Infection by CagA-positive Helicobacter pylori strains in patients with ischemic heart disease: prevalence and association with exercise-induced electrocardiographic abnormalities.

The role of H. pylori infection in increasing the risk of ischemic heart diseases (IHD) is still debated. We determined serologically the prevalence of overall H. pylori and CagA-positive H. pylori infection in 63 consecutive patients with IHD and 189 gender- and age-matched controls. We also determined in patients the influence of the infection and the CagA serological status on the results of an exercise ECG test and other parameters considered possible variables that may enhance the risk of IHD. The prevalence of H. pylori infection in patients and controls was 79.3% and 73.0%, respectively (P = 0.403) and that of CagA-positive H. pylori infection was 69.8% and 42.3%, respectively (P = 0.0002). The scores of the ECG S-T segment and T-wave abnormalities in the course of an exercise ECG in uninfected patients and in patients infected by CagA-negative and CagA-positive H. pylori strains were (mean +/- SD): 1.59 +/- 0.67, 1.92 +/- 0.64, and 2.19 +/- 0.70, respectively; (P = 0.011, 95% confidence limits of difference 0.15-1.07, CagA-positive infected vs uninfected patients). There was no intergroup difference in the levels of peripheral white blood cells, glucose, cholesterol, triglycerides, creatinine, and systolic and diastolic pressure. In conclusion, genetic heterogeneity of H. pylori could possibly explain some conflicting results concerning the association of H. pylori infection with IHD. Coronary vessels of IHD patients infected by CagA-positive H. pylori strains may be damaged more severely than those of uninfected patients.

Transesophageal echocardiography for identifying potential cardiac sources of embolism in patients with stroke.

Pathologies of cerebral circulation are one of the most frequent causes of mortality and morbidity among the populations of Western countries. The incidence of ischemic events presumed to have a cardioembolic origin varies from 13% to 34% in the largest international multi-center studies. However, some authors have reported an incidence of general cardiogenic stroke ranging from 23% to 36% in younger patients. Transesophageal echocardiography (TEE) is a useful investigation for identifying cardiac sources of embolism in patients without vascular alterations involving the carotid and vertebral districts. This study comprised 73 patients with unexplained stroke who were investigated by both transthoracic echocardiography (TTE) and TEE. Vascular echocolor sonography had been performed in all of them with negative results. TEE demonstrated: atrial or ventricular thrombosis in 6 patients (8%), intracavitary neoplasm in 2 (2%), spontaneous echocontrast in 11 (13%), valve strands in 6 (7%), complex aortic plaque in 10 (11%), patency of the foramen ovale in 17 (19%), atrial septal aneurysm in 9 (11%), dystrophy and mitral calcifications in 9 (11%). In the other 18 patients, TEE did not reveal any anomalies. Definite sources of stroke (clots and tumors) were identified in 14% of all the lesions; however, the majority (86%) were potential sources. A comparison of the two echocardiographic techniques demonstrated a greater sensitivity and specificity of TEE. Although TEE was superior to TTE for identifying and evaluating potential embolic sources, we found both methods to be useful and would advise performing TTE before TEE. While TTE is not capable of identifying the majority of anomalies, it does provide useful information to guide subsequent transesophageal investigations.

[Evaluation of diastolic function of in patients addicted to recreational cocaine]. / Valutazione del rilasciamento ventricolare sinistro nei pazienti dediti all'uso voluttuario di cocaina.

BACKGROUND AND AIMS: The recreational use of cocaine is associated with cardiovascular pathologies, such as ischemic cardiopathy, myocarditis and cardiomyopathies, owing to the increased catecholamine stimulus, a propensity to coronary spasm, increased coagulative activity and inflammatory and degenerative phenomena of myocardiac cells. Early alterations of the diastolic phase may be visualised by evaluating the diastolic Doppler pattern of left ventricular filling. METHODS: For this purpose the authors compared blood pressure, heart rate, heart mass, protodiastolic (E wave) and telediastolic (A wave) filling rate and their ratio (E/A) on the Dopper mitral diastolic profile in a group of 10 patients addicted to the recreational use of cocaine (mean age 33 +/- 7) with those of 10 normal subjects (mean age 34 +/- 2). RESULTS: Patients using cocaine presented mean systolic arterial blood pressures of 130 +/- 12 versus 127 +/- 8 in control subjects (p = ns); mean heart rate was statistically significant with 98 +/- 14 versus 76 +/- 12 in controls (p < 0.05). There were no differences in cardiac mass between the two groups. In cocaine addicts the speed of the E wave was significantly slower: 58.4 +/- 8.6 versus 73 +/- 7.4 cm/sec (p < 0.05), and the speed of the A wave was significantly higher: 70.5 +/- 10.5 versus 62.6 +/- 4.3 cm/sec (p < 0.05), when compared with normal controls subjects; the E/A ratio of cocaine addicts was lower (0.75 +/- 0.34) compared to normal subjects (1.07 +/- 0.7), (p < 0.05). CONCLUSIONS: These data show that patients addicted to the recreational use of cocaine show preclinical alterations of the left ventricular diastolic phase prior to the onset of clinically evident pathologies.

[Heart involvement in Behcet's disease: a personal caseload en review of the literature]. / Il coinvolgimento cardiaco nella malattia di Behçet: casistica personale e revisione della letteratura.

BACKGROUNDS: Various cardiac abnormalities have been described in patients with Behçet's disease. The number of reports remains small, but increasing awareness have widened the spectrum of manifestations. We report our evaluation of cardiac involvement in 15 patients affected by Behçet's disease, diagnosed according to the criteria for the International Study Group for Behçet's Disease. PATIENTS AND METHODS: All the patients have been examined by a clinical, biochemical and instrumental point of view. Six patients resulted to be affected by heart diseases, in particular by mitral valve prolapse; moreover one of them presented an unexpected dilatative cardiomyopathy. CONCLUSIONS: The authors affirm that the pathological heart features are not so uncommon as previously reported in literature, emphasizing the necessity of a constant evaluation for the cardiovascular system also in the asymptomatic patients.

Reactive arthritis by staphylococcus epidermidis: report of an unusual case.

In the literature many cases of Staphylococcus epidermidis (SE) complications are reported, but we have not found any reference about reactive arthritis secondary to SE. We report an unusual case of a patient with SE bacteriaemia, who developed elbow arthritis, asymmetrical sacroiliitis, keratoderma and restrictive cardiomyopathy. The clinical pictures, the instrumental and biochemical findings, in particular the positivity of HLA B27, allow us to set this case in the complex and heterogeneous chapter of reactive arthritis.

[Therapy of arrhythmia induced by myocardial ischemia. Association of L-carnitine, propafenone and mexiletine]. / Terapia delle aritmie indotte da ischemia miocardica. Associazione di L-carnitina e propafenone e mexiletina.

To assess the anti-arrythmic effect of L-carnitina, propafenone and mexiletine, we tested the drugs in 50 patients with effort angina and ventricular ectopic beats (VEB). The patients were randomized in 5 groups: Group A: was treated with oral L-carnitine at the dose of 2 g x 3 for two weeks. Group B: oral propafenone at the dose of 300 mg x 3 for two weeks. Group C: as group B+L-carnitine+g x 3 at the second weeks. Group D: oral mexiletine at the dose of 200 mg x 3 for two weeks. Group E: as group D+L-carnitine 2 gr x 3 at the second week. After 7 and 14 days of treatment, in all patients an Holter examination was performed. Our results show that L-carnitine exerts a significant reduction of the VEB and its administration potentiates the anti-arrythmic effect of propafenone and mexiletine.

Treatment of advanced colorectal cancer with high-dose intensity folinic acid and 5-fluorouracil plus supportive care.

This randomised clinical trial, involving patients with advanced colorectal cancer, was carried out to compare the effectiveness of accelerated folinic acid (FA) plus 5-fluorouracil (5-FU) with that of the conventional regimen of 5-FU alone. Both regimens were administered with simulataneous supportive care. 185 patients were eligible: 94 were randomly allocated to receive FA 200 mg/m2 i.v. plus 5-FU 400 mg/m2 i.v. on days 1-5 every 3 weeks; and 91 to receive 5-FU 400 mg/m2 i.v. on days 1-5 every 4 weeks. The response rate was 33.3% in the accelerated FA/5-FU and 18.6% in the 5-FU arm (P = 0.045). Median survival was 13.5 months in the FA/5-FU arm and 7.5 months in the 5-FU arm (P = 0.039). Toxicity was mild and slightly more pronounced in the FA/5-FU arm (P = 0.078). This study indicates that, in patients with advanced colorectal cancer, accelerated chemotherapy with FA and 5-FU and simultaneous supportive care is capable of achieving a higher response rate and longer survival than conventional 5-FU alone, without severe toxicity.

[Comparison of pravastatin and diet in the treatment of hypercholesterolemia]. / Confronto tra pravastatina e dieta nel trattamento delle ipercolesterolemie.

Aim of this study is to point out a correct therapy for the treatment of poligenic hypercholesterolemia resistant to dietetic treatment. There have been studied 40 patients which, after repeated haematochemical controls, resulted affected by dyslipidaemia with prevalent increase of the cholesterol levels. After 30 days of standard hypo-caloric dietetic treatment were enrolled 23 patients, 13 males and 10 females, who presented a plasmatic cholesterol level superior to 250 mg% and LDL superior to 160 mg%. All the patients continued the dietetic treatment; 10 patients began pravastatin therapy at a dose of 20 mg/die while to the rest of them was given placebo. The 30th, 60th, 120th day were controlled the following haematochemical parameters: lipidic frame haematology, hepatic and renal function, glycemia and CPK. After 4 months of treatment the average plasmatic levels of cholesterol resulted different in the two groups: mg% (p < 0.001) in the pravastatin group and 262 mg% (P = ns) in the control group. Then, the pravastatin therapy was suspended and all 23 patients continued for 30 days, dietetic treatment and placebo. After 6 months a new control of the lipidic frame was performed. Our results showed that the hypocholesterolic therapy must be continued for ever. In fact, the suspension of the treatment is followed by an immediate rebound of the dislipidaemia which plasmatic cholesterol levels even superior to the basic levels with probable negative repercussion on the cardiovascular system.

Heparin treatment and resolution of left ventricular thrombosis.

In a 70-year-old man admitted to our hospital because of repeated episodes of transient disorientation, an ECG showed a recent inferior myocardial infarction. A two-dimensional echocardiography detected hypo-akinesia in the apex region, where a hyperechogenic oval and pedunculated mass with a maximum diameter of 1.5 cm, attributable to an organized thrombus, was located. After 20 days of therapy with calcium-heparin at a dose of 12,500 IU every 8 h, a two-dimensional echocardiography showed the complete disappearance of the mass. This and other recent reports confirm the thrombolytic activity of the drug and the possibility of postponing the immediate surgical removal of intraventricular thrombi in favour of heparin treatment.

[The evaluation of the antiarrhythmic activity of L-carnitine and propafenone in ischemic cardiopathy]. / Valutazione dell'attività antiaritmica della L-carnitina e del propafenone nella cardiopatia ischemica.

In order to evaluate a possible antiarrhythmic action of L-carnitine (C) in ischemic heart disease, 30 patients (20 males, 10 females, average age 64 years +/- 11) with ischemic heart disease who at examination with 24-hour dynamic ECG showed extrasystolic ventricular multifocal arrhythmia with a mean hourly rate of > 300 were randomized into three groups, the first of which was given a daily oral dose of 6 g C in three divided doses; groups 2 and 3 were given propafenone (P), 900 mg daily in three divided doses. After one week, all patients were again submitted to 24-hour dynamic ECG after which treatment was continued for another week as follows: group 1 continued on C (6 g daily), group 2 continued on P (900 mg daily), group 3 continued on P (900 mg daily) plus C (6 g daily). At the end of the second week, a further 24-hour ECG was performed the results of which showed that L-carnitine can significantly reduce the antiarrhythmic activity of the ischemic myocardium. In addition, at the end of the second week, a further significant reduction of the number of premature beats compared to the first week was found in patients for whom L-carnitine had been added to propafenone treatment.

[The association of amlodipine with isosorbide-5-mononitrate in the treatment of ischemic-hypertensive cardiopathy]. / Associazione di amlodipina con isosorbide-5-mononitrato nel trattamento della cardiopatia ischemico-ipertensiva.

Every form of therapy must always aim at obtaining maximum benefit with minimum use of drugs; also for the purpose of ensuring maximum patient compliance. With this end in mind, 21 patients with ischemic heart disease and arterial hypertension were divided into three groups of seven subjects each and submitted to different drug treatments with single daily doses: group 1 received isosorbide-5-mononitrate (60 mg), group 2 amlodipine (10 mg), and group 3 a combination of both drugs at the same dosage, for four weeks. Statistical analysis showed blood pressure values to have been significantly reduced in subjects receiving amlodipine both alone and in combination (p less than 0.05) while no significant variation was observed (p = n.s.) in those treated with isosorbide-5-mononitrate only. A significant reduction of diastolic blood pressure (p less than 0.05) occurred only in patients talking the combination. No significant changes of heart rate (p = n.s.) were observed in any of the groups. Tests at the cycling ergometer revealed increased in any of the groups. Tests at the cycling ergometer revealed increased maximal effort tolerance for all three groups but the increase was more marked in patients taking the combination (who from 130 +/- 10 Watt increased to 160 +/- 20 Watt). This was confirmed also by the reduced consumption of trinitrine capsules which diminished in groups 1 and 2 from an average of 5/week to 2/week but was completely abolished in group 3. Also ST depression was significantly reduced (p less than 0.05) only in this latter group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arrhythmias from swallowing]. / Aritmie da deglutizione.

We describe the case of a 51-year old, non cardiopathic patient, with recurrent attacks of supraventricular tachycardia induced by swallowing. In the existing literature we found several descriptions of hypokinetic arrhythmias, easily explained by a mechanism of vagal inhibition. The cases of predominantly hyperkinetic arrhythmias, however, are much less common. In these patients the origin of the disease seems to be due to sympathetic oesophageal fibers and superior and medium cardiac nerves. In the present case, as in the others reported in the literature, the drug of choice seems to be Amiodarone which appears to be the most effective in preventing tachyarrhythmias caused by swallowing.

[Captopril and hypertensive cardiopathy : therapeutic effects and hormonal changes]. / Captopril e cardiopatia ipertensiva: effetti terapeutici e modificazioni ormonali.

The effect of a single oral dose (50 mg) of captopril was studied in 12 hypertensive patients divided into 2 groups: 6 had a normal hemodynamic profile; the other 6 had NYHA class III or IV heart failure. Medical history and clinical and laboratory investigation showed that the heart failure was due exclusively to arterial hypertension. Mean arterial pressure (MAP), aldosterone, plasma renin activity (PRA) and atrial natriuretic factor (ANF) were followed for 4 hours after administration of captopril. MAP values showed a similar decrease in the 2 groups but the variations in the 3 hormones were much greater in the second group. This group showed higher basal levels of PRA, aldosterone and ANF; after stimulation PRA increased sharply preceded by a substantial decrease in aldosterone and ANF. To explain this phenomenon, the Authors propose that the liver of the patients with heart failure is unable to rapidly compensate the reduction in synthesis of angiotensin II caused by the drug with a corresponding increase in angiotensinogen production; the consequent sharp drop in plasma aldosterone would lead to a rise in renin production by the kidney. The arteriolar and venous vasodilatation induced by the ACE-inhibitor, would explain the drop in intra-atrial pressure with reduced plasma levels of ANF. The decrease in ANF could also be caused by the inhibition of the renin-angiotensin system of the heart leading to improved blood supply and hence myocardial contractility.

[Dilated cardiomyopathy secondary to idiopathic hypoparathyroidism in adults. Description of a case]. / Miocardiopatia dilatativa secondaria ad ipoparatiroidismo idiopatico dell'adulto. Descrizione di un caso.

The authors report the clinical history of a 56-year-old man with cardiomyopathy due to undiagnosed hypocalcemia. Heart dilation and hypokinesia were assessed by echocardiography. Cardiac failure was refractory to digitalis preparations and to diuretics. The restoration of serum calcium to normal levels obtained with adequate therapy dramatically improved the motion of ventricular walls and decreased the size of the left ventricle. The pathogenetic mechanisms of hypocalcemic cardiomyopathy are discussed and the importance of considering the possibility of hypocalcemia when dealing with the differential diagnosis of cardiomyopathies is underlined. In the presence of hypocalcemic cardiomyopathy, the correction of calcium deficiency with calcitriol is the treatment of choice.

QRS changes in direct fetal electrocardiogram during uterine overstimulation; report of four cases.

Four cases are presented in which increased QRS complex voltages or deviation of the mean electrical axis were observed in the fetus by direct fetal electrocardiogram (ECG) during delivery under anaesthesia. There was transformation of the initial QRS aspect before delivery. These changes were only observed when large doses of oxytocin (20 IU in 500 ml) were used after Pentothal administration in deliveries in which other fetal ECG alterations (bradycardia, ST changes, T inversion) and/or low pH values had been observed. In case 1 there were ST level changes, inversion of the T wave and transformation of the QRS complex from RS to Rs. Case 2 showed a change from RS to QR type complex associated with repolarization defects. In cases 3 and 4, ST level changes, inversion and increased QRS complex voltages were observed. We checked that the modifications observed were not due to changes in position of the fetus during recording. It is thought that the acute redistribution of the fetal blood volume due to oxytocin overstimulation in fetal hearts with hypoxic signs may lead to compensatory mechanisms such as tachycardia, increased contractile activity (higher QRS) and functional predominance of one side of the fetal heart (deviation of the electrical axis) subjected to sudden load.

[Echocardiographic diagnosis of left ventricular myxoma. Description of a case and review of the literature. Myxomas of the left ventricle]. / Diagnostica ecocardiografica del mixoma ventricolare sinistro. Descrizione di un caso e revisione della letteratura. I mixomi del ventricolo sinistro.

A case of left ventricular myxoma diagnosed by echocardiography and successfully removed by left ventriculotomy is reported. This is a 21 year old male, with the few symptoms which simulating an hypertrophic cardiomyopathy in contrast to the large size of the tumour. It is possible that myxomas are responsible for sudden death. Therefore, in presence of new cardiac signs kind and relevance, the possibility of a myxoma should be considered. The diagnosis can be easily ruled out (or confirmed) by echocardiography, which represents a valuable tool in the diagnosis of myxomas.

Myxoma of the left ventricle.

We report a case of left ventricular myxoma in a 19-year-old man which presented as intermittent aortic valve obstruction. Echocardiography provided a comprehensive diagnosis, and excision through a left ventriculotomy was safely accomplished.