Diagnosis and treatment of asymptomatic left ventricular systolic dysfunction after myocardial infarction.

The increased survival after acute myocardial infarction induced an increase in heart failure with left ventricular systolic dysfunction. Early detection and treatment of asymptomatic left ventricular systolic dysfunction give the chance to improve outcomes and to reduce costs due to the management of patients with overt heart failure

Coronary artery perforation: How to treat it?

AbstractCoronary artery perforation fortunately represents a rare complication of coronary catheterization but, if not properly and promptly treated, it is burdened by a high mortality rate. Rates of coronary perforation may be potentially higher when atherectomy devices are used or very complex calcified lesions are treated. Cardiac tamponade constitutes the most severe clinical consequence.We report the case of an intra-stent coronary perforation at the end of revascularization of a non-ST elevation myocardial infarction (NSTEMI), followed by an immediate impairment of hemodynamic compensation, due to significant pericardial effusion and subsequent cardiac tamponade.The use of covered stents has revolutionized the management of coronary perforation and this has meant that the use of emergency CABG has decreased over the years with satisfactory immediate and short-term outcomes, reducing the incidence of acute cardiac tamponade and mortality without surgery

A rare case of Prinzmetal angina 3 days after coronary artery stenting with a second-generation drug-eluting stent.

Non previsto

Pacing ventricolare destro: una risorsa o una minaccia?

Early after the beginning of the pacemaker era, endocardial right ventricular apex has been the most extensively used site for cardiac pacing because it was easily accessible and reliable in a long-term perspective. However many data have demonstrated that this kind of pacing is suboptimal from a physiologic point of view because it causes several adverse effects such as altered ventricular contraction geometry, mitral regurgitation, perfusion alterations and interference with myocardial ion channels which determine a worsening of left ventricular function. Several strategies have been proposed to solve these problems (alternative pacing sites, specific algorithms able to reduce the percentage of ventricular pacing) which are still under evaluation. In this review we analyzed the effects of right apical ventricular pacing and its possible alternatives

[Heart ischemia and psychosomatics: the role of stressful events and lifestyles].

Objective: the aim of our study was to evaluate the role of stressful events, lifestyles and various socio-environmental factors in the beginning of ischemic cardiac diseases, together with cardiovascular factors. Materials and methods: 64 patients with recent cardiac ischemia and 64 controls matched 1:1, according to their sex and age, have been evaluated. The study required the filling in of clinico-anamnestic reports and the evaluation of stressful events, using the Holmes Rahe scale. Results: in the 44% of the patients who had a heart ischemia, an emotional striking event occurred few days before, with a 28% incidence of work and family problems. The mean score of the Holmes Rahe Social Readjustment Rating Scale was statistically significantly higher among cases (p<0,05). The percentage of the subjects who experienced a stressful event during the last year was significantly higher among those with an ischemic event even though the heart disease factors were similar in the 2 groups of cases and controls. Conclusions: although the known heart risk factors predispose to ischemic event, our results suggest that stressful and emotional factors play a fundamental role in increasing the risk