ABSTRACT
BACKGROUND: The aim of this study was to evaluate the safety and efficacy of ambulatory external cardioversion (EC) by means of monophasic and biphasic shock in patients with persistent atrial fibrillation (AF). METHODS: One hundred and twenty-seven consecutive patients with AF were submitted to EC, preceded by short general anesthesia with propofol, after pretreatment with oral anticoagulants for at least 3 weeks and, if not contraindicated, with amiodarone. In 87 of these patients we used monophasic shock and in 40 patients we used biphasic shock. Our protocol provided for up to 3 shocks delivered at an energy level ranging between 200 and 360 J for monophasic and from 70 to 175 J for biphasic shock. The patients were discharged after 4 hours of ECG monitoring and following a determination of serum CK-MB at the fourth hour. RESULTS: The mean age of the patients submitted to EC with monophasic and biphasic shock (65 +/- 9 vs 67 +/- 7 years) and the duration of AF (34 +/- 22 vs 32 +/- 25 days) were similar. The efficacy of EC with monophasic shock was 85% and the mean energy delivered was 266 +/- 81.5 J. The efficacy of the EC with biphasic shock was 98% and the mean energy delivered was 127 +/- 40 J. The difference between the percentage of efficacy and the number of joules delivered was statistically significant (p < 0.05). The mean value of the CK-MB after 4 hours following delivery of the shock was not significantly different: 2.5 ng/ml for monophasic vs 1.7 ng/ml for biphasic shock (p = NS). CONCLUSIONS: In our patients, ambulatory EC of persistent AF is safe and feasible; biphasic shock is more efficacious and requires less energy with respect to monophasic shock.
Subject(s)
Ambulatory Care , Atrial Fibrillation/therapy , Electric Countershock/methods , Age Factors , Aged , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Clinical Enzyme Tests , Creatine Kinase/blood , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Safety , Sex Factors , Time FactorsABSTRACT
Bacterial endocarditis in pregnancy is uncommon. We described two cases: the first case of endocarditis, caused by staphylococcus epidermidis (at the 35th week of pregnancy) was complicated by severe aortic valvular insufficiency; the second case, endocarditis caused by streptococcus alpha hemolytic (at the 32nd week of pregnancy) was complicated by severe mitral valvular insufficiency associated with multiple systemic emboli. Therapy consisted, in the first case of partum-induction followed by antibiotic therapy; in the second case it consisted of specific antibiotic therapy followed by gestation. There was no maternal or fetal mortality in the two cases.
Subject(s)
Endocarditis, Bacterial , Pregnancy Complications, Infectious , Staphylococcal Infections , Adult , Ampicillin/therapeutic use , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/etiology , Echocardiography , Electrocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Gentamicins/therapeutic use , Humans , Infant, Newborn , Male , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Penicillin G/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidisABSTRACT
Giant cell arteritis is a disease of the elderly of unknown origin. It involves large, medium and small sized arteries. The extracranial arteries, especially the aorta and its main branches, are rarely involved. The typical histologic features are fibrous intimal proliferation, the disruption of the internal elastic lamina, the presence of mixed cellular infiltrate, plasma cells and histiocytes and giant cells. We report the case of a 78-year-old patient, who died of acute myocardial infarction. The autopsy unexpectedly revealed giant cell arteritis involving the coronary arteries and other systemic arteries.
Subject(s)
Giant Cell Arteritis/complications , Myocardial Infarction/etiology , Aged , Giant Cell Arteritis/pathology , Humans , Male , Myocardial Infarction/pathologySubject(s)
Echocardiography , Heart Neoplasms/diagnosis , Myxoma/diagnosis , Adult , Aged , Female , Humans , Middle Aged , PrognosisABSTRACT
Left ventricular false tendons (or anomalous bands) have been described in several anatomic studies. Recently the echocardiographic features of such false tendons have been reported also. We have found a prevalence of 36 cases in 1,600 consecutive patients examined (2.2%). False tendons represent a rather common and benign phenomenon. Echocardiography is the most useful tool in the detection of false tendons.
