Minerva cardioangiologica
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Minerva cardioangiologica · Feb 2001
Editorial Review Comparative Study[Atrial fibrillation and thromboembolic events prevention. State of the art].
Atrial Fibrillation (AF) is a common cardiac arrhythmia and stroke is its most devasting complication. The rate of ischemic stroke among people with AF is approximately six times that of people without AF and varies importantely with coexistent cardiovascular diseases; therefore stratification of AF patients into those at high and low risk of thromboembolism has become a crucial determinant of optimal antithrombotic prophylaxis. Multivaria-te analyses of prospective studies consistently show prior TIA/stroke, diabetes, age, heart failure to be independently predictive of stroke; left ventricular dysfunction is also strongly associated with stroke risk. ⋯ The addition of aspirin to low- dose warfarin regimen does not provide any significant benefits and should be avoided. Therapy with aspirin is appropriate for patients who are at low risk of stroke or are unable to receive anticoagulants. AF patients treated with aspirin, should be periodically evaluated for development of high-risk features favoring anticoagulation.
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Minerva cardioangiologica · Feb 2001
Review Comparative Study[Ventricular pre-excitation: electrophysiopathology, criteria for interpretation and clinical diagnosis. References for geriatrics].
The authors review the state-of-the-art on ventricular pre-excitation in medical and arrhythmological literature in order to facilitate the recognition of the various clinical forms, like classic and occult Wolff Parkinson withe syndrome and Lown Ganong Levine syndrome. A historical introduction reviews our electrophysiopathological knowledge of the electrical activation and conduction of ventricular pre-excitation compared to normal, starting from the anatomic discovery of conduction pathways to the possible use of transesophageal electrostimulation and endocavity mapping to study electric potentials. Avantgarde technologies have also been developed to eliminate anomalous pathways firstly by using a direct current dirscharge and secondly radiofrequency. ⋯ This section also describes the positional peculiarities of the Kent-Paladino bundle, the left ventricular, septal (anterior and posterior) and the multiple-bundle ones. The authors also illustrate the criterion and meaning of endocavity mapping in the search for anomalous bioelectric potentials that identify the pathway or the location of the endocardiac bundle and/or foci to be eliminated. A new echocardiographic technique is described with a conventional M mode, digitalised 2D and tissular Doppler which has a comparable ability to identify the anomalous pathways of electric conduction using a non-invasive method. (ABSTRACT TRUNCATED)
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Minerva cardioangiologica · Dec 2000
Review Comparative Study[Evolution in the pharmacological treatment of venous thrombosis according to evidence-based medicine].
Today therapeutic protocols must be in accordance with Recommendations derived by Randomized Controlled Trials (RCT) Evidences. Deep Venous Thrombosis (DVT), post-thrombotic syndrome and pulmonary embolism (PE) are different forms of the thromboembolic venous disease. The Authors, according with Evidence-Based Medicine, review the most significant RCT about Low-Molecular-Weight Heparin (LMWH). ⋯ RCT showed also a long-term lower DVT relapse and PE incidence with LMWH than with oral anticoagulants. The Authors report their own experience with LMWH and early ambulation for the treatment of DVT versus standard UH therapy. Their retrospective analysis confirms lower incidence of complications: growth of the thrombus, severe haemorrhages, PE.
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Minerva cardioangiologica · Mar 1999
Review[Critical ischemia in elderly patients. Evaluation of the effect of two different methods of Iloprost therapy on the efficacy, tolerance, modification of quality of life and self-sufficiency].
The use of Iloprost in the treatment of critical leg ischemia in very old patients can lead to tolerability problems, related to the drug used and to the kind of patient treated. The aim of this study was to evaluate the impact of this therapy on the activities of daily living and on the quality of life of the patient together with its efficacy and tolerability. ⋯ Iloprost can be used in the treatment of critical leg ischemia even for very old patients with good tolerability and effectiveness. In the double daily administration no relevant side effect was observed. This approach is to be preferred also in terms of cost-effectiveness.
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Minerva cardioangiologica · Dec 1997
Review Case Reports[Iatrogenic false aneurysm of the ulnar artery. A clinical case and review of the literature].
Nowadays false aneurysms have become an important part of the workload of a vascular surgeon as a result of the increasing number of iatrogenic arterial trauma occurring during diagnostic and therapeutic procedures requiring puncture or exposure of blood vessels. A case of a false aneurysm in the ulnar artery caused by a simple syringe needle during an intravenous cannulation is reported. ⋯ The vascular operation consisted in proximal and distal arterial control, resection of the aneurysm and end-to-end anastomosis. After surgical treatment the patient experienced an excellent anatomic and functional recovery.