Effect of therapy with streptokinase, diltiazem, and heparin on ventricular arrhythmias in unstable angina.

We evaluated the effect of three different anti-ischemic therapeutic regimens on ventricular arrhythmias in 25 patients hospitalized for unstable angina. All patients were randomized to receive (in addition to infusion of heparin, diltiazem, and nitrates), either placebo, or streptokinase (SK) 1,500,000 U in 1 h, or SK 250,000 U in 30 min followed by 100,000 U/h for 48 h. Patients underwent ECG monitoring during the first 72 h after admission and for 24 h after 15 days of oral therapy with diltiazem, aspirin, and transdermal nitrates. Premature ventricular complexes (PVC) and ventricular tachycardia episodes (VT) were significantly reduced during the early phase of hospitalization and after 15 days, in patients treated with prolonged SK infusion. Ventricular arrhythmias are a frequent finding in unstable angina; they are correlated neither to the severity of coronary disease nor to ventricular function; prolonged infusion of SK added to heparin, diltiazem, and nitrates seems to reduce the number and severity of ventricular arrhythmias.

[Echocardiographic and polygraphic study of acute/effects of Ibopamine on cardiac performance]. / Studio ecocardiografico e poligrafico degli effetti acuti della Ibopamina sulla performance cardiaca.

The effects of Ibopamine, a new orally active dopaminergic agent, on cardiac performance were studied both in a group of healthy volunteers and in a group of patients with congestive heart failure (CHF), using non-invasive methods, such as echocardiography and polygraphy. Randomly, and in double-blind fashion, the healthy volunteers received single doses of Ibopamine 50, 100 and 150 mg orally every 3 days. The CHF patients, also randomly and in double-blind fashion, were given single doses of either placebo or Ibopamine 100 or 150 mg every 2 days. Echocardiographic and polygraphic data were recorded in baseline conditions and 3, 6 and 8 hours after the drug administration. The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at the same time. The following parameters were considered: echocardiography: left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum excursion (IVSE), left ventricular posterior wall excursion (LVPWE), per cent fractional fiber shortening (%FS); polygraphy: electromechanical systole (Q-A2), total ejection time (ET), pre-ejection period (PEP), ET/PEP ratio. In CHF patients, body weight and 24-h diuresis were also measured daily. Neither of the two groups showed significant changes in HR, SBP and DBP with any drug dose. A shortening of ET (-2.2%, p less than 0.01) and Q-A2 (-2.8%, p less than 0.001) was found in the group of normal subjects with a dose of 50 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Right heart impairment in sarcoidosis: haemodynamic and echocardiographic study.

62 patients with histologically confirmed sarcoidosis (7 with Stage 0, 9 with Stage I, 20 with Stage II, 26 with Stage III) underwent right heart haemodynamics (Swan Ganz) and M-mode echocardiography. Haemodynamic study showed mild to moderate pulmonary hypertension in many patients with Stage II and III sarcoidosis, and 5 patients with Stage 0 healed sarcoidosis, showed borderline values of right sided pressures. Echocardiographic study showed increased right ventricular index (RVI) and right ventricular anterior wall thickness (RVAWT) in most patients. The good correlations between echocardiographic and haemodynamic data suggest that echocardiography may be a useful technique for the non-invasive assessment of the effects of pulmonary hypertension on the right heart in sarcoidosis.

[Echo-angiocardiographic correlations in congenital abnormalities of the mitral valve (author's transl)]. / Correlazioni eco-angiocardiografiche nelle anomalie congenite della mitrale.

Echocardiographic findings satisfactorily compared with angiocardiographic data in six infants affected by congenital abnormalities of the mitral valve. Peculiar echocardiographic features were as follows: a) mitral stenosis: reduced E-F slope of the anterior mitral leaflet, paradoxical diastolic movement of the posterior leaflet, enlargement of the left atrium; b) "parachute mitral valve": small, dysmorphic, stiff mitral valve, with an extra echo projecting between those of the two leaflets; c) "cor triatriatum": enlarged left atrium whose cavity is divided in two portions by an extra echo; d) "hypoplastic left heart syndrome": the mitral leaflets are thin, short. The ventricular cavity and the diameter of the aorta are small; the right ventricle and the pulmonary artery are on the contrary markedly dilated.

[Effects of dopamine, noradrenaline and isoproterenol on pulmonary circulation in anesthetized dogs]. / Effetti della dopamina, della noradrenalina e dell'isoproterenolo sul circolo polmonare di cani anestetizzati.

Experiments were performed on 19 anaesthetized open-chest dog instrumented with polyethylene catheters inserted: into the aorta, in pulmonary artery and in left atrium and with an electromagnetic flow-transducer placed around the ascending aorta in order to record : systemic arterial and pulmonary pressures, mean left auricular pressure and phasic aortic flow. Heart rate, stroke volume, total systemic and pulmonary resistance, cardiac work were moreover calculated. Each dog was given intravenously by slow infusione : Dopamine (micrograms 5--10--20/kg/min/ 5 min), Isoproterenol (microgram 0.125--0.25--0.5/kg/min/5 min) and Norepinephrine (microgram 0.25--0.5--1 /kg/min/5 min). Results obtained on systemic hemodynamics agree with those reported by many other investigators. On pulmonary circulation : Isoproterenol, at the tested doses, elicited vasodilator effects, Norepinephrine increased total pulmonary resistance but not pulmonary vascular resistance, while Dopamine did not modify or slightly reduced vascular pulmonary tone.

[Echocardiography in Ebstein's anomaly (author's transl)]. / L'ecocardiografia nella malattia di Ebstein.

Results about an echocardiographic study of 20 patients with Ebstein's anomaly diagnosed by cardiac catheterization and angiography, are referred. In 8 patients an echocardiogram and phonocardiogram were recorded and in five patients an echocontrast examination was performed. The echocardiographic features constantly recorded in Ebstein's anomaly are represented by anterior chamber dilatation, interventricular septum paradoxical movement, anterior tricuspid leaflet wide excursion, decreased diastolic closure rate and delayed closure of tricuspid valve compared to mitral valve. The reduced left ventricular dimension and frequent incidence of "hammock-like" shape of mitral valve during systole and reduced diastolic closure rate of anterior mitral leaflet are pointed out. Possible causes of anterior chamber dilatation, of interventricular septum paradoxical motion and delayed tricuspid closure are discussed. According to the previous study no echocardiographic pattern is surely diagnostic of the disease by itself; a delayed tricuspidal closure (more than 70 msec) when associated to an anterior tricuspid leaflet wide excursion and decreased E-F slope, is of particular value for diagnosis.