[Women and cardiovascular diseases]. / La donna e le malattie cardiovascolari.

The authors draw attention to the important role played by menopause in the onset of arterial hypertension, enhanced coronary risk and dyslipidemia, for which a particularly useful association has been found to be estrogens, only if administered by mouth (alone or with progestins), and statins. The authors review numerous studies for or against the use of estrogens as a means of reducing arterial hypertension and the incidence of myocardial ischemia in menopausal women. In order to ensure therapeutic efficacy, replacement estrogen therapy should not be started at not too late an age, but instead as young as possible (the first 5 years after the start of menopause are optimal), namely before levels of endothelial estrogen receptors start to fall. Moreover, therapy should not be continued for more than 5 years in order to avoid the risk of breast cancer and endometrial carcinoma. With regard to myocardial infarction, it is worth noting that women show a higher frequency of silent and atypical infarction leading to a late diagnosis and therefore the arrival in the coronary unit half an hour or an hour later than men. Together with the onset of myocardial infarction at an older age in women compared to men (5-10 years), and the fact that diagnosis is less accurate in women and treatment less sophisticated, this accounts for the higher immediate and medium-term mortality figures in women following myocardial infarction. However, at least in America studies have shown that the less aggressive diagnostic and therapeutic management of myocardial infarction in women compared to men is not sufficient to cause a significant difference in mortality between men and women 30 days after the event. Turning to arrhythmia, it is worth recalling that supraventricular tachycardia with close rapid complexes, caused by return in the atrioventricular node is more frequent in females and in the second lutein or progestin phase of the menstrual cycle, thus demonstrating the protective role of estrogens against the onset of arrhythmia. The authors also point out the frequent association between ischemic ictus and chronic non-valvular atrial fibrillation in women aged over 75 since they present a very high risk (94%) of death by ischemic ictus. On the one hand, the guidelines recommend the use of anticoagulating therapy in these patients, but on the other there is a very high risk of hemorrhage which acts as a major constraint. Lastly, pregnancy is mentioned as a condition that facilitates the onset of arrhythmia; for example, orthodromic supraventricular tachycardia in Wolf Parkinson White and ventricular tachycardia which usually regresses post-partum.

[Cardiac enzymes in acute cerebrovascular diseases: their behavior in relation to ECG]. / Gli enzimi cardiaci nella cerebropatia acuta vascolare: loro comportamento in relazione all'E.C.G.

The blood levels of CPK and CPK MB enzymes were measured in 3 groups of patients: group A consists of 13 patients affected by acute vascular cerebropathy (A.V.C.) with evident ECG changes, group B consists of 10 patients showing fairly slight or no changes in the ECG and group C is the control group. It was noted that in patients affected by A.V.C., CPK and CPK values increase over a time span between the 2nd and 4th days and the 8th and 9th days of the condition, with peaks on the 4th day. The rise in CPK MB that reaches a highly significant statistical difference in group A compared to group B and C (P less than 0.01) is particularly interesting. Further, group A consists of older patients and is characterised by a larger number of deaths; death often coincides with peaks in CPK MB and in total CPK. It is therefore deduced that a high value of these enzymes, just as appreciable changes in ECG have an unfavourable prognostic value and that the increase in CPK MB expresses a real myocardial problem that probably contributes, along with the cerebral damage, to the death of the patient.

[Spontaneous recovery of sinus rhythm in long-standing mitral fibrillation]. / Ripristino spontaneo di ritmo sinusale in mitralica fibrillante da vecchia data.

The case of a 73-year-old woman with a 10 year history of mitral valvulopathy in atrial fibrillation is reported. On two occasions spontaneous recovery of sinus rhythm occurred. The first, lasting about 48 hours, followed acute digitalis poisoning. On the second occasion there was a slight intermittent 1st degree A-V blockage, though no glucoside had been taken for about 5 months.

[Echocardiographic study of movements of the interventricular septum in type B Wolff-Parkinson-White syndrome. Description of 2 cases]. / Contributo allo studio ecocardiografico dei movimenti del setto interventricolare nel W.P.W. di tipo B. Descrizione di due casi.

In the first case interventricular septum movements in a man of 65 and in one of 24, with type B W.P.W., were recorded echocardiographically. The septum described a typical expulsive "beak" movement followed by a paradoxical anterior movement during ventricular systolic ejection. In the second case, the septum gives rise in the pre-expulsive phase to a marked posterior incisure before going through its normal posterior movement in the systolic phase. Stress is laid on the aspecificity of the series of septal movements in the first case as it is common to other conditions, namely total left branch block, extrasystole originating from the night ventricle and many cases of temporary intracardial electrostimulation with floating catheter in the right ventricle. It is considered however that echocardiographic investigation in type B W.P.W. is useful in any case because, unlike surface ECG which is always the same, it offers information about the extent of the pre-excited zone.

[Clinico-electrocardiographic findings in 3 cases of blocked atrial tachycardia]. / Rilievi clinico-elettrocardiografici su tre casi di tachicardia atriale bloccata.

Through the clinical and ECG description of three cases of atrial tachycardia with 2:1 block (T.A.B.) not linked to hypopotassaemia or intake of digitalis, attention is called to the following points: 1) T.A.B. is frequently preceded by other atrial arrhythmias (F. A., common T.P.S.V. etc.); 2) Amiodarone is useful in many cases in restoring sinus rhythm; 3) At surface ECG, T.A.B. can be distinguished, with a few exceptions, from atrial flutter with which it is often confused, essentially owing to the morphology of the P wave in normal practice, a finding that suggests the pathogenesis of the two arrhythmias is different (return arrhythmia the flutter, arrhythmia due to ectopic focus te T.A.B.); 4) the PR segment of the P wave is lengthened even without digitalis intake (as in 2 of the 3 cases described): this might be not a straightforward, chance association but an integral part of T.A.B. owing to simultaneous disturbance of A-V conduction.

[Medical treatment of arrhythmias in myocardial infarct. Results of the use of bunaftine]. / Terapia medica delle aritmie nell'infarto miocardico. Risultati dell'impiego della bunaftine

After a short survey of the physiopathology of arrhythmia in myocardial infarction, especially at the initial stage, the results of using bunaphthine in 21 personal cases of myocardial infarction are reported and the fully satisfactory results described. This substance is held to be an effective, useful antiarrhythmia drug which can be usefully employed in the prophylaxis of arrhythmia in myocardial infarction.

[Atrio-ventricular and intra-ventricular conduction disorders in a case of acute cerebrovascular disease]. / Turbe della conduzione atrio-ventricolare e intra-ventricolare in un caso di cerebropatia vascolare acuta

Transient atrioventricular (1st-degree and 2nd-degree (type II) block, coronary node rhythm, dissociation) and intraventricular (left anterior hemiblock) disturbance were noted in a 67-yr-old man with acute cerebral thrombosis. It is suggested that one of more of the following factors were responsible from time to time for these unusual ECG signs: disturbance of neurovegetative regulation with predominant vagal hypertonus, circulation deficiencies in the conduction tissue due to decreased cardiac output, and histological lesion of specific tissue.