Fever of Unclear Origin and Cytopenia Because of Acute Splenic Sequestration in a Young Immunocompetent Carrier of Beta-Globin Mutation for Hb Valletta

Fever of unclear origin is a clinical challenge in medical practice. Infectious diseases, neoplasms, and collagen vascular illnesses are its main causes in adults and children. Acute splenic sequestration crises, a known potentially fatal complication of sickle cell disease and sickle beta-thalassemia, are uncommon in beta-heterozygosis. We describe a case of prolonged recurrent episodes of fever with spontaneous resolution, commencing at age 10 in a 15-year-old boy with a history of hypochromic microcytic anemia attributed to a thalassemic trait. He was admitted twice to our university hospital for continuous-remittent fever with a pruritic, macular evanescent Still's skin rash, severe spl…

Bioelectrical impedance parameters versus BNP testing to differentiate decompensated heart failure from chronic obstructive pulmonary disease.

Clinical-anamnestic and instrumental data in outpatients suffering from venous disease

The authors studied 200 consecutive outpatients with symptoms due to venous disease of the lower limbs. All the patients underwent anamnestic, clinical and instrumental evaluation (c.w. Doppler velocimetry and strain-gauge plethysmography). The results of this study showed that some anamnestic and clinical data are significantly related to venous disease detected by instrumental techniques. The superficial and deep vein hypertension were, instead, correlated to oral contraceptive use.

Tolerability and efficacy of high-dose furosemide and small-volume hypertonic saline solution in refractory congestive heart failure

Thirty patients aged 65-85 years, with refractory New York Heart Association (NYHA) class IV congestive heart failure (CHF) were treated with an intravenous infusion of furosemide (250-2000 mg/d) and small-volume hypertonic saline solution (150 mL of 1.4-4.6% NaCl) twice a day for 6 to 12 days. A daily fluid oral intake of 1000 mL and previous cardiac therapy were maintained. Clinical signs and symptoms of CHF, such as dyspnea, edema and weakness, improved, as did severity of illness as defined by NYHA class. The infusion was well tolerated. After a 12-month follow-up, 24 patients (80%) were alive and in the NYHA class assigned on discharge from the hospital. This therapeutic combination is…

Long-term effects on immune-inflammatory and neuro-endocrine pathways of a new therapeutic strategy for advanced heart failure

The safety of diltiazem versus digoxin short-term administration in heart failure rate control of patients with atrial fibrillation and congestive heart failure.

One-year renal and cardiac effects of bisoprolol versus losartan in recently diagnosed hypertensive patients: a randomized, double-blind study.

BACKGROUND AND OBJECTIVES: Hypertension is a significant cause of chronic renal injury and its effective treatment is capable of reducing the rate of renal failure. beta-Adrenoceptor antagonists (beta-blockers) have been reported to induce a deterioration in renal function, while several data have indicated a renoprotective effect of treatment with the angiotensin II type 1 receptor antagonist losartan. Previous studies of the interaction between the selective beta(1)-blocker bisoprolol and kidney function were performed only for short- and medium-term periods. The aim of this study was to compare the antihypertensive efficacy and renal and cardiac haemodynamic effects of bisoprolol with th…

Relationship between non-invasive measurement of endothelial function and familial hystory of cardiovascular event in hypertensives subjects of recent onset.

Angiotensin converting enzyme gene polimorfism and central obesity: relationship with blood pressure and left ventricular structure and function

Effects of Two Different ACE Inhibitors, Captopril and Delapril, in the Early Phases of Acute Anterior Myocardial Infarction

Objective: This study was aimed at investigating the effects of captopril or delapril before and just after thrombolysis in acute anterior myocardial infarction (AMI). Patients and Methods: Study participants consisted of 89 patients, hospitalised within 4 hours of the onset of symptoms. Patients were randomly divided into two groups: the first group (45 patients, pretreatment group) received captopril 6.25mg or delapril 7.5mg orally about 15 minutes before intravenous administration of recombinant tissue plasminogen activator (rt-PA) 100mg; the second group (44 patients, late-treatment group) received captopril or delapril about 4 to 6 hours after thrombolytic treatment. Captopril/delapril…

Small-volume hypertonic saline solution and high-dosage furosemide in the treatment of refractory congestive heart failure. A pilot study

Objective: To evaluate a new therapeutic approach to hospitalised patients with refractory congestive heart failure (CHF) based on published data on the efficacy of furosemide (frusemide) intravenous infusion in refractory CHF and of small volumes of hypertonic saline solution in the low-flow state. Design and Setting: Prospective, uncontrolled study of hospital inpatients. Study Participants and Interventions: Thirty patients (20 males and 10 females) aged 65 to 85 years with refractory New York Heart Association (NYHA) functional class IV CHF were given a twice-daily intravenous infusion of a small volume of hypertonic saline solution (150 ml of 1.4 to 4.6 NaCl) containing high-dosage fur…

Is there any novelty on the horizon of heart failure management in internal medicine? The evaluation of body fluid accumulation

Is there a link between liver steatosis, carotid atherosclerosis and C-reactive protein in metabolic and non-metabolic patients?

Treatment of Congestive Heart Failure in the Elderly

Congestive heart failure (CHF) is a complex clinical syndrome which constitutes the epilogue of the natural history of virtually all heart diseases and in its advanced stages, has a poor prognosis. In the elderly, heart failure exhibits particular characteristics linked to the age-related alterations of cardiovascular system, to the association with other pathologies, to the atypical clinical presentation and to the increased iatrogenic risk. Heart failure now afflicts over 1% of the general population with nearly 1 in 10 elderly subjects affected, and the frequency of CHF is progressively increasing in most industrialized societies1,2. Further, CHF remains a significant cause of death and …

Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?

The aim of the present study was to evaluate the effects of a normal-sodium (120 mmol sodium) diet compared with a low-sodium diet (80 mmol sodium) on readmissions for CHF (congestive heart failure) during 180 days of follow-up in compensated patients with CHF. A total of 232 compensated CHF patients (88 female and 144 male; New York Heart Association class II–IV; 55–83 years of age, ejection fraction <35% and serum creatinine <2 mg/dl) were randomized into two groups: group 1 contained 118 patients (45 females and 73 males) receiving a normal-sodium diet plus oral furosemide [250–500 mg, b.i.d. (twice a day)]; and group 2 contained 114 patients (43 females and 71 males) recei…

452 Effects of a normosodic versus hyposodic diet in compensated congestive heart failure

OMEGA 3 FATTY ACIDS LEVEL: REDUCTION RISK OF SUDDEN DEATH FROM MYOCARDIAL INFARCTION

heart failure, after high dose of furosemide plus small volume saline solution (HSS) and after an acute saline loading

EFFECT OF CANREONATE PLUS ANGIOTENSIN-CONVERTING ENZYME INHIBITORS VERSUS ANGIOTENSIN-CONVERTNG ENZYME INHIBITORS AOLNE ON SYSTOLIC AND DIASTOLIC FUNCTION IN PATIENTS WITH ACUTE ANTERIOR MYOCARDIAL INFARCTION

evaluation of BNP plasma levels and bioelectrical impedance analysis (BIA) in decompensated heart failure. A double blind study

Cardiovascular Effects of I/D angiotension converting enzyme gene polymorphism in heathy subjects

Effect of physical training on exercise capacity, gas exchange and N-terminal pro-brain natriuretic peptide levels in patients with chronic heart failure.

BACKGROUND: Decreased exercise capacity is the main factor restricting the daily life of patients with chronic heart failure. N-terminal pro-brain natriuretic peptide (NT pro-BNP) is strongly related to the severity of and is an independent predictor of outcome in chronic heart failure. DESIGN: The study aimed to evaluate the effect of exercise training on functional capacity and on changes in NT pro-BNP levels and to assess the effect of exercise training on quality of life. MATERIALS AND METHODS: Sixty patients (45 men/15 women, mean age 52.7 years; +/-5.3 SD), with stable heart failure (45 ischaemic/hypertensive and 15 idiopathic patients), in New York Heart Association (NYHA) functional…

Impact of ''off-label'' use of ivabradine on exercise capacity, gas exchange, functional class, quality of life, and neurohormonal modulation in patients with ischemic chronic heart failure.

Background: Epidemiologic studies indicate that elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients (pts) with chronic heart failure (CHF). Clinical trials with b-blockers suggest that HR reduction is an important mechanism of their benefit in pts with stable CHF. Pharmacologic inhibition of the If current now provides the opportunity of pure HR reduction. The purpose of this study was to evaluate the impact of ‘‘Off-Label’’ use of ivabradine on exercise capacity, gas exchange, functional class, quality of life, and neurohormonal modulation in pts with ischemic CHF. Methods: Between January 2008 and June 2008, a graded maximal exercise test with re…

Echocardiographic PCWP evaluation in decompensated heart failure: relationship with B-type natriuretic peptide and bioelectrical impedance anaysis.

Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur)

Background High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. Methods A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or …

delayed facilitated percutaneous coronary intervention versus immediate in reperfused stemi

The dry weight maintainance, estimated with bioelectrical impedance analysis, predicts freedom from congestion and post-discharge clinical outcome in ambulatory heart failure despite previous class III-IV symptoms

Is losartan able to improve renal haemodynamics in hypertensives? a long term study

Thrombolysis plus heparin versus heparin alone in the acute phases of unstable angina: preliminary findings

Abstract Several studies have shown conflicting effects of thrombolysis in patients with unstable angina. In these trials the time between presentation with chest pain and randomization was long (12 hours to 3 days). This study compared thrombolysis and heparin with heparin-alone treatment in patients in the acute phase of unstable angina. One hundred fifty-three consecutive patients hospitalized with chest pain at rest (first episode) lasting >5 minutes but P = 0.013). Data suggest that thrombolysis plus heparin produces faster clinical stabilization than heparin alone in patients treated during the acute phase of unstable angina.

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 …

Effects of the Combination of Candesartan plus Captopril in Elderly Patients with Anterior Myocardial Infarction

Objective: To verify the feasibility, tolerability and efficacy of the combination of captopril (75 mg/day) and candesartan (8 mg/day) in early postinfarction phases of not thrombolysed and unreperfused anterior acute myocardial infarction (AMI) in elderly patients. Design and Patients: 71 patients (aged >65 years) hospitalised for anterior AMI were randomised in a double-blind manner into two groups: group A included 35 patients who received captopril 75 mg/day within 3 days of admission plus candesartan 4mg, as a first dose, and 8 mg/day successively; group B included 36 patients who received captopril 75 mg/day and placebo. 90 days after admission, patients underwent echocardiography to …

Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: a double-blind study.

OBJECTIVES: The aim of this study was to evaluate the effect of a new treatment for refractory congestive heart failure (CHF) on brain natriuretic peptide (BNP) plasma levels and hydration station. BACKGROUND: The study was aimed at evaluating the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) in refractory CHF patients. METHODS: A total of 94 patients (34 women/60 men) with refractory CHF (age 55 to 80 years) were enrolled. They had to have an ejection fraction <35%, serum creatinine <2 mg/dl, blood urea nitrogen <60 mg/dl, a reduced urinary volume, and a low natriuresis (<500 ml/24 h and <60 mEq/24 h, respectively). Pati…

Non alcoholic liver steatosis asymptomatic carotid atherosclerosis and C-reactive protein in diabetic and non-diabetic patients.

Evaluation of regional haemodynamic and alterations of vascular wall of the lower limbs in hypertensive subjects.

Short-Term Effects of Hypertonic Saline Solution in Acute Heart Failure and Long-Term Effects of a Moderate Sodium Restriction in Patients With Compensated Heart Failure With New York Heart Association Class III (Class C) (SMAC-HF Study)

INTRODUCTION: Hypertonic saline solution (HSS) and a moderate Na restriction plus high furosemide dose showed beneficial effects in compensated heart failure (HF), in short and long terms. The study was aimed to verify the effects of this combination on hospitalization time, readmissions and mortality in patients in New York Heart Association (NYHA) class III. METHOD: Chronic ischemic or nonischemic cardiomyopathy uncompensated patients with HF in NYHA III functional class with ejection fraction <40%, serum creatinine <2.5 mg/dL, blood urea nitrogen <60 mg/dL and reduced urinary volume were single-blind randomized in 2 groups: the first group received a 30-minute intravenous infusion of fur…

Comparison of Ivabradine Versus Metoprolol in Early Phases of Reperfused Anterior Myocardial Infarction With Impaired Left Ventricular Function: Preliminary Findings

BACKGROUND: beta-blockers in ST-segment elevation myocardial infarction (STEMI) are indicated for patients without a contraindication, particularly in patients with high heart rates (HR) or blood pressures. Epidemiological studies have shown that elevated HR represents a risk factor for cardiovascular morbidity. The study investigates the feasibility, tolerability, and the effects after 30 days of follow-up of ivabradine (IVA) versus metoprolol (METO) in early phases of anterior STEMI reperfused by percutaneous coronary intervention (PCI). METHODS AND RESULTS: Patients with a first anterior STEMI, Killip class I-II, an acceptable echocardiographic window, and admitted within 4hours of the o…

DIAGNOSTIC VALUE OF SEGMENTAL AND WHOLE BODY IMPEDANCE ANALYSIS IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE DYSPNEA

BIOELECTRICAL IMPEDANCE ANALYSIS FOR PREDICTION OF HOSPITAL ADMISSION DUE TO CARDIAC DECOMPENSATION IN AMBULATORY HEART FAILURE: A FOLLOW-UP STUDY

Short-term walking physical training and changes in body hydration status, B-type natriuretic peptide and C-reactive protein levels in compensated congestive heart failure.

BACKGROUND: Congestive heart failure (CHF) is associated with decreased exercise tolerance, alterations in body fluid balance and activation of neurohumoral and inflammatory pathways. Physical training, despite the contraindications of the past, is recommended for its beneficial effects on exercise capacity and quality of life. We investigate the effects of a short-term (ten weeks) walking physical training program (PT) on body hydration state (HS), B-type natriuretic peptide (BNP) and C-reactive protein (CRP) levels. METHODS AND RESULTS: 22 patients with CHF (mean age 62.7+/-4.8 years, 15 men, mean ejection fraction 38.9+/-3.6%, NYHA class II-III), were enrolled. Eleven patients were rando…

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…

415 Does angiotensin-converting enzyme I/D polymorphism afect blood pressure and diastolic function? Findings after six years of follow up in healthy subjects

Severe Brochostenosis by Oral Propafenone Immediately After Commencing Treatment

Propafenone is a membrane-stabilizing agent belonging to a subgroup of the Vaughan Williams class I antidysrhythmic agents, structurally resembling propranolol and characterized by weaker beta-blocking activity. Despite respiratory complications having been reported as examples of side effects, very few reports have been published in the literature.We describe the case of an elderly woman with a history of hypertension and allergy to Parietaria, grass, olive, mites, and with periodic asthmatic manifestations, for whom the administration of oral propafenone for recurrent supraventricular dysrhythmia was associated with the sudden onset of severe bronchostenosis.A 78-year-old woman was freque…

Steatosi epatica non-alcolica e aterosclerosi carotidea asintomatica in soggetti con e senza sindrome metabolica: uno studio caso-controllo

Effects of canrenoate plus angiotensin-converting enzyme inhibitors versus angiotensin-converting enzyme inhibitors alone on systolic and diastolic function in patients with acute anterior myocardial infarction

Background Aldosterone (ALDO) exerts profibrotic effects, acting via the mineralocorticoid receptors in cardiovascular tissues. Aldosterone antagonism in combination with angiotensin-converting enzyme inhibition may better protect against the untoward effects of ALDO than angiotensin-converting enzyme inhibition alone. Methods In a double-blind randomized study, the tolerability and efficacy of canrenoate (25 mg/d) plus captopril versus captopril alone were evaluated in 510 patients with an acute anterior myocardial infarction (MI), a serum creatinine concentration 5.5 mEq/L and creatinine levels to >2.0 mg/L after 10 days of treatment were observed. At 180 days, the mitral E-wave–A-wave ra…

Combination of indomethacin and statin compared with indomethacin and placebo in patients with a first episode of acute pericarditis: preliminary findings

The aim of the present study was to evaluate the safety and efficacy of the combination of indomethacin and statin compared with indomethacin plus placebo in patients with a first episode of pericarditis. A total of 55 consecutive patients with acute pericarditis were randomized in a double-blind manner into two groups: group I (statin group) was treated with 150 mg of indomethacin plus 10 mg of rosuvastatin, and group 2 (placebo group) was treated with 150 mg of indomethacin plus placebo. Both groups received treatment up to the normalization of inflammation markers and for the following week. Clinical and laboratory assessments [white cell count, ESR (erythrocyte sedimentation rate) and C…

acute coronary syndrome following large-volume paracentesis. Case report and pathophysiology

Early ultrasonographic markers of atherosclerosis in adul white recent onset of primary hypertension and familial history of cardiovascular event

Clinical Trial: High-dose furosemide plus small-volume hypertonic saline solutions vs. repeated paracentesis as treatment of refractory ascites.

Summary Background  In patients with cirrhosis, ascites is defined as refractory when it cannot be mobilized or recurs early in standard diuretic therapy. Aim  To compare the safety and efficacy of intravenous high-dose furosemide + hypertonic saline solutions (HSS) with repeated paracentesis in patients with cirrhosis and refractory ascites. Patients and methods  Eighty-four subjects (59/25 M/F) with cirrhosis, mostly of viral aetiology, admitted for refractory ascites, were randomly assigned to receive furosemide (250–1000 mg/bid i.v.) plus HSS (150 mL H2O with NaCl 1.4–4.6% or 239–187 mEq/L) (60 patients, Group A) or to repeated paracentesis and a standard diuretic schedule (24 patients,…

Role of segmental and whole body bioelecttrical impedance analisys (BIA) in acute heart failure diagnosis

High-Dose Torasemide is Equivalent to High-Dose Furosemide with Hypertonic Saline in the Treatment of Refractory Congestive Heart Failure.

Objective: A randomised, double-blind study was performed to evaluate the effects of the combination of high-dose torasemide and hypertonic saline solution (HSS) infusion versus high-dose furosemide (frusemide) and HSS in the treatment of refractory New York Heart Association class IV congestive heart failure (CHF). Materials and methods: Eighty-four patients (55 males, 29 females) with refractory CHF, aged 55–84 years, with an ejection fraction <35%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, a reduced urinary volume and a low natriuresis, were randomised to two groups. Group 1 (27 males, 15 females) received an intravenous infusion of furosemide 500mg plus HSS (150mL of 1.4…

Lymphocyte beta-adrenergic receptors in young subjects with peripheral or central obesity: relationship with central haemodynamics and left ventricular function

This study was designed to evaluate total (t) and surface (s) β-adrenergic receptor (BAR) density and their relationship with central haemodynamics and left ventricular function in young subjects with central or peripheral obesity. A total of 31 obese subjects (BMI ≥30.5 kg. m−2 for males and >27.3 kg. m−2 for females) aged less than 40 years and without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) were studied. Nine had peripheral obesity and 22 central obesity according to WHR values; there were 20 lean controls (BMI <25 kg. m−2 for males and <24.7 kg. m−2 for females). Casual (c) and 24 h ambulatory mean blood pressures (MBP-24 …

Different effects of losartan and delapril on plasma PAI-1 levels in patients with mild to moderate hypertension

ACE probably influences the fibrinolytic system at acentral point by converting angiotensin I to angiotensin II,which increases PAI-1 activity. This effect appears to bemediated via the AT1-receptor in humans. The RAAS mayalso contribute to a reduction in t-PA production by degra-dation of bradykinin, since the latter increases the release ofprostacyclin, nitric oxide, and t-PA from endothelial cells.Accordingly, ACE inhibitors not only influence the fibrino-lytic system by a reduction of PAI-1 activity but also byincreasing t-PA activity [1–3]. However, few studies haveanalysed the effects of AT1-R antagonists on t-PA and PAI-1plasma levels and the in vivo effects of AT1-R antagonistson th…

Does angiotensin-converting enzyme gene polymorphism affect blood pressure? Findings after 6 years of follow-up in healthy subjects.

Background: There has been an increase in research into the association between angiotensin-converting enzyme (ACE) gene deletion polymorphism and cardiovascular disease, with conflicting results. The present prospective long-term study was conducted to evaluate whether the DD genotype could also be associated with a higher prevalence of hypertension in healthy subjects, over 6 years of follow-up. Methods: Population: 684 healthy volunteers (aged, 25–55 years): normotensive and free of cardiovascular diseases, with acceptable echocardiographic window. All subjects had to have a normal electrocardiogram (ECG) and echocardiogram (ECHO) at entry. Study protocol: All subjects underwent a comple…

Combination of high bolus dose of tirofiban with half dose thrombolytics for the treatment of subacute stent thrombosis

Acute stent thrombosis is rare and it is usually related to complications during the procedure. Subacute thrombosis is far more common and is associated with a high incidence of acute myocardial infarction and death. Restoration of flow by thrombolysis, emergency bypass surgery or emergency percutaneous transluminal coronary angioplasty (PTCA) has had only limited success with respect to myocardial salvage. We report the case of a patient who suffered from recurrent subacute stent thrombosis, in whom administration of tirofiban at high-dose bolus in association with a half dose of recombinant tissue plasminogen activator succeeded in restoring normal myocardial flow and stable clinical cond…

Advantages of immediate two-dimensional echocardiography in patients with acute cardiac ischemic events

Abstract We hypothesized that the assessment of kinetic alterations on two dimensional echocardiogram (2DE) would provide greater diagnostic information than clinical symptoms and ECG changes only. The study was aimed to determine sensitivity of 2DE in patients with cardiac ischemic events and to improve the indications to thrombolysis. Three-hundred ninety-one patients (87 F; 304 M) hospitalized for suspected acute myocardial infarction (AMI), first episode, within 4 h from the onset of symptoms, suitable for thrombolysis Killip class I–II and with unstable angina (UA), were admitted in the study. Patients had to show ECG changes and alterations of segmentary motion on 2DE performed at ent…

Use of bivalirudin for heparin-induced thrombocytopaenia after thrombolysis in massive pulmonary embolism: a case report

A 68-year-old man was referred to the emergency department 6 h after onset of sudden acute dyspnoea. Immediate ECG showed sinus tachycardia with the typical S1-Q3-T3 pattern and incomplete right bundle branch block. The echocardiogram showed the presence of mobile thrombus in the right atrium, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Lung spiral computed tomography (CT) showed bilateral pulmonary involvement and confirmed the picture of a thrombotic system in the right atrium and caval vein. Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) and heparin (alteplase 10 mg bolus,…

Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure.

Studies have shown that patients with compensated heart failure (HF) receiving high diuretic doses associated with normal sodium diet and fluid intake restrictions demonstrated significant reductions in readmissions and mortality compared with those who received low-sodium diets, and over a 6-month observation period, a reduction in neurohormonal activation was also observed. The aim of this study was to evaluate the effects of different sodium diets associated with different diuretic doses and different levels of fluid intake on hospital readmissions and neurohormonal changes after 6-month follow-up in patients with compensated HF. Four hundred ten consecutive patients with compensated HF …

Effects of captopril on plasma endothelin-1 during thrombolysis: Preliminary findings

A case of febrile illness and multiple pulmonary embolism in a young woman acting hormonal contrapceptives.

Exercise performance in hypertensives: felodipine vs cilazapril cross-over study

The Usefulness of Bioelectrical Impedance Analysis in Differentiating Dyspnea Due to Decompensated Heart Failure

Acute dyspnea poses a diagnostic challenge for physicians, and the current methods in differentiating cardiac from non-cardiac causes have been limited to date. Recently, the brain natriuretic peptide (BNP) rapid test has been validated in the emergency room. Nevertheless, the early accumulation of fluid in the interstitial space in the body and in the lungs, which characterizes patients with ADHF, is well estimated by BIA. We investigate whether bioelectrical impedance analysis (BIA) can serve as a noninvasive diagnostic tool in the differential diagnosis of acute decompensated heart failure (ADHF) in the emergency department (ED).A total of 292 patients presenting with acute dyspnea to th…

Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure.

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Background: There are several new strategies proposed to improve the outcome of patients with ST-elevation myocardial infarction (STEMI). One approach is the resurgent use of facilitated percutaneous coronary interventions (PCI). Until recently, deciding whether immediate PCI after combined treatment (facilitated PCI) is more appropriate than delayed PCI (short time) has not been investigated. The aim of this study, therefore, was to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 hr, and in patients initially successfully treated with pharmacological therapy and with delayed PCI (12–72 h). Methods: 451 reperfused STEMI patients, a…

Early and personalized ambulatory follow-up to tailor furosemide and fluid intake according to congestion in post-discharge heart failure

Congestive heart failure (CHF) worsening is a worldwide cause of rehospitalization and mortality, specially during the early period after hospitalization. Fluid accumulation plays a key role in the pathophysiology of both acute heart decompensation and disease progression. The effective use of drugs to maintain restored clinical stabilization in recently discharged patients is a difficult task, and it relies on matching the most appropriately tailored therapy to specific clinical profiles. However, no successful treatment has been shown to reduce post-discharge readmission. We evaluated in a case-control study the effectiveness of an early and personalized congestion-guided ambulatory progr…

Medium-term effects of bisoprolol administration on renal hemodynamics and function in mild to moderate essential hypertension

Arterial hypertension is a significant cause of end-stage renal failure; effective treatment of hypertensive patients reduces the rate of progression of this disorder. ss-Blockers, particularly nonselective agents, are associated with deterioration of renal function in patients with chronic renal failure. Previous studies on the interaction of the beta1-selective adrenergic antagonist bisoprolol with kidney function have been performed only acutely and over the short term. This study was designed to evaluate the antihypertensive efficacy and effects on renal hemodynamics and function of bisoprolol during medium-term (6 mo) treatment of patients with mild to moderate essential hypertension. …

Cardiopulmonary Exercise Testing in Patients with Chronic Heart Failure: Prognostic Comparison from Peak VO2 and VE/VCO2 Slope

Background: Cardiopulmonary exercise testing with ventilatory expired gas analysis (CPET) has proven to be a valuable tool for assessing patients with chronic heart failure (CHF). The maximal oxygen uptake (peak V02) is used in risk stratification of patients with CHF. The minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) has recently demonstrated prognostic significance in patients with CHF. Methods: Between January 2006 and December 2007 we performed CPET in 184 pts (146 M, 38 F, mean age 59.8 ± 12.9 years), with stable CHF (96 coronary artery disease, 88 dilated cardiomyopathy), in NYHA functional class II (n.107) - III (n.77), with left ventricular ejection frac…

Evaluation of BNP levels and bioelectrical impedance measurements after a novel therapy of refractory congestive heart failure

Wet BNP, fluid and hemodynamic status at discharge in Acute Heart Failure

We comment the noteworthy results of Pimenta et al. concerning the significance of discharge BNP levels in acute HF patients. The innovation of Pimento's study is the systematic research of the potential relationship between BNP and clinical and hemodynamic parameters. We focused the attention on the importance of wet "BNP" in managing HF and its ability to reflect congestion and multiple underlying patho-physiological disturbances. The first observation, regarding the statistical order, underlines the importance of renal insufficiency at discharge in genesis of higher BNP levels. Secondly, we note that the relationship between natriuretic peptides and the non-invasive measurement of the fl…

Sodium: an ld emery or a new friend for advanced failured patients?

Effects of cilazapril on renal haemodynamics and function in hypertensive patients: a randomised controlled study versus hydrochlorothiazide.

In this study the efficacy and safety of short-term cilazapril administration on renal haemodynamics were evaluated in mild to moderate hypertensive subjects. Our final goal was to evaluate whether the reduction in blood pressure achieved by treatment was associated with maintained renal function. After a run-in period with placebo, 40 hypertensive subjects without renal or cardiac diseases were randomly allocated to a double-blind 4 week controlled trial with cilazapril 5 mg once a day (20 patients) or hydrochlorothiazide 25 mg once a day (20 patients). Renal haemodynamics measurements included effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) by radionuclide study us…

Sensitivity, Specifity and Predictive value of the Echocardiography and Troponin- T test combination in patients with non-St Elevetion Acute Coronary Syndromes

Intavenous high dose furosemide plus small volume of hypertonic saline solutions (HSS) versus seriated paracentesis in treatment of refractory ascites: a pilot study

Intravenous high dose furosemide plus small volume of hypertonic saline solution (HSS) versus seriated paracentesis in treatment of refractory ascites: a pilot study

Long-Term Effects of Dietary Sodium Intake on Cytokines and Neurohormonal Activation in Patients With Recently Compensated Congestive Heart Failure

Abstract Background A growing body of evidence suggests that the fluid accumulation plays a key role in the pathophysiology of heart failure (HF) and that the inflammatory and neurohormonal activation contribute strongly to the progression of this disorder. Methods and Results The study evaluated the long-term effects of 2 different sodium diets on cytokines neurohormones, body hydration and clinical outcome in compensated HF outpatients (New York Heart Association Class II). A total of 173 patients (105 males, mean age 72.5±7) recently hospitalized for worsening advanced HF and discharged in normal hydration and in clinical compensation were randomized in 2 groups (double blind). In Group …

Two-dimensional echocardiographic evaluation of left ventricular ejection fraction by the ellipsoid single-plane algorithm: a reliable method for assessing low or very low ejection fraction values?

The reliability of two-dimensional (2D) echocardiographic estimation of left ventricular ejection fraction (EF) is commonly recognized, but no satisfactory data are available about the accuracy of low or very low EF values determined by 2D echocardiography (ECHO-EF). The purpose of our study was to assess the reliability of low ECHO-EF values obtained using a simple time-economical algorithm such as the ellipsoid single-plane area-length method. Radionuclide angiography (RAD-EF) was taken as the standard of comparison. We studied 59 consecutive patients (31 women and 28 men) referred to our echocardiographic laboratory. Both 2D echocardiography and radionuclide angiography were blindly perf…

Effects of captopril on myocardial protection during cardioplegia

Abstract The study aimed at checking effects exerted by captopril (C) on human myocardial ACE system as well as the role played by tissue ACE inhibition in reducing reperfusion damage. A human experimental model was used during cardioplegia due to aorto-coronary-by-pass (CABG). Fifty-four patients with coronary artery disease affecting 3 vessels having suffered from acute myocardial infarction anterior (AMI-ant), homogeneous as far as ejection fraction (35–55%), number of grafts (3), clamping time, age and sex, were randomised in a double blind experiment, and were given captopril or placebo (P). A total of 4 mg/l Captopril was mixed into the cardioplegic solution with blood according to th…

Captopril does not affect plasma endothelin-1 during thrombolysis and reperfusion.

Studies showed that endothelin-1 (ET-1) was increased in the acute myocardial infarction (AMI). Experimental studies reported that captopril was able to reduce ET-1 secretion, and that ET-1 was increased during reperfusion. This study was aimed to verify if captopril was able to reduce plasma ET-1 during thrombolysis in AMI. Seventy-three patients, hospitalized for suspected AMI within 4 h from the onset of symptoms suitable for thrombolysis (1st episode), Killip class 1-2, were randomized (double blind) into two groups: group 1 (37 pts), 8 F/29 M, received captopril, 6.25 mg, orally 15 min before thrombolysis. Group 2: (36 pts) 8 F/28 M, received placebo before thrombolysis. All patients m…

Biolectrical impedance analysis as a new diagnostic tool for heart failure diagnosis in parimary care: preliminary data

803 Effects of high dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus, in refractory congestive heart failure. Long term effects

Association between reduced lymphocyte beta-adrenergic receptors and left ventricular dysfunction in young obese subjects

This study was designed to evaluate total (t) and surface (s) beta-adrenergic receptors (BAR) density and their relationships with left ventricular function in young obese subjects. BAR density, plasma insulin, catecholamines and left ventricular function were evaluated in 27 young obese subjects (BMI30.5 kg/m2 for males and27.3 kg/m2 for females) without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) and in 20 lean controls (BMI25 kg/m2 for males and24.7 kg/m2 for females). Both groups were matched for gender, age and body height. BAR density was evaluated according to Böyum and De Blasi methods. Plasma catecholamines by high perfus…

Effects of Losartan and Delapril on the Fibrinolytic System in Patients with Mild to Moderate Hypertension

Background and objectives: Angiotensin-converting enzyme (ACE) probably influences the fibrinolytic system at a central point by converting angiotensin I to angiotensin II, which increases plasminogen activator inhibitor-1 (PAI-1) activity. This effect appears to be mediated in humans via the angiotensin II type 1 (AT1) receptor. The objective of this study was to evaluate, in patients with mild to moderate hypertension, the change in tissue plasminogen activator (t-PA) and PAI-1 plasma levels after treatment with an AT1-receptor blocker (losartan 50 mg/day) or an ACE inhibitor (delapril 60 mg/day). Patients and methods: 30 hypertensive patients and 15 controls were enrolled. Essential hype…

Delayed facilitated percutaneous coronary intervention is better than immediate in reperfused myocardial infarction

The pathophysiology of acute heart failure: the key role of fluid accumulation

Time to ferry heart failure onto new shores: The need to effectively customize long-term therapy

Immediate versus delayed facilitated percutaneous coronary intervention. A pilot study

The study was aimed to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI <2 hours, and in patients initially successfully treated with pharmacological therapy and delayed PCI (12-72 hours). All patients had to have successful reperfusion, to receive the combination of a standard abciximab infusion plus half dose rtPA. Similar results were observed in both groups. Delayed PCI group showed a favorable trend in restenosis and bleedings (ns) and a significant reduced angiographic evidence of thrombus formation in IRA. Our very preliminary data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI. The studied …

158: Is Bioelectrical Impedance Analysis Helpful for Heart Failure Management in the Emergency Department?

Effects of administration of captopril, metoprolol, and the captopril-metoprolol combination as adjuvant therapy during thrombolysis in acute myocardial infarction

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.…

The combination ace-inhibitors plus canreonate in patients with anterior myocardial infarction: safety and tolerability study.

There is recent evidence that aldosterone (ALDO) exerts pro-fibrotic effects, acting via the mineral-corticoid receptors in cardiovascular tissues and partial aldosterone escape during ACE-inhibition treatment occurs.A double blind randomised study was performed to evaluate the feasibility, and tolerability of the administration of the 25 mg/day of canreonate plus captopril versus captopril alone in patients with anterior AMI unsuitable for thrombolysis and/or not receiving thrombolytic treatment, and unreperfused after thrombolysis. Fifty five patients hospitalised for anterior AMI,with a serum creatinine concentration2.0 mg/dl and a serum K concentration5.0 mmol per liter were randomised …

Sensitivity, specificity and predictive value of the echocardiography and troponin-T test combination in patients with non-ST elevation acute coronary syndromes.

Introduction: Patients with a negative troponin (TnT) result showed 1.4% mortality during a mean follow-up of 9–10 weeks. Mortality was greater in patients with an evidence of ischemic ECG changes and a negative TnT test (1.6–4.4%). Few studies have examined the efficacy of echocardiography (2DE) in patients with chest pain. The purpose of the present study was to determine the clinical utility, sensitivity and specificity of the combination of TnT levels and 2DE in patients presenting with chest pain, ST-depression, T-wave negative and no diagnostic ECG. Methods: 280 consecutive patients with chest pain and presence of ST depression, T-wave inversion, and non-diagnostic ECG, acceptable 2DE…

Does plasma endothelin during thrombolysis depend on infarct size? A pilot study

Dear Sir, Endothelin is a recently discovered endotheliumderived vasoconstrictive peptide [1]. Endothelin's actions are altered in various models of cardiac injury [2]. Furthermore, it has been shown that endothelin is increased during reperfusion [2]. Studies have shown a significant increase in endothelin-1 (ET-1) in the early phases of acute myocardial infarction (AMI) and percutaneous transluminal coronary angioplasty (PTCA) [3-8]. In addition, a significant inverse relation between ventricular function and plasma ET-1 has been shown [6]. These data suggest that ET-1 may provide a marker of endothelial injury in the early phases of coronary ischemia or may even contribute to alterations…

An unusual presentation of massive pulmonary embolism mimicking septal acute myocardial inferction treated with tenecteplase

A 31-year-old man (175 cm, 82 kg) was referred to the emergency department 2 h after the sudden onset of acute dyspnea. Immediate ECG showed sinus tachycardia with ST elevations from V1 through V2 and a diagnosis of septal acute myocardial infarction was made. ECG on admission to the cardiology department showed the same results plus the S1-Q3-T3 pattern. Echocardiogram revealed a normally contracting left ventricle, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Thrombolytic therapy with tenecteplase 8000 IU and heparin 5000 IU was administered 5-10 min after hospitalisation and the patient was haemodynamic…

cardiovascular effects of I/D angiotensin converting enzyme gene polymorphismin healty subjects: Findings after follow-up of six years

Background - An increasing number of studies with conflicting results regarding the association between angiotensin-converting enzyme (ACE) gene deletion polymorphism and cardiovascular disease has recently been published. The present prospective long-term study was conducted to evaluate whether the DD genotype could also be associated with a higher prevalence of hypertension in healthy subjects over 6 years of follow-up. We also investigated the effects of the ACE-I/D genotypes on diastolic function by echocardiography in healthy subjects without any risk factors and any events after 6 years of follow-up. Methods - Population: 684 healthy volunteers (aged 25-55 years) normotensive and free…

Early carotid atherosclerosis and cardiac diastolic abnormalities in hypertensive subjects

Despite the fact that it is known that hypertension may be associated to early atherosclerosis manifestations, few data are to date available on the relationship between early carotid abnormalities and left ventricular diastolic dysfunction. To address this issue, 142 hypertensive patients (64 females and 78 males) younger than 55 years, at the first diagnosis of mild-to-moderate essential hypertension (WHO/ISH criteria), were selected from a database consisting of 3541 subjects referred to ultrasound cardiovascular laboratory in the last 5 years. Carotid intima-media thickness (IMT) was detected by high-resolution vascular ultrasound and left ventricular structure and function by the use o…

Whole-body and segmental bioelectrical impedance analyisis to predict rehospitalization due to worsening of congestive heart failure in anbulatory patients

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…

Safety and tolerability of abciximab in patients with acute myocardial infarction and failed thrombolysis.

Abstract Aim: The aim of this study was to evaluate glycoprotein IIb/IIIa receptor inhibitor effectiveness in AMI patients with unsuccessful thrombolysis. Methods: Eighty-four patients hospitalised within 4 h of symptom onset were randomised (single blind) into two groups. Regardless of the group, placebo or GP IIb/IIIa inhibitors were administered to patients who did not present with reperfusion signs 30 min after starting thrombolysis and 30–60 min after the end of full thrombolysis in patients with pain recurrence and ST-segment elevation. Reperfusion was assessed by the creatine kinase peak occurring within 12 h, by the observation of rapid ST-segment reduction (50–70% within 1 h) in 12…

Thrombolysis for massive pulmonary embolism in pregnancy: a case report

Relationship between left ventricular hypertrophy, diastolic function and extracardiac atherosclerosis in newly diagnosed hypertensives

Unusual case of recurrent pyrexia of unknown origin and cytopenia due to acute splenic sequestration crisis in a young patient with splenomegaly and beta-globin mutation for Hb-Valletta

Effects of Administration of Glycoprotein IIb/IIIa Receptor Antagonists in Patients with Failed Thrombolysis

Aim To evaluate the effectiveness of glycoprotein (GP) IIb/IIIa receptor antagonists in patients with acute myocardial infarction (AMI) who have undergone unsuccessful thrombolysis.

Safety and efficacy of exercise testing with atropine in patients with recent uncomplicated ST elevation acute myocardial infarction

Background: Exercise testing (ET) remains the most accessible and widely used technique for the detection of coronary artery disease (CAD) and for the assessment of its severity. Failure to reach 85% of maximal predicted heart rate (MPHR) during exercise may render an ET nondiagnostic for ischemia detection in patients with recent uncomplicated ST elevation acute myocardial infarction (STEMI). We sought to investigate the injection of atropine in patients who fail to achieve 85% of age-predicted heart rate during ET, defining its safety and efficacy to raise heart rate to adequate levels as well as to determine its effect on ET interpretation. Methods: Between January 2005 and December 2008…

Thrombolysis for massive pulmonary embolism in pregnancy: a case report

Mortality from pulmonary embolism (PE) in pregnancy might be related to challenges in targeting the right population for prevention. Such targeting could help ensure that the correct diagnosis is suspected and adequately investigated, and allow the initiation of the timely and best possible treatment of this disease. In the literature to date only 18 case reports of thrombolysis in pregnant women with PE have been reported, and showed beneficial effects for both mother and fetus in terms of mortality and complications with acceptable bleeding risks. We present here the case of a pregnant patient with massive PE who underwent successful thrombolysis. A 26-year-old pregnant (at 24 weeks) woma…

Safety and feasibility of atropine added in patients with sub-maximal heart rate during exercise myocardial perfusion SPECT.

Failure to reach 80% of maximal predicted heart rate (HR) during exercise may render a myocardial perfusion single photon emission computed tomography (SPECT) study non-diagnostic for ischemia detection. We sought to investigate the injection of atropine in patients who fail to achieve 80% of age-predicted HR during exercise performed for myocardial perfusion SPECT (MPS), defining its safety and efficacy to raise HR to adequate levels as well as its effect on MPS interpretation.Between January 2002 and December 2004, we studied 3,150 consecutive patients (2,253 men and 897 women, mean age 55 +/- 6 years) who were referred to a single office-based nuclear cardiology laboratory for MPS using …

Evaluation of regional haemodynamics and alterations of vascular wall of the lower limbs in hypertensive subjects

This study was designed to analyse the relationship between arterial hypertension and changes in arterial blood flow and vascular wall damage of the lower limbs in hypertensive patients with various degrees of hypertension. Six hundred and fifty-four hypertensive patients (421 males and 233 females) aged 35 to 70 years and 88 healthy subjects (63 males and 25 females) aged 39 to 60 years were studied. Strain-gauge plethysmography of the lower limbs was used to calculate arterial calf blood flow (RF), arterial calf blood flow after post-ischaemic hyperaemia (PF), basal and minimal vascular resistances (BVR and MVR), time to reach peak flow (tPF), time until 50% reduction of peak flow (tT1/2)…

Relationship between ACE-DD polymorphism and diastolic performance in healthy subjects.

Background—The ACE-D allele has been associated with cardiovascular disease. The study evaluates the relationship between the ACE-ID genotypes and diastolic function in healthy subjects after 6 years of follow-up. Methods—Two hundred and seventy-five healthy volunteers aged 25–55 years had normal physical examination, 12-lead ECG, acceptable echocardiographic windows and echocardiogram at entry. Venous blood was drawn for DNA analysis. Results—Two hundred and forty-two subjects completed 6 years of follow-up. Three genetically distinct groups were obtained: ACE-DD group (n=71, 26F/45M, mean age 48±7 years); ACE-ID (n=115, 39F/76M, mean age 40±7 years); and ACE-II (n=56, 20F/36M, mean age 47…

Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure.

BACKGROUND: The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure. METHODS AND RESULTS: Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/…

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…

Angiotensin-converting enzyme gene deletion polymorphism determines an increase in frequency of migraine attacks in patients suffering from migraine without aura.

Many authors have reported an association between the angiotensin-converting enzyme (ACE)-D allele and coronary heart disease and other cardiovascular diseases. The mechanism underlying the positive associations between the ACE-D alleles and diseases are not yet clear. Previous reports showed an association between migraine without aura and ACE-D allele polymorphism. The study is aimed to evaluate if the DD genotype could also be associated with the frequency and duration of migraine without aura. In 302 patients suffering from migraine without aura (at least for 1 year), with no history of cardiovascular diseases and major risk factors for ischemic events, the genotypes of the ACE gene, pl…

A new method to measure cardiac inositol levels in intact animals.

Inositol levels have been studied in cellular cultures and recently by perfusion of isolated hearts. The study was aimed to assess inositol turnover in rabbit hearts from intact animals. Thirty rabbits were injected i.v. three times (every 12 hr) with 25 microCi/kg of myo-3H-inositol. The rabbits 12 hr after the last injection were killed and the hearts perfused according to Langerdorff technique. Systolic and diastolic ventricular pressures (SVP, DVP), dp/dt, and coronary flow (CFl) were measured. The hearts (n = 14) were perfused under aerobic conditions and 16 hearts under ischemic conditions for 30 min. In addition, 5 hearts were perfused under aerobic conditions for 10 min, and 6 heart…

The challenge of the volume status assessment in heart failure.

Long-term evaluation of quinapril in mild to moderate hypertension: assessment of renal haemodynamics and function.

Six-month echocardiographic study in patients with submassive pulmonary embolism and right ventricle dysfunction: comparison of thrombolysis with heparin.

Abstract Introduction The aim of this study was to assess the effect of thrombolysis versus heparin treatment on echocardiographic parameters and clinical outcome, during hospitalization and within the first 180 days after admission, in patients with first episode of submassive pulmonary embolism (SPE) and right ventricle dysfunction (RVD). Methods Consecutive patients (age, 18–75 years) with a first episode of SPE, symptoms onset since no more than 6 hours, normal blood pressure (> 100 mm Hg), echocardiographic evidence of RVD and positive lung spiral computed tomography were double-blind randomized: 1 group received 100 mg of alteplase (10-mg bolus, followed by a 90-mg intravenous infusio…

Intravenous high dose furosemide plus small volume of hypertonic saline solution (HSS) versus seriated paracentesis in treatment of refractory ascites.

One year atorvastatin treatment in patients with familial hypercholesterolrmia: effects on CRP and fibrinogen

Novel strategies: challenge loop diuretics and sodium management in heart failure--part II.

Ultrasonography NAFLD subclinical carotid atherosclerosis and inflammatory markers in patients with and without metabolic syndome.

ASSOCIAZIONE TRA HS-PCR E DIMENSIONI DELL'ATRIO SINISTRO IN IPERTESI MAI TRATTATI IN RITMO SINUSALE

Relationship between ultrasonographic measurements of inferior vena cava and bioelectrical impedance analysis parameters in patients with decompensated congestive heart failure.

Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure

Background: Diuretics, have been accepted as first-line treatment in refractory heart failure, but a lack of response is a frequent event. A randomised single blind study was performed to evaluate the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) infusion in the treatment of refractory NYHA class IV congestive heart failure (CHF). Materials and methods: Sixty patients (21 F/39 M) with refractory CHF (NYHA class IV) of different etiologies, unresponsive to high oral doses of furosemide, ACE-inhibitors, digitalis, and nitrates, aged 65–90 years, were enrolled. They had to have an ejection fraction (EF) < 35%, serum creatinine < 2 mg/dl, B…

851 Role of segmental and whole body bioelectrical impedance analysis (BIA) in acute heart failure diagnosis

Safwty of bioelectrical impedance analysis inevaluation of patient with liver chirrosis and relation with severity of disease

Bioelectrical Impedance Analysis and prediction of hospitalization for heart failure in ambulatory patients with symptomatic left ventricular dysfunction: preliminary data

impedance analyisis to predict rehospitalization due to worsening of congestive heart failure in anbulatory patients

Ultrasonography of the inferior vena cava and analysis of bioelectrical impedance in the assessment of decompensated heart failure.

A new option in measuring bioimpedance in congestive heart failure

We read with particular attention the interesting article of Tang and Tong1 concerning the measurement of impedance for assessing volume status in heart failure (HF). This technology is useful in detecting subclinical congestion and predicting future HF events.

Role of segmental and whole body bioelectrical impedance analysis in acute heart failure diagnosis.

Commotio cordis without arrhythmic event and resuscitation: ECG, echocardiographic, angiographic and cardiovascular resonance imaging study

We describe a case of commotio cordis in which the patient had an extensive cardiac evaluation, including ECGs, a coronary angiogram, a left ventriculogram, repeated echocardiography and cardiovascular MRI (CMRI). A healthy 17-year-old boy sustained an open-handed blow to the anterior part of the chest from a friend with whom he was playing. On admission ECG was performed that showed ST-T alterations and a TNI increase, with echocardiographic evidence of a localised pericardial effusion associated with a persistent myocardial blush at selective angiography. In addition, CMRI confirmed a local delayed enhancement in the same zone. An echocardiogram examination performed 30 days after dischar…

Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects.

Background Diuretics have been accepted as first-line treatment in refractory congestive heart failure (CHF), but a lack of response to them is a frequent event. A randomized, single-blind study was performed to evaluate the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) infusion in the treatment of refractory New York Heart Association (NYHA) class IV CHF and a normosodic diet during follow-up. Materials and Methods One hundred seven patients (39 women and 68 men, age range 65-90 years) with refractory CHF (NYHA class IV) of different etiologies, who were unresponsive to high oral doses of furosemide, angiotensin-converting enzyme inhib…

Are BNP plasma levels useful in heart failure diagnosis each time? A dyspneic patient with anasarca.

Changes in natriuretic peptides and cytokines plasma levels in patients with heart failure, after high dose of furosemide plus small volume saline solution (HSS) and after an acute saline loading