Acute myocardial infarction and left bundle branch block with changing axis deviation.

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a LBBB with changing QRS morphology and changing axis deviation. There are several possible explanations for the intermittent shift in the QRS axis in the presence of complete left bundle branch block. The most plausible explanation is the coexistence of left posterior hemiblock and predivisional left bundle branch block. We present a case of a left bundle branch block with changing axis deviation in a 93-year-old Italian woman admitted to the Cardiology Unit with an acute myocardial infarction.

Revelation of changing axis deviation at the end of atrial fibrillation without acute myocardial infarction.

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of revelation of changing axis deviation at the end of atrial fibrillation without acute myocardial infarction in a 74-year-old Italian man. Also this case focuses attention on changing axis deviation.

Acute myocardial infarction without significant coronary stenoses associated with endogenous subclinical hyperthyroidism.

Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. Nowadays, there is growing interest regarding endogenous sublinical hyperthyroidism and the cardiovascular system. We present a case of acute myocardial infarction without significant coronary stenoses in a 75-year-old Italian woman with endogenous subclinical hyperthyroidism. Also this case focuses attention on the importance of a correct evaluation of endogenous subclinical hyperthyroidism.

Left bundle branch block and changing axis deviation during acute myocardial infarction.

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a left bundle branch block with changing QRS morphology and changing axis deviation. We present a case of a left bundle branch block with changing axis deviation in an 86-year-old Italian man admitted to the Cardiology Unit with an acute myocardial infarction. Also this case focuses attention on left bundle branch block with changing axis deviation.

Acute myocardial infarction with significant left main coronary artery stenosis, significant 3-vessel coronary artery disease and elevated troponin-I at admission.

Exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be a specific finding of left main coronary artery (LMCA) stenosis. Lead aVR and lead v1 ST segment elevation has been reported, during an attack of chest pain, in patients with LMCA disease with ST segment depression in leads V3, V4 and V5 (with maximal depression in V4). ST-segment elevation in lead aVR in patients with angina at rest can be related to transmural ischemia of the basal part of the interventricular septum, frequently due to LMCA or multivessel coronary disease too. 3-vessel coronary artery disease (CAD) and LMCA disease show a frequent combination of leads with abnormal ST segments during chest pain with ST-segment depression in leads I II V4-V6, and ST-segment elevation in lead aVR. When ST-segment status in lead aVR combines with troponin T, ST-segment elevation in lead aVR and positive troponin T on admission are useful predictors of LMCA or 3-vessel CAD. We present a case of acute myocardial infarction with significant left main coronary artery stenosis, significant 3-vessel coronary artery disease and elevated troponin I at admission in an 83-year-old Italian woman. Also this case focuses attention on the importance of the recognition of the patterns suspected for LMCA and/or 3-vessel coronary disease.

Atrial flutter, ventricular tachycardia and changing axis deviation associated with scleroderma.

Rhythm disturbances have been described in immunological and connective diseases. Scleroderma is a fibrotic condition characterized by immunological abnormalities, vascular injury and increased accumulation of extracellular matrix proteins. The heart is one of the major organs involved in scleroderma, the involvement of which can be manifested by myocardial disease, conduction system abnormalities, arrhythmias, or pericardial disease. Additionally, scleroderma renal crisis and pulmonary hypertension lead to significant cardiac dysfunction secondary to damage in the kidney and lung. Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of atrial flutter, ventricular tachycardia and changing axis deviation in a 61-year-old Italian woman with scleroderma. This case focuses attention on changing axis deviation and on the presentation of arrhythmias in scleroderma. The underlying arrhythmogenic mechanisms are probably multiple and intriguing, even though the myocardial fibrosis and immunological autoantibody-mediated mechanisms seem to play a pivotal role.

Endogenous subclinical hyperthyroidism and cardiovascular system: time to reconsider?

Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. Exogenous sublinical hyperthyroidism is a thyroid metabolic state caused by L-thyroxine administration. Endogenous subclinical hyperthyroidism is a thyroid metabolic state in patients with autonomously functioning thyroid nodule or multinodular goiter, various forms of thyroiditis, in areas with endemic goiter and particularly in elderly subjects. Endogenous subclinical hyperthyroidism is currently the subject of numerous studies and it yet remains controversial particularly as it relates to its treatment and to cardiovascular impact nevertheless established effects have been demonstrated. Recently, acute myocardial infarction without significant coronary stenoses and recurrent acute pulmonary embolism have been reported associated with subclinical hyperthyroidism without L-thyroxine administration. So, it is very important to recognize and to treat promptly also endogenous subclinical hyperthyroidism.

Main pulmonary artery aneurysm.

Alterations of main pulmonary artery have been described in literature. Main pulmonary artery aneurysm is very rare with few available published data. We present a case of echocardiographic finding of a main pulmonary artery aneurysm in a 78-year-old Italian woman.

The chance finding of a ventricular septal defect in a 2-day-old newborn infant.

Certain congenital cardiac defects may go undetected for several years due to lack of symptoms and signs.Ventricular septal defects can occur as part of more congenital cardiac malformations or as an isolate finding. The natural history of ventricular septal defects depends on the size of the defect and on the pulmonary resistance. We present a case of the chance finding of a ventricular septal defect in a 2-day-old newborn infant with an interatrial septal aneurysm.

Myocarditis and cardiomyopathy HIV associated.

Heart muscle involvement associated with human immunodeficiency virus (HIV) infection may present as myocarditis, dilated cardiomyopathy or as isolated left or right ventricular dysfunction. Histopathological and ultra structural findings with different degrees of cardiac-chamber dilation have been described and an important role of the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) and IL-6 has been suggested. We present a case of myocarditis in a 47-year-old woman with HIV associated cardiomyopathy, focussing attention on heart muscle involvement in HIV disease.

Changing axis deviation and intermittent right bundle branch block during acute myocardial infarction.

Dissimilar electrocardiographic patterns associated with right bundle branch block have been described. The prognosis of right bundle branch block in the absence of underlying cardiac disease is good but it may be poor in other cases, particularly coronary artery disease. Changing bundle branch block, new right bundle branch block, right bundle branch conduction disturbances have been reported in literature. Changing axis deviation has been reported alone or during acute myocardial infarction also associated with atrial fibrillation. Intermittent right axis deviation has been rarely reported in the presence of left bundle branch block also during atrial fibrillation and with acute myocardial infarction too. Isolated left posterior hemiblock is a very rare finding and transient right axis deviation associated with a left posterior hemiblock pattern has been also rarely described associated with acute myocardial infarction. We describe a case of changing axis deviation with intermittent right bundle branch block in a patient admitted with acute myocardial infarction. Also this case focuses attention on changing axis deviation and intermittent right bundle branch block during acute myocardial infarction.

ST-segment elevation and diminution of prostate-specific antigen in a patient with coronary spasm and without significant coronary stenoses.

Many patients with acute coronary syndrome (ACS) had no culprit lesion. Coronary spasm is a frequent cause of ACS and should regularly be considered as a differential diagnosis. Prostate-specific antigen (PSA) is an established marker for detection of prostate cancer. Both elevated as well as diminished PSA have been reported during acute myocardial infarction(AMI) and our preliminary observations have concluded that when elevation of PSA occurs during AMI, coronary lesions are frequent and often more severe than when a diminution of PSA occurs. Moreover, our preliminary observations have concluded also that when elevation of prostate-specific antigen occurs during AMI, it seems to relate to a higher occurrence of major adverse cardiac events in the first 8 days after AMI than when a diminution of PSA occurs. We present a case of ST-segment elevation in a patient with diminution of PSA, coronary spasm and without significant coronary stenoses. Our report extends the evaluation of PSA during ACS.

Changing axis deviation and acute myocardial infarction.

Changing axis deviation has been rarely reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also rarely reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of changing axis deviation in a 77-year-old Italian woman admitted to the Cardiology Unit with an acute myocardial infarction. Also this case focuses attention on changing axis deviation and acute myocardial infarction.