Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Dec 2008
Review[Treatment of acute and recurrent pericarditis. What the clinical cardiologist should know].
Pericarditis is a common clinical problem, above all in its incessant and recurrent forms. Treatment should be targeted according to etiology, but this is often unfeasible with a conventional approach, because most cases are labeled as "idiopathic" in the majority of immunocompetent patients from developed countries. Clinical risk stratification of acute pericarditis may be useful to select patients who should be admitted to hospital, and in whom a complete evaluation should be performed to identify causes that require specific therapy. ⋯ Corticosteroids are too often considered and should be limited to rare, specific indications (definite rheumatologic disease, presumed autoimmune etiology, intolerance or contraindications to aspirin or non-steroidal anti-inflammatory drugs, pregnancy) being a clear risk factor for a prolonged and chronic course of the disease in idiopathic or viral forms. Despite the common fear of a possible evolution towards constrictive pericarditis, such complication is not recorded in acute and recurrent pericarditis of viral and idiopathic etiology. The prognosis is good in these cases and the risk of constriction is related to the presence of a specific etiology and not to the number of recurrences.
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G Ital Cardiol (Rome) · Nov 2008
[Prehospital thrombolysis for the treatment of ST-elevation acute myocardial infarction. Three-year results in the province of Foggia].
Treatment for ST-elevation myocardial infarction (STEMI) is based on early reperfusion therapy (coronary angioplasty or fibrinolysis). Such treatment requires the adoption of healthcare models that allow to perform angioplasty within 90 min of first medical contact, or when this is not the case and in absence of any contraindications, prehospital thrombolysis. ⋯ This study confirms the feasibility, high effectiveness and low risk of prehospital thrombolysis provided that therapy is undertaken by trained staff according to prespecified protocols in the context of a well defined organized model.
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Takotsubo cardiomyopathy is a syndrome characterized by acute regional systolic dysfunction of the left ventricle, frequently related to psycho-physical acute stress, and usually reversible. This rare syndrome involves more often the female sex with the highest frequency of occurrence between the seventh and eighth decade of life. Etiology has not been clarified yet and several hypotheses have been postulated: multiple epicardial coronary artery damage, abnormal coronary microcirculation, catecholamine-mediated cardiac toxicity, and neurogenic stunning. ⋯ Ventricular angiography shows the typical regional wall motion abnormalities (apical akinesia and hyperkinesia of the mid-basal segments) that give to the syndrome its name (takotsubo is a traditional Japanese octopus trap or pot). Echocardiography performed in the acute phase also evidences wall motion abnormalities that characteristically regress in the following days. There is no specific treatment for this syndrome, but supportive and symptomatic therapy is usually administered.
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The older age of the population, together with some bad habits, first of all the lack of regular physical activity, is giving rise to a huge increase in the epidemiologic burden of cardiovascular diseases in our country. Epidemiological, clinical and laboratory studies have provided definitive evidence that physical activity is able to improve fitness and to reduce cardiovascular morbidity and mortality. ⋯ However, despite the fact that the benefits of an active lifestyle have been demonstrated by numerous scientific data, only a minority of Italians engage in regular physical exercise. Promoting physical activity in the general population and in patients affected by cardiovascular disease is therefore one of the primary objectives of our healthcare institutions in the next decades.