An unusual interventricular septal bounce in a patient with dermatomyositis: a case report

Background In literature it has been reported in 1998, for the first time, a case of a 54-year-old man who developed constrictive pericarditis (CP) 12 years after diagnosis of dermatomyositis (DM). To our knowledge, this may be the only case reported. Case summary A 16-year-old man presented to our institution because of symptoms posing a suspicion for an inflammatory disease; after physical examination, lab tests, and other investigations (electromyography, magnetic resonance, and muscular biopsy) was diagnosed as having DM. Patient also showed hepatomegaly and congested jugular veins: after clinical and imaging investigations (transthoracic echocardiography and transoesophageal echocardiography) he was diagnosed as having a CP. Patient underwent pericardial resection and the final outcome consisted of a completely regression of the symptoms. Discussion Cardiac involvement in patients with DM ranges between 6% and 75%, and it can be clinically manifest or, far more frequently, sub-clinic. Pericardial involvement as a complication of DM is widely reported in the literature, but in almost all cases as acute pericarditis, effusive pericarditis or cardiac tamponade and almost never as a CP

Effectiveness of the antihypertensive action of lisinopril on left ventricular mass and diastolic filling

The effect of antihypertensive treatment with lisinopril (10 to 20 mg) on left ventricular mass and diastolic function was studied in 35 patients with mild to moderate hypertension. At baseline 6 and 12 months after treatment responders to lisinopril were examined by complete echo Doppler in order to measure left ventricular mass, diastolic and systolic function. Only 30 patients concluded the study follow-up. Lisinopril successfully reduced mean blood pressure (from 122 +/- 10 to 110 +/- 11 mmHg), without modification in heart rate, and left ventricular mass index (from 145 +/- 57 to 116 +/- 42 g.m-2) at month 6, with mild additional reduction at month 12. Isovolumic relaxation time was reduced but still abnormal at months 6 and 12, whereas deceleration time significantly changed only (from 230 +/- 40 to 195 +/- 35 msec) at month 12. Our results indicate that lisinopril is more successful in reducing left ventricular mass than in improving diastolic filling

Effect of antihypertensive treatment with nitrendipine on left ventricular mass and diastolic filling in patients with mild to moderate hypertension

Nitrendipine is a dihydropyridine calcium antagonist that may be active when administered once daily. The aim of the study was to assess the effect of antihypertensive treatment with nitrendipine (20-40 mg) on left ventricular mass and diastolic function. Forty patients with mild to moderate hypertension (diastolic pressure greater than or equal to 90 and less than or equal to 114 mm Hg) were enrolled; a complete echo Doppler examination was performed at baseline, and 8 and 12 months after treatment in order to measure left ventricular mass and diastolic and systolic function. Only 28 patients completed the study follow-up. At month 8 nitrendipine had already successfully reduced blood pressure (mean 122 +/- 9 to 92 +/- 10 mm Hg) without modifying heart rate, and left ventricular mass index (150 +/- 48 to 123 +/- 34 g/m2), with a further reduction at month 12. Isovolumic relaxation time was reduced at month 8 from 138 +/- 28 to 111 +/- 17 ms, but the diastolic pattern was completely modified only after 1 year, with a normalization of deceleration time (from 220 +/- 35 to 188 +/- 12). Systolic function did not change. Our results indicate that nitrendipine is a powerful antihypertensive agent that reduces left ventricular mass, but requires a longer period of time to improve diastolic filling patter

Left atrial and auricular thrombosis in patients with atrial fibrillation: from pathophysiology to treatment

Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia, and its prevalence is increasing, partly due to the progressive aging of the population. AF predisposes to thrombus formation in the atria and the atrial appendage through a complex interaction among local, systemic and hemodynamic factors, significantly increasing the risk for cerebral and systemic thromboembolic events. These complications have a major impact in terms of morbidity and mortality, and numerous therapeutic strategies have been proposed to reduce such risk. Systemic anticoagulation is the main strategy in the prevention of atrial and left atrial appendage thrombosis, and the advent of non-vitamin K antagonist oral anticoagulants (NOACs) has been a significant step forward, especially for safety, compared to warfarin. While prevention of atrial appendage thrombosis with NOACs has been widely explored, their role in the resolution of thrombi is less clear. The use of NOACs in this setting is largely unexplored, and some studies are underway to clarify their effectiveness. The objective of this paper is to review the literature on atrial and left atrial appendage thrombosis, describing pathophysiological mechanisms and current treatment strategies using NOACs

Left atrial and auricular thrombosis in patients with atrial fibrillation: from pathophysiology to treatment

Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia, and its prevalence is increasing, partly due to the progressive aging of the population. AF predisposes to thrombus formation in the atria and the atrial appendage through a complex interaction among local, systemic and hemodynamic factors, significantly increasing the risk for cerebral and systemic thromboembolic events. These complications have a major impact in terms of morbidity and mortality, and numerous therapeutic strategies have been proposed to reduce such risk. Systemic anticoagulation is the main strategy in the prevention of atrial and left atrial appendage thrombosis, and the advent of non-vitamin K antagonist oral anticoagulants (NOACs) has been a significant step forward, especially for safety, compared to warfarin. While prevention of atrial appendage thrombosis with NOACs has been widely explored, their role in the resolution of thrombi is less clear. The use of NOACs in this setting is largely unexplored, and some studies are underway to clarify their effectiveness. The objective of this paper is to review the literature on atrial and left atrial appendage thrombosis, describing pathophysiological mechanisms and current treatment strategies using NOACs