1,721,041 research outputs found
La desincronizzazione cardiaca: parametri elettrici ed ecocardiografici.
No full textOverview su parametri elettrici ed ecocardiografici della desincronizzazione cardiac
Le complicanze della terapia con ICD e come ridurle con le nuove tecnologie e con i nuovi sistemi.
No full textUn defibrillatore automatico impiantabile
(ICD) deve essere inteso come un sistema integrato
composto da un elettrocatetere posizionato
in ventricolo destro – con funzione di
sensing/pacing e defibrillazione – ed un dispositivo
ICD (ICD monocamerale). Il sistema
ICD pu avere anche un elettrocatetere
per sensing/pacing in atrio destro (ICD bicamerale)
e uno in seno coronarico per la stimolazione
ventricolare sinistra (ICD atriobiventricolare).
L’ICD pu essere responsabile,
pi o meno tardivamente dall’impianto,
di complicanze a diversa espressione clinica e
dipendenti o dal sistema stesso (ad es. un
malfunzionamento strutturale o circuitale) o
da eventi clinici legati alla procedura di impianto
o a processi infettivi (ad es. sanguinamento,
decubito, endocardite).
Per meglio analizzare la natura delle complicanze
e come le nuove tecnologie possano aiutare
a migliorare l’outcome del paziente portatore
di un ICD, necessario valutare il sistema
ICD nel tempo e nelle sue singole componenti
(elettrocatetere/i e dispositivo ICD)
A New Paradigm in Cardiac Resynchronization Therapy?
No full textWe thank Polasek et al for the opportunity to clarify some crucial points of our study.1 First, our study is obser- vational and retrospective, thus needing further confirmation by prospective ad hoc studies as stated in the report. Obvi- ously, given the retrospective and observational nature of the study, a con- trol group cannot be expected unless we performed cardiac resynchronization therapy (CRT) device implantation dis- regarding the guidelines and it is not our case. Accordingly, we just commented on reported results, but we did not discourage CRT implantation in these patients. Second, the hypothesis gener- ated by our data was the existence of an upper cut-off value of QRS duration above which CRT is less effective because of extensive electrical and structural remodeling. Our observations are consistent with findings that showed a worse clinical outcome and prognosis related to either left bundle branch block morphology or prolonged QRS duration in patients with heart failure.2,3 A recent large prospective observational study, totaling 3,319 patients with CRT, showed that cardiac mortality was highest at the upper extremes of QRS duration.4 Moreover, a subanalysis of the Resynchronization Reverses. Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial showed a linear reduction of left ventricular vol- umes after CRT as the QRS duration in- creases from 120 to 180 ms, followed by a declining efficacy from 180 ms on- ward.5 Third, it is important to underline that we described and commented the results of meta-analysis as usually is done in the discussion section.6 Further- more, we deliberately chose to comment on the graph showing the combined end point of death and hospitalization for heart failure, rather than death only, because this is more representative of the efficacy of CRT given the well- established deleterious economic and clinical impact of hospitalization for worsening heart failure.7,8 Finally, we would advise Polasek et al that it is hard to discuss unpublished results and compare them with others using different end points: a less validated end point (!10% reduction of the left ventricular end-systolic diameter) in Polasek data and a well-established end point (!15% reduction of the left ventricular end- systolic volume) in our study
Paradoxical effect of ajmaline in a patient with Brugada syndrome
No full textAims: The typical Brugada ECG pattern consists of a prominent J-wave associated with ST-segment elevation localized in the right precordial leads V1-V3. In many patients, the ECG presents periods of transient normalization and the Brugada-phenotype can be unmasked by the administration of class-I antiarrhythmics. Reports have documented the heterogeneity of the Brugada syndrome ECG-phenotype characterized by unusual localization of the ECG abnormalities in the inferior leads. Case report A 51-year-old man, without detectable structural heart disease, was referred to us because of a history of syncope, dizziness, and palpitations. The ECG showed a J-wave and ST-segment elevation in the right precordial leads, suggesting Brugada syndrome. As other causes of the ECG abnormalities were excluded, the patient underwent an electrophysiological study that documented easy induction of ventricular fibrillation. During infusion of ajmaline, new prominent J-waves and ST-segment elevation appeared in the inferior leads, whereas the basal ECG abnormalities in the right precordial leads normalized. After infusion of isoprenaline, the ECG-pattern resumed the typical Brugada pattern. An implantable cardioverter-defibrillator was recommended.
Conclusion: In our patient, the double localization of the typical Brugada-pattern and the paradoxical effect of ajmaline on the ECG abnormalities confirmed the possibility of a phenotype heterogeneity in the Brugada syndrome
A quadricuspid aortic valve in an asymptomatic 40-year-old man: A case report
No full textBackground: Integrated transthoracic and transesophageal echocardiography enables identification and characterization of a quadricuspid aortic valve anomaly. Case presentation: A totally asymptomatic 40-year-old white man was referred to our Division of Cardiology after accidental finding of a heart murmur. Transesophageal echocardiography detected a quadricuspid aortic valve characterized by four cusps of equal size and severe aortic valvular regurgitation, without any further anomalies. He underwent a successful aortic valve repair. Conclusions: Quadricuspid aortic valve anomaly is a rare congenital cardiac defect that can cause progressive valvular complications
Prognostic significance of silent myocardial ischemia in variant angina pectoris
No full textThe present study investigates the prognostic significance of silent myocardial ischemia in variant angina. Forty-eight-hour Holter monitoring and coronary angiography were performed in 54 patients with transient ST elevation and no history of myocardial infarction admitted to the coronary care unit for worsening of symptoms. Coronary artery spasm was documented in most of these patients. Over the subsequent month, 20 patients (group 1) had a major coronary event (2 died, 6 had nonfatal myocardial infarction and 12 had urgent coronary revascularization), and the remaining 34 patients (group 2) had a good clinical outcome. From 2,578 hours of recording, 547 ischemic episodes were identified of which only 9% were associated with angina. The mean daily number of ST elevation in group 1 was similar to that in group 2 (4.8 ± 5.1 vs 4.1 ± 4.6; p = not significant). Conversely, the mean daily duration of such ischemic episodes was consistently greater in group 1 than in 2 (79 ± 36 vs 37 ± 25 minutes; p < 0.005). The occurrence of ≥ 1 long-lasting (≥10 minutes) episode of ST elevation was observed in 18 of 20 patients in group 1 (sensitivity 90%), but only in 4 of 34 in group 2 (specificity 88%). Significant coronary atherosclerosis (>50% stenoses) was found at angiography in 18 of 20 patients in group 1, and in 18 of 34 in group 2. Furthermore, morphologic analysis of coronary angiograms revealed the presence of a complex coronary stenosis (overhanging edges, irregular borders or intracoronary thrombus) in 16 of 20 patients in group 1, but only in 4 of 34 in group 2 (p < 0.0005). It is concluded that silent myocardial ischemia is an important predictor of unfavorable short-term clinical outcome due to high-risk (complex morphology) coronary stenoses in variant angina. Patients with coronary artery spasm but without plaque disruption have a benign prognosis. © 1991
Correlati psicologici in pazienti con sincope vasovagale e sincope unexplained: uno studio di follow-up.
No full textObiettivi: Gli scopi della presente ricerca sono: 1) la valutazione psicologica e psicosomatica di pazienti con sincope vasovagale (VVS) e inspiegata (US), alla baseline e ad un follow-up di 4.5 anni; 2) la valutazione di eventuali aspetti psicologici moderatori della ricorrenza della sincope.
Metodi: 88 pazienti (52.3% donne; età 51.9±20.0 anni) con sospetta sincope vasovagale, sottoposti al tilt-test, sono stati valutati attraverso una scheda anamnestico-clinica e strumenti psicologici sia auto che etero-valutativi (Symptom Questionnaire, Psychosocial Index, Fear Questionnaire, Illness Attitudes Scale, interviste basate sui criteri DSM e DCPR).
Risultati e conclusioni: Il 90.9% del campione alla baseline e l’86.8% al follow-up presenta almeno una diagnosi DSM o una sindrome DCPR, evidenziando al follow-up una maggior frequenza di distimia tra i pazienti US. Mentre alla baseline i pazienti US auto-riferiscono maggior distress psicologico, al follow-up mostrano un maggior livello di depressione (SQ) e di esperienze di trattamento (IAS). Solamente nei pazienti con VVS, tuttavia, lo stress (PSI) e la depressione (SQ) iniziali influiscono significativamente sulla comparsa di recidive. I pazienti con sincope presentano un’elevata comorbilità psichiatrica e psicosomatica. Coloro che presentano US mostrano un profilo psicologico subclinico peggiore rispetto ai VVS; tuttavia, solamente in questi ultimi stress e depressione predicono una maggiore probabilità di incorrere in recidive sincopali. È quindi auspicabile una maggiore attenzione ai correlati psicologici della sincope, utilizzando parametri clinici e sub-clinici, allo scopo di valutarne l’eventuale influenza sul decorso degli episodi sincopali
Miocardite acuta focale simulante un infarto miocardico con sopraslivellamento del tratto ST: descrizione di un caso clinico e revisione della letteratura
No full textMyocarditis is associated with a broad spectrum of clinical and electrocardiographic manifestations, ranging
from completely asymptomatic courses to signs of myocardial infarction or cardiogenic shock.
Endomyocardial biopsy is considered the gold standard for the diagnosis of myocarditis; however, in clinical
practice, cardiovascular magnetic resonance (CMR) plays a leading role, being the most accurate noninvasive
method for tissue characterization.
We report the case of a 22-year-old patient hospitalized for acute precordial pain associated with ST-segment
elevation in leads DI and aVL, mimicking acute myocardial infarction, in whom CMR led to the correct diagnosis
of acute focal myocarditis
Management of traumatic implantable cardioverter defibrillator lead perforation of the right ventricle after car accident: A case report
No full text: The authors reported a case of traumatic implantable cardioverter defibrillator (ICD) lead perforation of the right ventricular (RV) apex caused by a motor vehicle accident. Clinical and echocardiographic features combined with changes in electrical parameters of the offending lead were decisive for the final diagnosis. Optimal management of ICD lead RV wall perforation is currently unclear. In our report, RV perforation was responsible for cardiac tamponade. This complication was uneventfully managed by open surgical procedure
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