Cryptogenic stroke as a working diagnosis: the need for an early and comprehensive diagnostic work-up

Atrial fibrillation; Cryptogenic stroke; Implantable cardiac monitorFibril·lació auricular; Ictus criptogènic; Monitor cardíac implantableFibrilación auricular; Ictus criptogénico; Monitor cardiaco implantableIn the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study, the causes of ischemic stroke were identified in 43% of cryptogenic stroke patients monitored with implantable cardiac monitor (ICM), but one-third of these patients had non-cardioembolic causes. These results suggest the need for an early and comprehensive diagnostic work-up before inserting an ICM

Maternal Anti-Ro/SSA Autoantibodies and Prolonged PR Interval in a Competitive Athlete: Beyond Training-Induced Electrical Remodeling

: Prolongation of the PR interval is common among competitive athletes. However, further investigations should be performed when the PR interval is markedly prolonged. We report the case of a young male athlete with an autoimmune-mediated atrioventricular block due to circulating anti-Ro/SSA-antibodies in the mother (late progressive congenital form). (Level of Difficulty: Advanced.)

Le indicazioni al trattamento con immunoglobuline endovena nelle malattie reumatiche. [Indications for intra-venous immunoglobulin treatment in rheumatic diseases]

Con l’immissione in commercio delle Immunoglobuline per uso endovenoso (IVIG), che risale ormai al 1981, è stato possibile ampliarne enormemente le utilizzazioni terapeutiche, dimostrando l’efficacia di tale trattamento in condizioni cliniche le più diverse. In particolare, sulla base della progressiva acquisizione di conoscenze circa la capacità delle IVIG ad alte dosi di interferire a vari livelli col sistema immunitario, ne è stato proposto l’impiego in moltissime patologie su base autoimmunitaria o comunque dipendenti da meccanismi di tipo flogistico-immunitario. Ci limiteremo in questa sede a riportare le indicazioni al trattamento con IVIG, di quelle situazioni cliniche, di stretta competenza reumatologica, per le quali l’evidenza di efficacia sia sufficientemente solida, sia cioè basata su sperimentazioni cliniche allargate e adeguatamente controllate. Prima di procedere alla disamina degli aspetti terapeutici è tuttavia opportuno ricordare brevemente i meccanismi invocati per spiegare la potente attività immunomodulante di cui sono dotate le IVIG. I meglio conosciuti e documentati sono i seguenti

Autoimmune Calcium Channelopathies and Cardiac Electrical Abnormalities

Patients with autoimmune diseases are at increased risk for developing cardiovascular diseases, and abnormal electrocardiographic findings are common. Voltage-gated calcium channels play a major role in the cardiovascular system and regulate cardiac excitability and contractility. Particularly, by virtue of their localization and expression in the heart, calcium channels modulate pace making at the sinus node, conduction at the atrioventricular node and cardiac repolarization in the working myocardium. Consequently, emerging evidence suggests that calcium channels are targets to autoantibodies in autoimmune diseases. Autoimmune-associated cardiac calcium channelopathies have been recognized in both sinus node dysfunction atrioventricular block in patients positive for anti-Ro/La antibodies, and ventricular arrhythmias in patients with dilated cardiomyopathy. In this review, we discuss mechanisms of autoimmune-associated calcium channelopathies and their relationship with the development of cardiac electrical abnormalities