[Silent myocardial ischemia with raised ST tract in 2 octogenarian patients without ischemic cardiopathy]. / Ischemia miocardica silente con sopraslivellamento del tratto ST in due soggetti ottuagenari senza cardiopatia ischemica.

The authors describe two recently observed cases of silent angina with ST segment elevation. The patients, both 80-years old, were submitted to 24-hour Holter examination to account for recurrent episodes of dizziness. The examination revealed silent angina with ST elevation concentrated mainly in the late evening and morning hours, accompanied by accelerated heart rate. Treatment with low diltiazem doses was completely successful.

[Chiari's network: persistence of the embryonic remnants of the valve of the sinus venosus in the right atrium. Echocardiographic and clinical analysis in a group of subjects]. / La rete di Chiari: persistenza dei residui embrionali delle valvole del seno venoso in atrio destro. Analisi ecocardiografica e clinica in un gruppo di soggetti.

As echocardiography is being used more often, its value and accuracy are becoming more fully appreciated, especially for identifying normal anatomic variants and their possible erroneous interpretation as pathologic states. We report the echocardiographic and clinical findings observed in sixteen subjects examined at our Cardiological Service in the period from January 1987 to April 1988. Mean age of these subjects is 40 +/- 27.04. Of these subjects, six are affected by other cardiac pathologies and ten are unaffected (Group A). First, we describe in all the patients M-mode and two dimensional patterns of persistence of the right venous sinus valve known as the Chiari network. This structure can present as a highly mobile, highly reflective echo target, which can be seen especially by means of the bi-dimensional technique. The Chiari network could be seen with all four standard approaches. The two most diagnostic views are, in our experience, the short axis parasternal view (62.5%), and the subcostal view (87.5%). In a great number of subjects (75%) the Chiari network could be seen in at least two approaches. Second, in Group A we make a clinical examination. Nine subjects in this group show the presence of a cardiac systolic murmur with vibratory characters from grade 1/6 to grade 3/6. 50% of the same patients presented supraventricular arrhythmias (particularly, two presented reciprocating paroxysmal supraventricular tachycardia and one paroxysmal atrial fibrillation). The significance of these findings is not clear yet. We, at least, emphasise that the Chiari network could be confused with other curvilinear highly mobile, echo targets such as right-heart vegetations, flail tricuspid leaflets, a small right-heart thrombus or even a pedunculated right heart tumor (especially right atrial myxoma). On the contrary, this structure might be considered a "normal anatomic variant".

[Dynamic left intraventricular obstruction in acute myocardial ischemia]. / Ostruzione dinamica intraventricolare sinistra in corso di ischemia miocardica acuta.

A case of a 60-year-old woman suffering from hypertension, who presented an episode of acute myocardial ischemia with an elevation of the ST segment in the anterior ECG lead, is reported. On examination, a transient loud systolic murmur was present; it completely disappeared soon after the cessation of acute myocardial ischemia. Doppler echocardiography was performed a few times, during and after the acute ischemia: it was able to show a sort of "hour-glass" deformation of the left ventricle due to the akinesia of the anterior and apical segments. This functional anatomic deformation hampers the outflow from the left ventricle thus creating a dynamic left intraventricular gradient, which is clearly shown by pulsed wave and continuous Doppler echocardiography.