Comparison of ST segment changes on standard and Holter electrocardiogram during exercise testing.

In order to compare the ST segment changes recorded simultaneously on Holter (Del Mar Avionics 445B recorder and DCG VII Scanner) and standard electrocardiogram, 22 patients with chest discomfort and normal resting ECG were evaluated during exercise testing. The conventional ECG was recorded using chest lead V5 and a modified lead II. The Holter recording was done using the bipolar chest lead CM5 and the same modified lead II. Bifurcating electrodes permitted simultaneous recording of electrocardiogram on both systems from the same electrode sites. Seven of the 22 patients had a positive test and 15 had a negative test by both systems. In 7 positive cases the amplitude of ST segment depression was compared. The Holter lead CM5 showed higher amplitude of ST segment depressions in 6 cases compared to the conventional lead V5: 3 cases by 0.5 mm; 2 cases by 1 mm and 1 case by 2.5 mm. In 1 case it was identical. The amplitude of ST segment depression in lead CM5 ranged from 1 to 3.5 mm (mean 2.2 +/- 0.6 mm) and in lead V5 from 1 to 2.5 mm (mean 1.5 +/- 0.6 mm). Thus the amplitude of ST depression was higher in lead CM5 by a mean of 0.7 mm compared to the lead V5. ST segment depression was present only in 6 cases in the modified lead II. ST segment depressions were reproduced faithfully in 3 patients and within the variation of 0.5 mm in other 3 cases by the Holter system.(ABSTRACT TRUNCATED AT 250 WORDS)

[Familial hypertrophic myocardiopathy: complex ventricular arrhythmias in healthy family members]. / Miocardiopatia ipertrofica familiare: aritmie ventricolari complesse nei parenti sani.

The aim of the present study was to evaluate the electrocardiographic changes among the members of a family affected by hypertrophic cardiomyopathy. Seventeen unaffected members and 8 affected members were studied by 24-hour Holter monitoring. Twenty-five normal controls were also studied by 24-hour Holter monitoring. One out of 7 (12.5%) patients with hypertrophic cardiomyopathy, 8 out of 17 (47%) unaffected relatives and 20 out of 25 (80%) controls did not show ventricular arrhythmias. One out of 7 patients (12.5%), 4 out of 17 (23.5%) unaffected relatives and 3 out of 25 (12%) of the control group showed Lown classes I-II ventricular arrhythmias. Complex ventricular arrhythmias (III-V Lown classes) were detected in 5/7 (71.4%) of patients, in 5/17 (29.5%) of unaffected members and only in 2/25 (8%) of the normals. Among the unaffected members we compared the prevalence of complex ventricular arrhythmias between the offspring of patients with that of the unaffected first-grade relatives. Three out 7 (43%) of the offspring of the patients showed complex ventricular arrhythmias and none among the offspring of normal first-grade relatives showed such arrhythmias. Neither the patients nor their relatives in this study showed any significant ST segment changes during the 24-hour Holter monitoring. We suggest that in first-grade relatives of patients with familial hypertrophic cardiomyopathy, complex ventricular arrhythmias could be a marker of latent disease, without clinical and echocardiographic manifestations.

[Stroke: Holter monitoring in 15 hypertensive patients]. / Ictus: monitoraggio Holter in 15 ipertesi.

The objective of the study is to evaluate the prevalence of ventricular arrhythmias during acute stroke in hypertensive patients: 15 hypertensive patients (9 males and 6 females; mean age 56 +/- 5) without clinical and electrocardiographic evidence of organic heart disease underwent 24 hour Holter monitoring during acute stroke. Another group of 15 uncomplicated hypertensive patients (14 males and 1 female, mean age 49 +/- 5) without clinical and electrocardiographic evidence of organic heart disease underwent 24 hours Holter monitoring as controls. The Holter monitoring was repeated in 8 patients who survived during follow-up, after a mean period of 15 months: 13/15 (86%) patients with acute stroke had ventricular arrhythmias against the 7/15 (47%) in the control group. Moreover 9/15 (60%) of patients with stroke had complex ventricular arrhythmias against the 3/15 (20%) in the control group; 6/8 patients who survived stroke, during follow-up showed complex ventricular arrhythmias but the degree of severity was lower when compared to the acute phase; 9 patients during acute stroke showed episodes of prolongation of QTc interval during Holter monitoring. The systolic blood pressure was found generally higher during the acute phase of stroke than before. Our results show higher prevalence of ventricular arrhythmias especially of the complex forms during acute stroke in hypertensive patients.

[Distributions, mean values and correlations of various coronary risk factors in a population of Veneto]. / Distribuzioni, medi e correlazioni di alcuni fattori di rischio coronarico in una popolazione del Veneto.

During the National Research Council (CNR) program called Atherosclerosis-Risk Factors 2 (ATS-RF2) a random sample of 1903 subjects (50.1% male) aged 20-59 years was examined in the general population of Mirano-Venice. Mean values of serum total cholesterol and triglycerides, body mass index, as well as systolic and diastolic blood pressure were assessed. On the whole these turned out to be higher in men and increased with age. The continuously distributed variables showed an approximately normal distribution and a close correlation. Comparing our results with those obtained by other Italian units co-operating in the same CNR program, different levels of serum total cholesterol and systolic blood pressure were observed. The overall risk factor pattern in northern Italian regions is closer to that reported in the literature for central European countries than to that of southern Italian regions. These findings might explain why mortality due to ischaemic heart disease is higher in northern Italy and becomes progressively smaller in central and southern Italy.

[Prevalence, characteristics and clinical correlates of left ventricular hypertrophy in stable hypertension. Echocardiographic study]. / Prevalenza, caratteristiche e corrispettivi clinici dell'ipertrofia ventricolare sinistra nell'ipertensione arteriosa stabile. Studio ecocardiografico.

251 in stable hypertensives were studied with M-Mode and two-dimensional echocardiography, in order to evaluate the prevalence of left ventricular hypertrophy (LVH), its patterns and clinical correlates. 54 subjects (21%) had been treated previously with antihypertensive drugs while the remaining 197 (79%) had not. A normal left ventricle was found in 69 subjects (27.1%; group A); a concentric LVH (h/r greater than or equal to 0.45) was found in 99 (39.4%; group B), while an eccentric LVH (left ventricular myocardial mass index greater than 140 g/m2, h/r less than 0.45) in 83 (43.1%; group C). An asymmetric LVH (septum to posterior wall thickness ratio greater than or equal to 1.3) was found in 33 subjects (3 did not fulfill the criteria for LVH, 21 had a concentric, and 10 an eccentric LVH). Mean age was significantly higher in group B as compared to groups A and C. The body mass index was comparable in all groups. Mean systolic blood pressure was significantly higher in groups B and C as compared to A. The duration and the severity of hypertension did not differ among the three groups. W.H.O. stage III was absent in group A, but no differences were found between group B and C as for W.H.O. stage distribution. We conclude that such factors as BMI, duration and severity of hypertension poorly correlate with the occurrence of LVH and its patterns. The fact that group B hypertensives were older than the others on average is against the hypothesis that eccentric hypertrophy follows the concentric pattern. Whether these two patterns represent separate entities in relation to different hemodynamic profiles deserves further investigation.

[Syncope in childhood]. / Le sincopi in età pediatrica.

Syncope may be defined a sudden and transient loss of consciousness due to a reversible alteration of brain function. Three main groups of syncopes can be identified: cardiac, vascular and non-cardiovascular. All the patients (63) admitted to the emergency unit of Pediatric Clinic of the University of Padua from January 83 to July 84 and reporting one or more episodes of loss of consciousness were examined. Their age ranged from 1 month to 15 years. All the patients were investigated with the same study protocol: ECG, EEG, 24 hours ECG monitoring, routine blood examinations; other tests were done when needed. The cause of syncope was established in 53,8% of cases; for 6,3% of patients the cause was cardiac (arrhythmic), in 38% it was vascular (vasovagal syncope), in 6,3% it was non-cardiovascular (neurologic or metabolic). The cause of syncope was not identified in 46% of the patients, which is also in agreement with other studies. However, we were able, through the use of our protocol, to identify quickly and non invasively the etiology of the syncope in 25% of the patients.

Spontaneous changes in very high blood pressure after admission to the hospital and their relation to target organ involvement.

Spontaneous changes in blood pressure (BP) over a week after admission to the hospital were investigated in 127 patients admitted with diastolic BP at or above 120 mm Hg. Average BP decreased from 205/129 at admission to 174/110 on the 8th day. Regression analysis showed highly significant negative slopes which were related to initial levels but not to the presence or type of target organ involvement. After 1 week, 66% of the subjects attained a diastolic BP lower than 120 mm Hg. More remarkably, 36% attained values lower than 105 mm Hg: 33% of these had BP values less than 95 mm Hg. While not ruling out the importance of very high BP readings, it is concluded that they do not necessarily represent any pattern of either fixed or severe hypertension nor imply a need for urgent antihypertensive treatment.

[Prevalence of arterial hypertension in the community. Experience of the province of Veneto]. / La prevalenza di ipertensione arteriosa nella comunita'. L'esperienza del Veneto.

In the context of a W.H.O. Community Control Program of Hypertension, 15.187 subjects aged 20-64 years were examined in three distinct areas of the Veneto region: Camposampiero (Padua), Valdagno (Vicenza) and Mirano (Venice). The prevalence of hypertension was evaluated according to W.H.O. criteria. The prevalence of the three forms of hypertension "systolic only", "diastolic only" and "systo-diastolic together", the difference according to sex and the correlation with age were also calculated. In particular the correlation with age was evaluated in four arbitrary classes of relative weight. The mean prevalence of hypertension into the three samples was 30.7%. The most common form was "systo-diastolic together" (15.5%). The prevalence of hypertension was higher in males and increased with age in both sexes. A positive association between the prevalence of hypertension and the age was observed in all the three classes of relative weight. This association was more noticeable in the classes of a higher relative weight. The association between weight and prevalence of hypertension is discussed in view of a primary prevention of hypertension. The results obtained clearly show the extent of the effort involved in order to control hypertension in the community.

[Value of cycloergometer and dynamic ECG (Holter ) in the diagnosis of coronary insufficiency (author's transl)]. / Confronto tra elettrocardiografia dinamica (Holter) e test da sforzo nella diagnosis di insufficienza coronarica.

The purpose of thee present work is to compare th value of two non invasive techniques: cycloergometer and dynamic ECG (Holter) in the diagnosis of ischaemic heart disease in subjects without basal ECG abnormalities and without clearcut clinical signs of coronary insufficiency. Twenty patients underwent both tests while in hospital. The ECG was continuously monitored for 24 hours according to the Holter method. In fifteen out of the twenty cases examined for results obtained with the two different techniques were in agreement; in three cases ischaemic ECG changes were seen only with the ergometer, in one only with the Holter and in one they were clearly present with the Holter, but were doubtful with the ergometric test. In our experience the Holter method should represent the first approach to studying patients suspected to be suffering from angina pectoris in view of its good sensitivity and of the absence of risk and contraindications. Maximal exercise test should be reserved to the patients in whom the Holter method has given negative results. The latter not only has a diagnostic value, but also "quantifies" the degree of ischaemia by recording symptomatic and asymptomatic ST depressions.

[Screening of hypertension in a community. Data from the "Camposampiero Project" (author's transl)]. / L'ipertensione arteriosa nella comunità: valutazione dello stato del controllo in una popolazione generale. Dati dal "Progetto di Camposampiero".

During the initial phase of the international "Community Control Programme of Hypertension" sponsored by W.H.O., and carried out in Italy by the Clinica Medica II of the University of Padua, a random sample of 5852 subjects was screened (11% of the whole population). The response rate was of 75.3%; the prevalence rate of hypertension (160 or 95), based on casual blood pressure readings, was 29.5%. Measures of the control of hypertension and other relevant results are: a 35.6% of all hypertensives were aware of their condition, and of these 41% were under treatment. Effective treatment of hypertension was seen in one 12.3% of all treated hypertensives (values lower than 16/95), while 14.2% of all hypertensives had values at or above 200 (systolic) or 120 (diastolic). 98.2% of all hypertensives were not under effective control. As a whole, control of hypertension was better in women and in elderly patients.

Clinical experiences with methyldopa.

1. The hypotensive effect of methyldopa alone or associated with other hypotensive drugs was evaluated in 155 patients. After 10 days of treatment, the blood pressure was back to normal in 80% and in 50% of the patients with mild and moderate hypertension, and it was significantly decreased in those with severe hypertension. 2. Contrary to other hypotensive drugs, it did not produce a significant increase in BUN and serum creatinine. Occasional or recurrent episodes of orthostatic hypotension were observed in about 18% of the cases, but in none did it produce important symptoms of cerebral or myocardial ischaemia.

[The orthostatic hypotension in patients treated with antihypertensive drugs (author's transl)]. / L'ipotensione ortostatica da farmaci antiipertensivi.

Occasional or recurrent episodes of orthostatic hypotension were observed in 58 out of 584 hypertensive patients treated with alpha-methyldopa, beta-blockers and clonidine alone or associated with diuretics and/or hydralazine and/or reserpine. They occurred more frequently in the elderly. In none dicardial ischaemia. In only 3 cases it caused drowsiness and in 2 transient T wave inversion. These results suggest that postural hypotension does not contraindicate the continuation of antihypertensive treatment.

Blood pressure and its spontaneous variations in a northern Italian population.

1. Blood pressure has been measured in a random sample of 5852 subjects (both sexes, 20-64 years old). The prevalence of hypertension (blood pressure greater than or equal to 160 mmHg and/or 95 mmHg; 150 mmHg and/or 90 mmHg under the age of 30 years) was 29-5%. 2. In a cohort of 972 detected hypertensive subjects, longitudinal changes (2 and 5 months after the initial examination) were evaluated. The phenomenon of regression toward the mean value was evident. 3. The implications of the variability of blood pressure in a community control programme of hypertension are discussed.