Impatto dell'anemia sulla prognosi dei pazienti sottoposti a PCI

Salvage treatment with ganciclovir in a splenectomized, polytransfused patient affected by systemic inflammatory response syndrome

A 23-year-old man was admitted to hospital with a 12-day history of daily fever. A clinical history revealed that 10 months previously, the patient had been splenectomized and polytransfused for a severe blunt trauma. On admission, laboratory data revealed significant leukocytosis (33,230/ul). The patient's general clinical conditions rapidly worsened into a severe systemic inflammatory response syndrome in four days. After 10 days of broad-spectrum antibiotic treatment, the temperature curve was unmodified and severe leukocytosis persisted (44,300 ul) with absolute lymphocytosis. Laboratory tests ruled out hematological diseases, pneumonia, abscesses and endocarditis. In the light of IgM …

Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction

Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr >23.7 was the best predictor of impaired collapsibility …

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria.

Background: Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. Materials and methods: 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. Results: The analysis of clinical characteris…

A second-degree atrioventricular block with double escape rhythm secondary to paroxysmal vagal hypertonia.

Autonomic dysfunction in a group of lower extremities arterial disease outpatients.

Background: The understanding of the specific role of sympathetic neural control and dysregulation in lower extremities arterial disease (LEAD) is still very limited. Aim of our study was to investigate the autonomic profile in LEAD patients and to evaluate if the eventual autonomic alterations were more severe in patients with advanced disease. Methods: We enrolled all consecutive outpatients with LEAD referred to our Departments between July 2012 and September 2014. They were compared to a group of matched outpatients without LEAD. All patients underwent Holter ECG monitoring. Time-domain analysis of heart rate variability (HRV) was evaluated. Results: Compared to controls, patients with …

Early detection of coronary artery flow and myocardial perfusion impairment in hypertensive patients evidenced by myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) frame count (TFC).

OBJECTIVE: In hypertensive patients with typical chest pain but absence of coronary stenosis the coronary microcirculation may be impaired, thus, our study aimed to appraise, in these subjects, the role of the coronary microcirculation, assessed by Myocardial Blush Grade (MBG) and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC). METHODS: A total of 95 subjects with chest pain and uninjured coronary arteries were recruited into the study: 80 subjects were hypertensive while 15 subjects were normotensive. The hypertensive subjects were divided into two subgroups: hypertensive subjects with positive scintigraphy and hypertensive subjects with negative scintigraphy. The TFC, a qu…

Chemotherapy-induced cardiotoxicity: role of the tissue Doppler in the early diagnosis of left ventricular dysfunction.

Cardiotoxicity is a common complication of chemotherapy. The aim of this study was to assess the cardiotoxicity of anticancer drugs using tissue Doppler imaging. A prospective study was carried out using patients with early breast cancer (72 women, median age: 57 ± 12 year) and other inclusion and exclusion criteria. Inclusion criteria were treatment with epirubicin, trastuzumab, fluorouracil, cyclophosphamide, taxotere, and taxolo; left ventricular ejection fraction (LVEF) of more than 50%; and absence of important pathologies. Exclusion criteria were presence of known heart disease, earlier exposure to mediastinal irradiation, and earlier chemotherapy. On the basis of treatment, patients …

Relationship between HRV measurements and demographic and clinical variables in a population of patients with atrial fibrillation.

Little is known about the role of HRV in atrial fibrillation (AF) patients. Aim of our study was to assess the relationship between HRV measurements and demographic and clinical variables in a population of 274 AF patients. We selected all consecutive patients with persistent/permanent AF among whom had performed a Holter ECG in our Department from April 2010 to April 2015. Time-domain analysis of HRV was evaluated. Demographic and clinical variables were collected for each patient. At multivariable logistic regression, a higher pNN50 was associated with ACE inhibitors/ARBs (p = 0.016) and a lower pNN50 with obesity (p = 0.037) and higher heart rate (HR) (p < 0.0005). A higher RMSSD w…

A re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardia.

The common atrioventricular nodal re-entry tachycardia is the most common form of paroxysmal supraventricular tachycardia. It starts frequently with a supraventricular ectopic beat that, on finding the fast pathway in refractory period, travels in the slow pathway as to appear as a prolongation of the PR interval on the ECG. In this study, we show a singular case of a common atrioventricular nodal re-entry tachycardia triggered by the spontaneous interruption of an atrial tachycardia.

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction.

Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (&lt; 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2.…

Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up.

In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF.One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization.At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (H…

Effect of Atrial Capture Beats on the Subsequent Cycle During Slow Common Atrioventricular Nodal Reentry Tachycardia

Heart rate variability in sick sinus syndrome: does it have a diagnostic role?

BACKGROUND: Hypothesis of our study was that the irregular rhythm of sick sinus syndrome (SSS) was characterized by an augmented HRV. Objective was to assess whether SSS patients had a typical HRV profile. METHODS: We screened all 1947 consecutive Holter ECGs performed in our Units of Vascular Medicine and Internal Medicine and Cardioangiology at the University of Palermo (Italy) from April 2010 to September 2014. Among these, we selected 30 patients with ECG criteria of SSS. They were compared to 30 patients without SSS matched for age, sex and comorbidities. RESULTS: The SSS group had a lower mean heart rate (HR) (P=0.003), and a longer mean NN max-min longer (P&lt;0.0005) compared to con…

Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

Introduction Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide. Methods Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0–24 h…

[Cardiovascular risk profile of patients with psoriasis].

The aim of this study was to assess the cardiovascular risk profile of patients with psoriasis compared to patients without psoriasis. A case-control assay was performed using 143 cases (psoriasis patients) and 104 controls (patients without psoriasis). We assessed the presence of hypertension, lipid profile (HDL, triglycerides), diabetes, and body mass index in both cases and controls. Psoriasis patients showed an unfavorable cardiovascular risk profile and a higher risk of cardiovascular events and metabolic syndrome than patients without psoriasis.

Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms

Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-bra…