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) · Oct 2008
[Thromboembolic risk in atrial fibrillation: new clinical perspectives].
Prevention of embolic complications is one of the major goals of therapeutic strategy for atrial fibrillation. The embolic risk is related to the presence and nature of underlying heart disease; furthermore cerebrovascular accidents associated with atrial fibrillation occur in a higher percentage in the elderly, representing 6.7% of the total number of cerebrovascular accidents in the 50-to-59-year-old population and 36% in the 80-to-89-year-old population. ⋯ Several risk stratification schemes have been developed to evaluate the thromboembolic/hemorrhagic risk profile in the individual patient, but they have shown intrinsic limitations. In this short report we compare different risk stratification schemes to predict thromboembolic risk in atrial fibrillation patients, and we discuss the application of these schemes into clinical practice and the effects on clinical events.
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G Ital Cardiol (Rome) · Oct 2008
[Sudden cardiac death in athletes with an apparently normal heart: the channelopathies].
Ion channelopathies are inherited arrhythmia syndromes, without apparent structural heart disease, which predispose to syncope and sudden death, often in association with exercise. They are referred to as "primary cardiomyopathies", where the arrhythmogenic substrate is found in the electrical properties of the heart. The diagnosis is based on the 12-lead ECG and a careful family history, hence the usefulness of a preparticipation cardiovascular screening including 12-lead ECG in order to identify the subjects at risk.
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G Ital Cardiol (Rome) · Sep 2008
Review Case Reports[Pulmonary embolism associated with paradoxical arterial embolism in a patient with patent foramen ovale].
Paradoxical embolism and patent foramen ovale have represented an issue of great interest during the last years, because of the strong correlation with cryptogenic stroke in young patients. The coexistence of pulmonary and paradoxical embolism is even more rare. We present the case of a patient with evidence of concomitant pulmonary embolism and paradoxical systemic arterial embolism, which suggests the presence of patent foramen ovale. The available literature about this infrequent clinical event is also reviewed.
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G Ital Cardiol (Rome) · Jun 2008
[Death after ST-elevation myocardial infarction in patients treated with fibrinolytic therapy, angioplasty, or conventional therapy. A post-mortem study to verify cardiac rupture as a cause of death].
Experimental clinical observations suggest that fibrinolysis (FL) in acute myocardial infarction, even though reducing global mortality, is associated with an increasing incidence of death in the first 24-48 h. The responsible mechanism is not yet known, although available evidence supports heart rupture as the possible cause. ⋯ Our study shows that cardiac rupture is the major cause of death in patients with ST-elevation myocardial infarction treated with FL and PTCA, suggesting that mechanical and lythic reperfusion injury, in coagulative necrosis, may represent a further cause of cardiac rupture that occurs early or within the first hours.
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G Ital Cardiol (Rome) · May 2008
[Percutaneous rheolytic thrombectomy with AngioJet for pulmonary embolism: methods and results in the experience of a high-volume center].
Pulmonary embolism is a common disease with significant mortality. Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism, especially with hemodynamic compromise. However, systemic drugs cannot achieve timely and effective treatment of acute pulmonary embolism in all patients. Recently, rheolytic thrombectomy has been proven to be effective in the treatment of massive thrombosis in vein grafts. The purpose of this study was to describe the rheolytic thrombectomy procedure and to evaluate the efficacy of thrombus removal using the AngioJet catheter in patients with acute massive and submassive pulmonary embolism. ⋯ Percutaneous rheolytic thrombectomy using the AngioJet catheter may be a valid treatment option for patients with massive or submassive pulmonary embolism with rapid and significant hemodynamic improvement and encouraging results at early and long-term follow-up. Greater laboratory and operator experience yield better clinical results.