Prostate-specific antigen levels in hypertensive patients suffering from a non-ST elevation myocardial infarction or a new-onset atrial fibrillation.

BACKGROUND: Increasing evidence suggests that prostate-specific antigen kallikrein (PSA) relates to the cardiovascular system. Recently, an association between PSA levels and aortic stiffness has been also reported in untreated essential hypertensive males. Elevated pulse pressure, a surrogate measure for increased proximal aortic stiffness, predisposes to myocardial infarction and atrial fibrillation. No studies, to date, have evaluated the relationship between PSA levels and the occurrence of AMI or new-onset atrial fibrillation in hypertensive male patients. Herein, we conducted a study to investigate this question. METHODS: This work is a retrospective, observational, study. Consecutive male patients were enrolled and divided in two groups: 58 patients with non-ST elevation myocardial infarction (NSTEMI) and 59 patients with new-onset atrial fibrillation. PSA levels gradually change with age and we prefer to use the percentage of age-specific PSA ranges (a.s. PSA) instead of the simple PSA levels. RESULTS: At multivariate analysis DM [0.263 (0.105-0.662); P=0.005], dyslipidemia [0.301 (0.105-0.863); P=0.025] and a higher percentage of a.s. PSA [0.908 (0.895-0.970); P=0.000] were significantly associated with the occurrence of NSTEMI. CONCLUSIONS: The main results of this study showed that a higher percentage of a.s. PSA significantly relates with the occurrence of NSTEMI. In addition, the results of our investigation, also, demonstrate that the significant correlation between higher percentage of a.s. PSA and the occurrence of NSTEMI persisted after adjustment for traditional CAD risk factors (age, DM, dyslipidemia, and smoking). Large studies are needed to further confirm our findings and to elucidate the causes and effects.

The chance finding at multislice computed tomography coronary angiography of myocardial bridging.

Myocardial bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. The pathophysiology of myocardial bridging is incompletely understood. With each systole, the coronary artery is compressed. Moreover, intravascular ultrasound analysis revealed a delayed relaxation after systolic compression, which may extend significantly into diastole. This explains both the impaired coronary flow reserve and ischemia. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to the development of atherosclerotic lesions because of haemodynamic disturbances. Myocardial bridging is sometimes associated with overt pathology, as well as it can just be an incidental finding without any significance. Myocardial bridging may cause angina pectoris, myocardial infarction, life threatening arrhythmias and even sudden cardiac death but most of them are harmless. Furthermore depressed left ventricular function, myocardial stunning, early death after cardiac transplantation has been also reported. Although the exact management is not well known, beta blockers seem to be the first choice. Stenting is controversial and one must think "twice" before stenting the bridged coronary artery. We report a case of chance finding at multislice computed tomography coronary angiography of two myocardial bridging. Also this case focuses attention on myocardial bridging and it confirms that multislice computed tomography coronary angiography technology represents a useful, noninvasive imaging method of its assessment.

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.

Supraventricular tachycardia associated with a clinically isolated demyelinating syndrome.

Ion channels are essential to a wide range of physiological functions including neuronal signaling, muscle contraction, cardiac pacemaking, hormone secretion and cell proliferation. Linking ion-channel gene mutations to inherited disorders has been described. Ankyrins are intracellular proteins required for the biogenesis and maintenance of membrane domains in both excitable and non-excitable cells. Dysfunction in ankyrin-based pathways seems to link abnormalities in vertebrate physiology including ataxia, axonal degeneration and arrhythmias. Analyzing the evolution of the autonomic disturbances in the demyelinating syndromes, the early onset of arrhythmias has been described. We present a case of supraventricular tachycardia in a 45-year-old Italian woman with a clinically isolated demyelinating syndrome. Also this case focuses attention on the presence of arrhythmias in the demyelinating syndromes.

Revelation of changing axis deviation at the end of atrial fibrillation during acute myocardial infarction.

It has been rarely reported changing axis deviation also during atrial fibrillation or atrial flutter. Changing axis deviation has been also rarely reported during acute myocardial infarction associated with atrial fibrillation too. We present a case of a 49-year-old Italian man with revelation of changing axis deviation at the end of atrial fibrillation during acute myocardial infarction. Also this case focuses attention on changing axis deviation.

A recurrent patent ductus arteriosus.

Patent ductus arteriosus (PDA) can occur as part of more congenital cardiac malformations or as an isolate finding. Spontaneous, transcatheter, surgical closure, and pharmacological treatment have been reported. We present a case of recurrent PDA after the initial course of a pharmacological treatment. Also this case focuses on recurrent PDA after the initial course of a pharmacological treatment.

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.

Acute myocardial infarction with changing axis deviation.

Changing axis deviation has been rarely reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been rarely reported also during acute myocardial infarction associated with atrial fibrillation. Isolated left posterior hemiblock is a very rare finding but the evidence of transient right axis deviation with a left posterior hemiblock pattern has been reported during acute anterior myocardial infarction as related with significant right coronary artery obstruction and collateral circulation between the left coronary system and the posterior descending artery. Left anterior hemiblock development during acute inferior myocardial infarction can be an indicator of left anterior descending coronary artery lesions, multivessel coronary artery disease, and impaired left ventricular systolic function. We present a case of changing axis deviation in a 62-year-old Italian man with acute myocardial infarction. Also this case focuses attention on changing axis deviation during acute myocardial infarction.

A dilated alcoholic cardiomyopathy.

Dilated forms of cardiomyopathy are characterized by ventricular chamber enlargement and systolic dysfunction with normal LV wall thickness. Among other causes, chronic excessive consumption of alcohol has a very important presence. We present a case of a dilated alcoholic cardiomyopathy in a 65-year-old man. Also this case focuses attention on dilated alcoholic cardiomyopathy.

A case of spontaneous closure of a muscular ventricular septal defect.

Ventricular septal defects can occur as part of more congenital cardiac malformations or as an isolate finding. Surgical closure, transcatheter occlusion and spontaneous closure have been reported. We present a case of spontaneous closure of a muscular ventricular septal defect. This case focuses attention on spontaneous closure of a muscular ventricular septal defect.