as an absolute contraindication to magnetic resonance. For pacemakers and implantable cardiac defibrillators, 87-77% of the respondents respectively indicated that the specific type of device may allow magnetic resonance, regardless the type of device. Ninety-three percent of the cardiologists did not perfectly recognize the meaning of the term 'Magnetic Resonance-conditional.' Half of respondents did not recognize the preliminary check to be performed on implanted electronic device before Magnetic Resonance. About 35% of the cardiologists replied that a magnetic resonance could not be prescribed in patients with implanted electronic devices because of a specific prohibition by Italian law. The results of the present survey highlight the need to fill knowledge gaps among cardiology specialists on this topic
Coronavirus disease 2019 vaccination-related pericarditis: a single tertiary-center experience
No full textVaccination represents a cornerstone of prevention in the COVID-19 pandemic. Rare adverse events including acute pericarditis and myopericarditis have been reported. METHODS: All consecutive patients referred to our referral center for pericardial diseases following COVID-19 vaccination from 1 April 2021 to 15 April 2022 were included. Acute pericarditis and myopericarditis were diagnosed according to ESC guidelines. Patients with SARS-CoV-2 infection were excluded from the study. RESULTS: Twenty-four patients (79% men) aged 39.7 ± 19.8 years were referred to our center with pericarditis after receiving COVID-19 vaccination. Thirteen (54%) patients were diagnosed with myopericarditis. The mean time between vaccination and symptoms onset was 7.0 ± 4.9 days, and the most frequent symptom was pericarditic chest pain (83%). Respectively, 50 and 33% of patients presented after the second and the third dose of the vaccine. Almost all patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine. Five patients (21%) experienced a recurrence of pericarditis. No patient died or developed constrictive pericarditis. Mean follow-up was 8.0 ± 3.2 months. CONCLUSION: COVID-19 vaccine-related pericarditis typically manifest with mild clinical signs, in young male individuals, a few days after the second or third vaccine dose and are commonly characterized by a rapid complete recovery
Colchicine for the treatment of the spectrum of cardiovascular diseases: current evidence and ongoing perspectives
Full text linkColchicine is one of the oldest drugs in medicine. Traditionally used to treat and prevent gouty attacks, it has been introduced into cardiovascular medicine for the treatment and prevention of pericarditis, starting from the positive experience in the treatment and prevention of polyserositis in familial mediterranean fever. Colchicine is a lipophilic drug that enters the cells and is eliminated by glycoprotein P. As granulocytes are lacking in this protein, colchicine is able to concentrate in these cells, exerting a substantial anti-inflammatory action, even with low oral doses. As these cells may trigger acute cardiovascular events, colchicine has been shown to be efficacious and safe to prevent acute coronary syndromes and ischemic stroke with an efficacy comparable to more established treatments, such as antiplatelet agents and statins. On this basis, colchicine seems a promising, efficacious, well tolerated, and cheap option for the prevention of several cardiovascular events, and it may become an additional pillar in the pharmacologic treatment of cardiovascular diseases
I dieci punti che il cardiologo deve conoscere su scintigrafia miocardica con traccianti ossei, amiloidosi e cuore
No full textL’amiloidosi cardiaca (AC), da sempre considerata una malattia rara ed incurabile, è stata oggetto, negli ultimi 10 anni, di una rivoluzione diagnostico-terapeutica. Da un lato la disponibilità di metodiche non invasive, tipicamente la scintigrafia miocardica con traccianti ossei, ha drasticamente cambiato l’epidemiologia della malattia, svelando la reale e crescente prevalenza della forma transtiretino-relata (ATTR), e modificato gli algoritmi diagnostici, riducendo il ricorso alla biopsia endomiocardica. Dall’altro, la disponibilità di nuove terapie specifiche, come il tafamidis, ne ha reso il riconoscimento precoce una necessità clinica e non uno sterile esercizio diagnostico. Da quando, nel 2016, Gillmore e collaboratori hanno proposto una nuova flow-chart diagnostica per la diagnosi differenziale fra ATTR e amiloidosi da catene leggere delle immunoglobuline (AL), attribuendo un ruolo dirimente alla scintigrafia con traccianti ossei, questa metodica è entrata nel vocabolario e nella pratica clinica del cardiologo impegnato nel campo delle cardiomiopatie. In questo articolo cercheremo di rispondere ai principali quesiti in tema di scintigrafia miocardica con marcatori ossei ed AC, offrendo al cardiologo le conoscenze utili per orientarsi in merito a richiesta, interpretazione e contestualizzazione clinica dell’esame
Pharmacologic treatment of acute and recurrent pericarditis. A systematic review and meta-analysis of controlled clinical trials
No full textINTRODUCTION: Recurrence is the most frequent complication following acute pericarditis and may occur in 30% patients, rising to 50% in case of multiple recurrences, lack of colchicine treatment or use of glucocorticoids. Available treatments include aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, anti-interleukin-1 (IL-1) agents.EVIDENCE ACQUISITION: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of pharmacological treatments for acute and recurrent pericarditis. Bibliographic databases were searched (PubMed, MEDLINE, Embase, Scopus, and the Cochrane Library) using the terms "acute pericarditis" or "recurrent pericarditis" and "colchicine" or "NSAIDs" or "glucocorticoids" or "immunosuppressive agents" or "immunoglobulins" or "anti-IL1 agents." Random-effects meta-analysis was used to assess the risk of recurrent pericarditis. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity.EVIDENCE SYNTHESIS: Eleven RCTs assessed the efficacy of pharmacological treatments for acute and recurrent pericarditis (colchicine and anti-interleukin-1 agents). Colchicine, assessed in nine RCTs, was effective in the reduction of recurrent pericarditis, compared with standard treatment (17% vs.34%, RR=0.50; 95% CI 0.42-0.60, P<0.001), without any differences according to clinical setting (i.e. acute pericarditis, recurrent pericarditis, post-pericardiotomy syndrome; P=0.58). Anti-interleukin-1 agents (anakinra, rilonacept), assessed in two RCT, were effective in the reduction of recurrences, compared with placebo (10% vs.78%, RR=0.14; 95% CI 0.05-0.35, P<0.001).CONCLUSIONS: A correct pharmacological management of pericarditis is key to prevent recurrences. Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs
Paradoxical Pulmonary Embolism in a Patient with Bilateral Renal Infarction: The Role of Contrast-enhanced Ultrasound Imaging
Full text linkWe present the case of a 52-year-old male who was admitted to the hospital for a bilateral pulmonary embolism. On the 5th day of hospitalization, an acute kidney injury (AKI) occurred. A transesophageal echocardiogram was performed and it demonstrated a large patent foramen ovale with a consistent right-to-left shunt. Contrast-enhanced ultrasound (CEUS) was performed and it demonstrated multiple bilateral renal ischemic areas. CEUS represents a valid alternative to computed tomography or magnetic resonance to confirm the diagnosis of bilateral kidney infarction, especially in patients who experience an AKI
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