Intermittent QT prolongation induced by short-term oral amiodarone therapy

Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed after administration of a low dose and short term use of oral amiodarone, in the absence of predisposing factors. We describe the case of a 41-year-old woman admitted to hospital because of a cardiac arrest from TdP. On hospital admission, ECG showed sinus bradycardia 46 bpm with marked QT prolongation

Acute effects of cardiac resynchronization therapy on arterial distensibility and serum norepinephrine levels in advanced heart failure

Background: Cardiac resynchronization therapy (CRT) has become an accepted method fortreating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffnessand a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drugrefractory HF.Methods: Fourteen cardiac HF patients (53.6 ± 9.1; 39–67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III–IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) < 35% and QRS duration ≥ 120 ms. Blood samples for norepinephrine and B-type natriuretic peptidewere collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition.Results: Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p < 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman.Conclusions: The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves

Perforated solitary ulcer of the colon - Report of a case

PURPOSE: A patient with a solitary colonic ulcer had sudden onset of crampy abdominal pain, anorexia, fever, and vomiting, with signs of positive peritoneal irritation. METHODS: The diagnosis was proved by histopathologic examination of right hemicolectomy material. RESULTS: An emergency laparotomy, with right hemicolectomy and ileotransversostomy, gave complete relief from symptoms. The patient was still asymptomatic at the two-year follow-up, and control colonoscopic examinations performed at 6 and 18 months after the operation were normal. CONCLUSION: Preoperative diagnosis of perforated solitary colonic ulcers localized at the right hemicolon may mimic acute appendicitis, and intraoperative findings may mimic colonic carcinoma. If the preoperative diagnosis is not certain, right hemicolectomy and ileotransversostomy, with regular colonoscopic controls, is a safe procedure in the treatment and follow-up of these patients

Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction?

Abstract Background: According to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC). Methods: We retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system. Results: Out of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively). Conclusion: More than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels