[An accelerated idioventricular rhythm and sports activity. Comments on a clinical case and a characterization of the arrhythmia]. / Ritmo idioventricolare accelerato ed attività sportiva. Considerazioni su di un caso clinico e caratterizzazione dell'aritmia.

In the evaluation of an accelerated idioventricular rhythm (AIVR) case presented by an athlete, even though considered qualified for agonistic sport practice in compliance with the COCIS protocol, the authors made some considerations relative to such type of arrhythmia. AIVR are characterized by a wide oscillation of frequency (from 40 to 120 b/min) and are distinguished as active AIVR when the ventricular center exceeds the discharge frequency in a non depressed sinusal activity; and it's passive AIVR when an automatic ventricular center substitutes the physiological pacemaker in the presence of sinusal bradycardia. This leads to think that it could be two different phenomenons. The first is characterized by a low frequency and is determined by the activation of some automatic cells located under the His bundle, and the second arises with the extrasystolic modality. Moreover, AIVR manifest a parasystolic type of behaviour that complicates the diagnostic differentiation. Therefore it can be considered that the arrhythmia of ventricular genesis (AIVR, ventricular tachycardia, parasystole) represents the varied expression of the same electrogenic substratum with different discharge potentiality. Thus was formulated the proposal of unifying the ventricular rhythms in one group which includes: rhythm of ventricular escapement, AIVR, parasystole and ventricular tachycardia.

[Prevention of paroxysmal atrial fibrillation with propafenone after withdrawal of amiodarone because of side effects]. / Profilassi della fibrillazione atriale parossistica con propafenone dopo sospensione di amiodarone per effetti collaterali.

The authors evaluated the efficacy of medium term prophylaxis of atrial fibrillation (AF) with propafenon (P) in 33 symptomatic patients. Consecutive patients were treated with P replacing previous therapy with amiodarone (A) withdrawn on account of adverse side effects occurring on average after 1.8 years' treatment. Quantification of AF episodes was based on symptoms reported by patients, ECG, and dynamic Holter-ECG performed every 3-6 months. During A treatment (average daily dosage 216 mg) 32% of patients had reported more than two episodes of AF, 52% one or two episodes, and 16 none during the last 6 months. During 6 months of P treatment (average daily dosage 586 mg) 28% had more than two episodes, 64% had one or two, and 8% had none. The difference of incidence of AF episodes between the two treatments was not statistically significant. Side effects requiring withdrawal of the drug were not observed with P. The results obtained confirm P as a valid therapeutic resource for treatment of recurrent paroxysmall AF. In addition, the drug was also well tolerated during medium term application.

"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists.

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.

[Alpha-interferon therapy: an echographic study of left ventricular function and a clinical assessment of cardiovascular complications]. / Terapia con alfa interferone: studio ecocardiografico della funzione ventricolare sinistra e valutazione clinica delle complicanze cardiovascolari.

Many side-effects of alpha interferon (alpha-I) therapy have occurred as a result of its widespread clinical applications. The hypothesis of alpha-I related cardiomyopathy is particularly interesting. Our study involved echocardiographic evaluation of left ventricular function and cardiovascular complications in 35 patients with chronic hepatitis treated with alpha-I at 20 MU/week for an average of 10.8 months. The results were compared with those of a control group. Of the values studied, only Max E V and the E/A ratio were statistically significant. No cardiovascular side-effects were found.

[Evaluation of the safety and efficacy of the lisinopril + hydrochlorothiazide and captopril + hydrochlorothiazide combinations in the treatment of essential arterial hypertension]. / Valutazione della sicurezza e dell'efficacia delle associazioni lisinopril + idroclorotiazide e captopril + idroclorotiazide nel trattamento dell'ipertensione arteriosa essenziale.

The aim of this study was to assess the efficacy and tolerability of the combinations of lisinopril (LIS) 20 mg + hydrochlorothiazide (HCTZ) 12.5 mg and captopril (CAP) 50 mg + HCTZ 25 mg in moderately hypertensive patients not adequately controlled by LIS or CAP alone. The study was multicentre (11 centres), open, random and carried out in parallel groups. After two weeks' placebo run in patients were randomly assigned to LIS 10-20 mg/o.d. or CAP 25-50 mg/b.i.d. treatment for 6 weeks. After this, patients with supine diastolic blood pressure (SDBP) greater than 90 mmHg were treated with the combinations LIS 20 mg + HCTZ 12.5 mg/o.d. or CAP 50 mg + HCTZ 25 mg/o.d. for 4 weeks; this dose was doubled if DBP was found to be greater than 90 mmHg after 2 weeks' combined therapy. A total of 175 patients were enrolled (92 females and 83 males) of which 153 completed the study. The LIS + HCTZ association caused a significant reduction of DBP in comparison to the other combined treatment (88.1 +/- 0.7 vs 90.3 +/- 0.7; p = 0.026). The statistical analysis of mean SBP values showed no significant difference between the two groups (144.0 +/- 1.3 vs 146.8 +/- 1.3; p = 0.15). At the end of the study 79.5% of patients treated with LIS + HCTZ presented normal results (DBP less than or equal to 90 mmHg), whereas the percentage of similar results in the comparison group was 72%. The percentage of "responder" patients to therapy (DBP reduced by 10 mmHg or more in relation to basal values) was 96.3% in the LIS + HCTZ group and 86.7% in the CAP + HCTZ group. In the CAP + HCTZ group 0.6% of patients reported adverse reactions, while only 0.3% were observed in the LIS + HCTZ group.

["Esophageal" angina and angina pectoris]. / "Angina esofagea" ed angina pectoris.

In the last few years the non cardiac angina-like chest pain has encompassed more and more agitation not only in many patients but also in cardiologists, gastroenterologists and psychologists, as it involves socio-economic, pathophysiologic and therapeutic problems. The socio-economic aspect is well explained by the fact that in the USA at least 200,000 patients a year suffering from non cardiac angina-like chest pain, even when coronary arteriography has demonstrated normal coronary vessels, nevertheless continue to require cardiologic examinations and, if no one has clearly demonstrated the origin of their pain, they continue to live as invalids in constant fear of myocardial infarction. The discovery that the esophagus may be one of the causes of chest pain in these patients presenting with a previous diagnosis of "atypical" angina pectoris, unfortunately cannot resolve definitively the problem. An association of esophageal angina in patients with angina pectoris treated for long periods of time with Ca-antagonists and nitroderivatives has been described. In addition, the provocative or spontaneous tests to demonstrate the esophageal origin of chest pain give only a "likely" and not a "definite" diagnosis of esophageal angina. This also means to no "gold standard" text exist. Lastly, the "likely" diagnosis of esophageal angina is made in only about 50% of patients leaving the problem of the remaining 50% unanswered. These uncertainties induce some psychologists to assert that the cause of non cardiac angina-like chest pain is in the head ("panic disorder") and not in the esophagus, where the observed motor disorders should be an epiphenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

The esophagus as a possible cause of chest pain in patients with and without angina pectoris.

In a series of 18 patients with angina pectoris, in whom treatment over at least 3 years with nitroderivatives and Ca-antagonists had become partially ineffective on chest pain, and in 18 patients with angina-like non-cardiac chest pain, the following examinations were carried out: upper gut x-ray and endoscopy, acid perfusion test, esophageal manometry, 24-hour esophageal pH monitoring associated with Holter recording. The presence or absence of coronary insufficiency was established by means of scintigraphic and ECG tests, Holter monitoring and coronary arteriography. In both groups the majority of patients had abnormal esophageal function, but in patients with angina pectoris treated for a long period of time the motility changes were prevalently reflux-related. With respect to the origin of chest pain, the esophagus was found to be the likely cause in 4 patients with angina pectoris, and the probable cause in another 10 of the same group; it was the likely cause in 7 patients without angina pectoris, and the probable cause in another 7 of the same group. As nitroderivatives and Ca-antagonists decrease the LES tone and the amplitude of esophageal pressure waves, long-term treatment with these drugs may be taken into account in the genesis of gastro-esophageal reflux and related changes, including esophageal pain.

Pericarditis: a probably overlooked complication of endoscopic variceal sclerotherapy.

Two cases of acute pericarditis following endoscopic variceal sclerotherapy (EVS) that were resolved with conservative management are described. This complication arose respectively one and three days after EVS. The possible pathogenesis is the involvement of the pericardium in an inflammatory reaction that develops in the esophageal wall and surrounding tissues. Only five cases have been previously reported in the literature; the authors suppose that this fact may be due to the mild symptoms presented by the patients, which may result in underestimation of this complication. The technical details of EVS in the seven patients with pericarditis were analyzed, but no common etiologic factor was found. The authors strongly advise regular checks for clinical and instrumental signs of acute pericarditis after every session of EVS, so that appropriate management can be undertaken in an early phase and, if necessary, further EVS sessions delayed, in order to avoid cardiac tamponade or constrictive pericarditis.

[Ambulatory electrocardiography in aged patients with syncope]. / L'elettrocardiografia dinamica nei pazienti anziani affetti da sincope.

3600 dynamic ecg recordings were carried out over a period of about seven years. In 408 cases (11.3%), indication for the investigation consisted of syncopal or equivalent minor episodes. 37 patients (9%) presented symptoms during the recording; in 12 cases (2.9%), the symptoms corresponded to an arrhythmia. An increase in atrial and ventricular arrhythmias with advancing age was also observed. Owing to the high incidence of arrhythmias in the elderly, and the poor correlation between symptoms and significant arrhythmias, dynamic ecg is therefore of little diagnostic value in syncope patients.

[Atrial myxoma in the aged. Apropos of 2 clinical cases]. / Il mixoma atriale nell'anziano. A proposito di due casi clinici.

Cardiac myxoma are a diagnostic dilemma, simulating a variety of cardiac and non cardiac diseases. Echocardiography is a powerful technique for diagnosing primary tumors of the heart. We report two cases of elderly patients, with atrial myxomas, for which operation was safely performed on the basis of echocardiography alone without preoperative catheterization.

[The behavior of various muscle enzymes in hypothyroidism]. / II comportamento di alcuni enzimi muscolari nell'ipotiroidismo.

The behaviour in hypothyroidism of certain muscular enzymes (CK, TOE, LDH, AST) was studied. A significant increase in these enzymes occurs in basal conditions and is gradually normalised by substitution therapy. This response might serve to distinguish hypothyroidism from other conditions causing an increase in muscular enzyme levels.

[Cardiovascular manifestations of dermatopolymyositis]. / Le manifestazioni cardiovascolari della dermatopolimiosite.

The cardiovascular symptoms of six patients suffering from polymyositis were considered with reference to Pearson's classification. Transmural ischaemia type ventricular repolarisation anomalies were noted in two patients while clinica signis of cardiopathy were not present. A progressive disturbance in intraventricular condition was noted in one case. In another patient signs of atrial tachycardial type paroxysms with a variable A-V block were noted. Dilatative cardiomyopathy with progressive congestive decompensation and hyperkinetic ventricular arrhythmias were noted in two patients. These conditions responded partially to medical treatment. ECGraphic signs of pseudonecrosis and clinicoechographic signs of mitral valve prolapse were noted in another patient. These signs were not accompanied by either coronary or valvular clinical involvement equivalents.

[Renal angiomyolipoma. Analysis of a clinical case in the light of current diagnostic possibilities]. / Angiomiolipoma renale. Analisi di un caso clinico alla luce delle attuali possibilità diagnostiche.

A clinical case of renal angiomyolipoma is examined. Until a few years ago diagnosis of this condition was almost exclusively intraoperative or during autopsy. Today, the introduction of new diagnostic techniques like echotomography and CT permit the identification of the lesion and its differentiation from other spreading renal processes. This has obviously had a beneficial effect on the choice of therapeutic approach.

[Carcinoid cardiopathy]. / La cardiopatia da carcinoide.

A series of 5 males and 2 females aged 23-73 yr with carcinoid cardiopathy is presented, all of them with clinical and instrumental signs of liver metastasis. The main clinical signs were dyspnoea and asthenia rendered ingravescent by effort, and, in the later stage, a frank picture of congestive cardiac decompensation. All subjected presented stethoscopic evidence of tricuspid valvulopathy, combined with pulmonary stenosis in 2 cases. The ECG picture displayed a constant reduction in cardiac potentials, together with right branch bundle block in 3 cases. In cases where an echocardiogram was taken, this confirmed tricuspid involvement. The disease progressed in all cases, and four patients died as a result of terminal liver failure.

Cardiovascular lesions in chronic pancreatitis: a prospective study.

We prospectively investigated fifty-four consecutive patients with proven chronic pancreatitis and 54 control subjects for the presence of cardiovascular lesions. Clinical and laboratory evidence of arterial involvement was found in 18 patients (33%) and in five controls (9%) (P less than 0.01). Electrocardiographic alterations indicating coronary heart disease were found in eight patients and in three controls, and peripheral symptoms and signs indicating obliterative atherosclerotic disease of the lower extremities were found in 12 patients (two had associated electrocardiographic changes) and in two controls. No significant differences in the prevalence of the major vascular risk factors were observed between patients with vascular lesions and those without, and between patients and control subjects. It is concluded that patients with chronic pancreatitis have more frequent cardiovascular lesions which tent to develop at an earlier age, compared to the general population. The possibility that chronic pancreatitis may favor the development of these lesions is discussed.