Italian heart journal : official journal of the Italian Federation of Cardiology
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Operations on the aortic arch remain a major challenge for the cardiac surgeon and neurologic injuries represent the most feared complication. During the last decades, different cerebral protection techniques, including deep hypothermic circulatory arrest, and retrograde and antegrade cerebral perfusion have been introduced into clinical practice to reduce the incidence of such complications. All three methods present advantages and disadvantages. In this review, the theoretical impact of the current methods of brain protection is reported and discussed.
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Cardiovascular complications are frequently observed in patients with chronic obstructive pulmonary disease (COPD) admitted to respiratory intensive care units and may affect the prognosis. The aims of this study were to evaluate a) the prevalence of cardiovascular complications in patients with COPD exacerbation admitted to respiratory intensive care units, b) which parameters detected at admission were predictive of cardiovascular complications, and c) the prognostic role of cardiovascular complications. ⋯ Cardiovascular complications occurred in many patients with COPD exacerbation admitted to respiratory intensive care units, and identify a subset of patients with higher mortality.
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Acute pericardial diseases are common disorders in several clinical settings. The presentation may include acute pericarditis and its recurrences, incidental pericardial effusion, cardiac tamponade, and occasionally constrictive pericarditis. New diagnostic techniques have improved the sampling and analysis of pericardial fluid and allow a comprehensive diagnostic approach. ⋯ Most cases of acute pericarditis are viral or idiopathic and self-limited; however, other etiologies should also be considered. The diagnostic yield of extensive laboratory evaluation and pericardiocentesis is low, and invasive procedures should be limited mainly to patients in whom therapeutic intervention is necessary. Treatment should focus on symptomatic relief, usually through the administration of non-steroidal anti-inflammatory drugs, and patients should be carefully evaluated and monitored for common complications of the disease.
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Systemic sclerosis (SSc) is a multisystem disorder characterized by widespread vascular lesions and fibrosis of the skin and specific internal organs. Cardiac involvement is a common finding in SSc, but often clinically occult. The aim of the present study was to analyze both left and right ventricular (RV) myocardial function in patients with SSc, and their relation to other instrumental features of the disease. ⋯ The relationships of RV myocardial diastolic dysfunction with both skin and pulmonary involvement as well as with the serological antibody pattern emphasizes the ability of DMI to identify patients with a more diffuse and severe form of SSc. This issue may be critical for the early identification of those SSc patients who are at higher risk of cardiac impairment, ideally when they are still asymptomatic before developing severe vasculopathy.
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Myocardial bridging, a systolic compression of an intramyocardial segment of an epicardial coronary artery, may be an incidental finding during coronary angiography or autopsy. However, some investigators reported a variety of acute coronary syndromes associated with this condition. We describe the case of a relatively young male patient (43 years old) referred to our emergency department for cardiac arrest and subsequent evidence of significant myocardial bridging at coronary angiography. The patient has been treated with an implantable cardioverter-defibrillator to prevent possible subsequent arrhythmic events associated with the myocardial bridging.