Efficacy of ranolazine for rhythm control in an elderly patient with paroxysmal atrial fibrillation.

We report the case of an elderly woman with coronary heart disease and paroxysmal atrial fibrillation. It could be hypothesized that the predisposing anatomic substrate for arrhythmogenesis in this patient derived from both age-related left atrial dilation and coexistent ischaemic heart disease. Unfortunately the usual antiarrhythmic therapy was unsafe or not feasible for this subject. Ranolazine 750 mg twice daily completely suppressed atrial fibrillation recurrences.

Stroke unit: a cardio-cerebral approach.

Stroke units are special units where stroke patients receive, simultaneously, medical and physical treatment. Compared to general neurological and medical wards, stroke units show a significant reduction of short- and long-time mortality, and an improvement of long-term quality of life. Nevertheless, mortality in these units is still high (1-year mortality approximately 32%; 5-year mortality degrees 60%), and consequently, new approaches are needed to control stroke parameters during the acute phase, with the goal to reduce mortality rates. The philosophy of our stroke unit in Fermo (Italy), is to establish a strong association between heart and brain care by approaching each stroke patient as a cardiocerebral patient. In particular, we perform 12-lead Holter ECG monitoring, to prevent the vicious cycle affecting correct cerebral and cardiac functions, and to react to cardiac complications, mostly arrhythmias, that can worsen cerebral damage. Holter ECG monitoring allows a fast physiotherapeutic approach, a better evaluation of metabolic parameters, and collectively, a better global evaluation of the patient during the acute phase of disease. In two years of activity, 80 patients that were admitted to our stroke unit during 1998, and treated as cardio-cerebral patients, were followed-up. This combined treatment decreased the 1-year mortality rate by about 30%, in comparison with the 22% mortality rate reported in the literature. These results confirm the validity of stroke units, as well as of our approach based on cardio-cerebral control of each stroke patient.

[Transesophageal echocardiography in patients with chronic atrial fibrillation and cerebral ischemia]. / Ecocardiografia transesofagea in pazienti con fibrillazione atriale cronica e malattia ischemica cerebrale.

The authors wanted to verify the possibility of discovering, by means of transesophageal echocardiography, cardiac causes that can't be clearly shown with 2D echocardiography, in patients who suffered a cerebral ischaemic pathology and who had a cronic atrial fibrillation. The left atrial appendage is not well visualized by the 2D echocardiographic approach. Transesophageal echocardiography has been shown to be superior to transthoracic imaging in the evaluation of the mass lesions in the left atrium and his appendage and often the best visualization of the mitral valve leaflets and aortic semilunar cusps.

Non invasive evaluation in cerebrovascular study: possibility and prospects.

The authors outline the importance of the global investigation of the cerebrovascular system in order to obtain more exact information about the ethiopathology of vascular ischaemic brain disease. Each patient is always submitted to the following investigations: Duplex scanner of epiaortic vessels, Transcranial doppler and echocardiographic screening in our vascular laboratory; moreover, when haemodynamic carotid artery stenosis is present, duplex scanner of femoro-popliteal vessels and microcirculatory study of the brain with Zenon133, via inhalation, were undertaken. In the second part of the study the authors refer a relationship between the instrumental doppler signal and the real risk evidenced by techniques which can provide information on the composition, structure and stability of the plaques and correlate this information with the data from the doppler analysis. Instrumental techniques such as thermal analysis, atomic absorption spectroscopy, ICP analysis and IR spectroscopy were used to carry out this study.