[A case of cardiogenic syncope in a drug-addict patient]. / Un caso di sincope di origine cardiogena in paziente farmaco-dipendente.

Torsade de pointes is a polymorphic ventricular tachycardia, associated with prolonged QT interval and characterized by twisting of the mean electrical axis of the QRS complexes around an isoelectric line. The long QT syndrome can be divided into two categories, congenital and acquired. The congenital long QT syndrome may be caused by some gene mutation, whereas the acquired form is usually associated with drugs and electrolyte imbalance. It usually remains asymptomatic or causes presyncope, although it may degenerate into ventricular fibrillation and may cause sudden death. The different presentation depends on the polymorphism that characterizes genotypic and phenotypic expression of proteic channel subunits, and on drug toxicity that provoke subunit dysfunction. The case report presented here is an example of prolonged QT interval syndrome in a patient with cocaine abuse and electrolyte disturbances.

[Measurement of carotid intima-media thickness and of pressure variability in arterial hypertension in menopause]. / Misurazione dell'ispessimento medio-intimale carotideo e della variabilità pressoria nell'ipertensione arteriosa in menopausa.

Forty women, with hypertension developed during menopause, were divided into two groups, depending on whether from the time of its beginning there were occurrences of clinic episodes expressing a more or less acute "organ damage" or not. In all patients a 24 hrs ambulatory blood pressure monitoring and a carotid ultrasound were carried out to evaluate the carotid intima-media thickness (IMT). The IMT resulted significantly superior in those patients presenting a vascular episode and as much significantly correlated to the pressure values, especially systolic; in particular, in "non dippers" patients there is evidence of correlations between percentages of "at risk" systolic pressure peaks, prevalence of plaques in carotidal vessels and higher IMT compared to those patients with night-time blood pressure decrease. The authors think that the presence of blood pressure values which are persistently, or nearly, high in 24 hrs, especially with wide variations, favours the development of plaques and, in any case, of a higher IMT, all "at risk" elements for acute events. The IMT carotid represents a further easily measurable index with non-invasive method, which can supply a useful evidence of structural alterations in menopause, especially when it is associated with hypertension, and also it represents a predictive evolutive marker for acute cerebro-cardiovascular lesions.