Cardiologia (Rome, Italy)
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Cardiologia (Rome, Italy) · Nov 1996
Review Case Reports[Valvular lesions in the course of nonpenetrating thoracic trauma: their diagnosis by transesophageal echocardiography].
Two cases are reported with nonpenetrating chest trauma and involvement of mitral valve in one case and aortic valve cusps in the other, without aortic rupture. In both patients transesophageal echocardiography allowed us an accurate diagnosis, confirmed by surgical findings. In the patient with involvement of the aortic cusps, the regurgitation developed 3 months after the trauma. ⋯ The operator performing the study must be aware of the possible coexistence of different cardiac lesions secondary to blunt chest trauma. In the case of valvular regurgitation the accurate definition of the pathophysiological mechanism is mandatory in order to choose the appropriate surgical strategy. In the case of aortic incompetence of unknown origin, a nonpenetrating chest trauma must be searched out during the clinical interview.
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Cardiologia (Rome, Italy) · Sep 1996
[Analysis of changes in repolarization for the differential diagnosis of narrow QRS supraventricular tachycardia and the site of the accessory pathway].
In view of the growing role of catheter ablation techniques for the treatment of supraventricular tachycardia, noninvasive determination of tachycardia mechanism and preliminary localization of the accessory pathway (AP) can simplify the cardiac catheterization procedure and reduce fluoroscopic exposure. The purpose of this study was to analyze the diagnostic value of repolarization changes during narrow QRS complex tachycardia (< 0.11 s). In 159 12-lead electrocardiograms during narrow QRS complex tachycardia (13 atrial tachycardias, 57 atrioventricular (AV) node reentrant tachycardias and 89 AV reciprocating tachycardias), the following were evaluated: 1) the tachycardia cycle length; 2) the presence of QRS alternans > or = 1 mm in at least 6 leads; 3) the presence of ST segment depression > or = 2 mm and/or T wave changes (inversion, notching); 4) the duration of retrograde atrial activation during tachycardia (right atrium-coronary sinus interval, in ms); the latter parameter, as well as tachycardia mechanism and accessory pathway location, were determined during an electrophysiologic study. ⋯ The magnitude of ST segment depression, significantly more marked in the AV reciprocating tachycardias (1.3 +/- 1.6 mm) than in AV node reentrant tachycardias (0.7 +/- 0.8 mm, p < 0.005), was directly related to the duration of atrial activation time during tachycardia (80 +/- 20 ms, and 32 +/- 12 ms, p < 0.001, respectively). The finding of ST segment depression and/or T wave changes during narrow QRS tachycardia suggest the presence of an AV reciprocating tachycardia; this phenomenon may be related to a different pattern of retrograde atrial activation. In conclusion, analysis of repolarization changes during narrow QRS tachycardia constitutes an additional electrocardiographic criterion to differentiate the tachycardia mechanism and, furthermore, can guide preliminary location of the AP, even in the absence of ventricular preexcitation.
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Cardiologia (Rome, Italy) · Sep 1996
Randomized Controlled Trial Clinical TrialTransesophageal echocardiography in critically-ill patients using a miniaturized probe: feasibility, efficacy and indications.
Transesophageal echocardiography (TEE) with standard probes may be unsuccessful in emergencies, and in critically-ill or non collaborative patients. A miniaturized pediatric probe was used to overcome these limitations. Thirty-nine patients (age 18-87 years, height 155-184 cm, weight 45-102 kg) were studied with the pediatric probe, and 21 of them were studied using both the pediatric and adult probes in a random sequence. ⋯ Imaging projections and diagnostic accuracy in a wide range of cardiac, aortic and mediastinal diseases were similar for both the pediatric and adult probes. Patient's compliance was much improved by the pediatric probe. In conclusion, TEE by pediatric probes can be used in critically-ill adult patients when the approach with the standard probe is unfeasible or when sedation is undesirable.
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Cardiologia (Rome, Italy) · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialTreatment of hypertension associated with stable angina pectoris: favourable interaction between new metoprolol formulation (OROS) and nifedipine.
This was a double-blind, within-patient, crossover study to evaluate the effects of a new formulation of metoprolol on blood pressure (BP) and myocardial ischemia. Twenty outpatients with mild to moderate essential arterial hypertension, chronic stable angina pectoris and positive exercise test, after a 2-week baseline placebo period, were randomized to receive long-acting metoprolol (OROS) 14/190 mg o.d., nifedipine SR 20 mg b.i.d. or their combination in a sequence of a 3 x 3 Latin square design. Two patients withdrew from the study (1 for adverse event during metoprolol and 1 for rise of BP during nifedipine). ⋯ ST depression at peak exercise was significantly reduced by each treatment. The slopes of correlations between the ST-segment variation and systolic BP, HR and rate-pressure product during exercise, significantly decreased after all treatments with respect to placebo baseline, more with the combination therapy than with nifedipine alone and metoprolol alone. In conclusion, based on our results the favourable interaction of metoprolol OROS and nifedipine given concomitantly, is likely to be due to a better control, respect to each individual therapy, of the pathogenetic mechanism of myocardia ischemia: BP and HR increases during exercise and during symptomatic ischemic episodes are controlled by the beta-blocker and coronary vasoconstriction during silent ischemia is prevented by the calcium-antagonist.