Out-of-hospital cardiac arrest caused by transient left ventricular apical ballooning syndrome.

We describe a case of out-of-hospital cardiac arrest due to ventricular fibrillation in a patient with transient left ventricular apical ballooning syndrome. Our report confirms that left ventricular apical ballooning may have the same complications of myocardial infarction, adding the early ventricular fibrillation to the previous findings of left ventricular wall rupture, ventricular arrhythmias during hospitalization and complete atrio-ventricular block. Moreover, left ventricular apical ballooning may have different and unusual clinical onsets, including sudden cardiac death due to ventricular tachyarrhythmias in the absence of associated symptoms. Therefore, in our opinion left ventricular apical ballooning may be considered as a possible cause of sudden death in otherwise healthy women.

Percutaneous coronary angioplasty in a patient with anomalous single coronary artery arising from the right sinus of Valsalva.

We describe a 74-year-old female patient with unstable angina. The coronary angiogram showed the presence of a single coronary artery arising from the right sinus of Valsalva, which is a very uncommon congenital anomaly, with subocclusive atherosclerotic plaques at the proximal and distal right coronary artery. The stenoses were treated through percutaneous coronary angioplasty and insertion of taxol-eluting stents, with complete relief of symptoms and without evidence of myocardial ischemia at 6-months follow up. Single coronary artery is a rare congenital coronary anomaly, which may be asymptomatic and occasionally detected in patients with myocardial ischemia due to atherosclerotic coronary artery disease. In these cases, percutaneous coronary angioplasty with stent insertion may be a successful therapeutic option; however, accurate morphologic identification of anomalous arteries is mandatory before planning these interventions, in order to recognize other possible mechanisms of myocardial ischemia (e.g. vascular compression) and to choose the most appropriate type of pharmacological, percutaneous or surgical intervention.

[Clinical implications of rheology in cardiovascular diseases]. / Implicazioni cliniche della reologia nella patologia cardiovascolare.

Although a close relationship between haemorrheological disorders and thrombogenesis has been known for a long time, only the recent introduction of newly developed analytical techniques has allowed a precise assessment of the main haemorrheological parameters. The employment of these techniques in routine clinical practice has enabled, for instance, a more accurate investigation of the pathogenetic triggers underlying numerous thrombotic disorders affecting the cardiovascular system. A survey of the most exhaustive prospective studies shows that some haemorrheological parameters (e.g. plasma and blood viscosity) as well as their main determining factors (e.g. haematocrit and fibrinogen) are well defined independent cardiovascular risk factors. Nonetheless, further large scale studies are required to adequately dissect the relative contribution of both haemorrheological alterations and other thrombophilic factors in the pathogenesis of different cardiovascular diseases related to thrombotic disorders.