International journal of cardiology
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Letter Case Reports
Revelation of an obstructive hypertrophic cardiomyopathy in an elderly patient.
Hypertrophic cardiomyopathy (HCM) is classified as a primary cardiomyopathy. HCM is a clinically heterogeneous but relatively common autosomal dominant genetic heart disease that probably is the most frequently occurring cardiomyopathy. HCM is characterized morphologically and defined by a hypertrophied, nondilated left ventriculum (LV) in the absence of another systemic or cardiac disease that is capable of producing the magnitude of wall thickening evident (e.g., systemic hypertension, aortic valve stenosis). ⋯ Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract, in asymmetric septal hypertrophy, establishes which is the best treatment strategy. In the treatment of HOCM, drug therapy with negatively inotropic drugs, percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion, surgical myectomy and DDD pacemaker therapy are considered the therapeutical options. We present a case of an obstructive hypertrophic cardiomyopathy in an 84-year-old Italian woman with a left ventricular outflow tract (LVOT) peak gradient with the Valsalva maneuver of 188 mm Hg and with a history of first episode of syncope.
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Comment Letter Review
Antioxidant interventions as novel preventive strategies for postoperative atrial fibrillation.
Atrial fibrillation is the most common sustained arrhythmia encountered following cardiac surgery. Although anti-arrhythmic drugs such as beta-blockers and amiodarone are recommended and used in clinical practice, the incidence of postoperative atrial fibrillation (POAF) is still very high. ⋯ Increased reactive oxygen species and activated atrial nicotinamide adenine dinucleotide phosphate (NADPH) oxidases after cardiac surgery are key targets for the prevention of POAF. In addition to statins, Vitamin C and E, N-acetylcysteine and carvedilol, some other anti-oxidant interventions such as thiazolidinediones, nitric oxide donor or precursor, probucol, levosimendan and NADPH oxidase inhibitors have emerged as novel strategies in the prevention of POAF.
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Comment Letter
The use of vasopressors in Takotsubo cardiomyopathy: impact on neurological practice.
Takotsubo has been reported in a wide range of clinical conditions. The choice of vasopressors in such situations needs careful consideration. This is highlighted in the management of status epilepticus where hemodynamic compromise is often iatrogenic though this may not be the case in the presence of concomitant Takotsubo cardiomyopathy.
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Further efforts in controlling blood pressure are warranted in patients with hypertension. Office blood pressure measurements, 24-h ambulatory blood pressure monitoring and home blood pressure monitoring are synergic techniques. But, according to available evidence about efficacy and cost-effectiveness of all these techniques, it is likely that for a better blood pressure management, office blood pressure measurements and home blood pressure monitoring could be extended to most of the hypertensive population in daily clinical practice, and limit the use of the 24-h ambulatory blood pressure monitoring just to the current indications.