Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome (TTS). Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance

Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy

To address the coronavirus (Covid-19) pandemic,1 strict social containment measures have been adopted worldwide, and health care systems have been reorganized to cope with the enormous increase in the numbers of acutely ill patients.2,3 During this same period, some changes in the pattern of hospital admissions for other conditions have been noted. The aim of the present analysis is to investigate the rate of hospital admissions for acute coronary syndrome (ACS) during the early days of the Covid-19 outbreak

Studio delle acque sorgive nel territorio comunale di Chiaravalle Centrale (CZ, Italia)

Il lavoro si propone di analizzare le caratteristiche idrogeologiche e geochimiche di alcune sorgenti, site nel bacino idrografico del torrente Beltrame nel territorio comunale di Chiaravalle Centrale (CZ, Italia). Il monitoraggio delle sorgenti attive, svolto dall’Istituto per i Sistemi Agricoli e Forestali del Mediterraneo (I.S.A.FO.M) del Consiglio Nazionale delle Ricerche (C.N.R.) - Sezione di Rende (CS, Italia) nel biennio 2008-2009, ha consentito di rilevare e misurare i principali parametri chimico-fisici e idrologici di tali emergenze per valutare il loro grado di potabilità e le relative caratteristiche idrodinamiche. Le analisi dei dati raccolti hanno evidenziato buone condizioni di potabilità ed hanno permesso di distinguere due gruppi di sorgenti caratterizzati da differenti velocità di deflusso e da ritardi di piena, rispetto ai valori di precipitazione, variabili tra uno e due mesi

Long‐term follow‐up of patients with cardiac syndrome X treated by spinal cord stimulation

Objective: To assess the long-term effect of spinal cord stimulation (SCS) in patients with refractory cardiac syndrome X (CSX). Methods: A prospective, controlled, long-term follow-up was performed of 19 patients with CSX with refractory angina who underwent SCS ( SCS group, 5 men, mean (SD) age 60.9 (8.5) years); 9 comparable patients with CSX who refused SCS treatment ( 3 men, mean ( SD) age 60.9 (8.8) years) constituted the control group. Clinical and functional status were assessed at the time of screening for SCS indication ( basal evaluation) and at a median ( range) follow-up of 36 (15-82) months. Results: The two groups at baseline did not show any difference in clinical characteristics and angina status. All indicators of angina status ( angina episode frequency, duration and short-acting nitrate use) improved significantly at follow-up in the SCS group (p<0.001) but not in controls. Functional status, as assessed by the Seattle Angina Questionnaire and a visual analogue scale for quality of life, improved at follow-up in the SCS group (p<0.001 for all scales) but not in controls. Exercise tolerance, exercise-induced angina and ST segment changes also significantly improved in the SCS group but not in controls. Conclusions: Data show that SCS can be a valid form of treatment for long-term control of angina episodes in patients with refractory CSX

Ischemic Heart Disease and Heart Failure: Role of Coronary Ion Channels

Heart failure is a complex syndrome responsible for high rates of death and hospitalization. Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure. However, coronary obstruction is only an element of a complex pathophysiological process that leads to myocardial ischemia. In the literature, attention paid to the role of microcirculation, in the pathophysiology of ischemic heart disease and heart failure, is growing. Coronary microvascular dysfunction determines an inability of coronary circulation to satisfy myocardial metabolic demands, due to the imbalance of coronary blood flow regulatory mechanisms, including ion channels, leading to the development of hypoxia, fibrosis and tissue death, which may determine a loss of myocardial function, even beyond the presence of atherosclerotic epicardial plaques. For this reason, ion channels may represent the link among coronary microvascular dysfunction, ischemic heart disease and consequent heart failure