Giornale italiano di cardiologia
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Case Reports
[Pulmonary and systemic embolism in a case of biatrial thrombosis. Role of two-dimensional echocardiography].
The authors describe the case of a 61-year-old woman affected with pulmonary embolism, in whom the presence of masses in both atria has been detected by two-dimensional echocardiography. The event of a systemic embolism and the dissolution of both masses after an anticoagulant therapy, has induced the authors to diagnose a biatrial thromboembolism propagating from the venous system and passage of thromboembolic material through a patent foramen ovale. These findings are, therefore, in differential diagnosis compared with other biatrial intracavitary masses.
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A case of acute poisoning caused by an overdose of flecainide (1.5 gr. per os), taken in order to commit suicide, is described here. With a plasmatic concentration of 5000 ng/ml the drug induced a soporose condition, shallow breathing with phases of apnea and intermittent muscular clonuses, a clinical picture of shock with a idioventricular rhythm at a rate of 40/min. and widening of the QRS (400 msec.). The infusion of orciprenaline and 5% glucose solution induced an increase in the ventricular frequency and the normalization of the circulatory condition. ⋯ Highest therapeutic level of flecainide was reached 48 hours after ingestion. The stimulation threshold during the acute phase was 1.8 mA and came down 1.3 mA after wash-out. The outcome was favourable.
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The acute electrophysiologic effects and therapeutic efficacy of intravenous and oral flecainide were assessed in 18 patients with recurrent supraventricular tachyarrhythmias, resistant to conventional antiarrhythmic agents. They were 22 to 76 years old (mean 50). Twelve patients underwent electrophysiologic study for the investigation of tachyarrhythmias. ⋯ After intravenous flecainide therapy, reentrant SVT was non inducible in the patients of group I and in 4 patients of group II. Flecainide was successful in the acute termination of 100% of automatic supraventricular tachycardia and 75% of fibrillation. The patients with atrial flutter developed a faster ventricular rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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We describe the case of a diastolic mitral and tricuspid regurgitation in a patient affected by acute myocardial infarction Ecg showed inferior myocardial infarction complicated by atrioventricular block and a junctional rhythm with frequent premature ventricular beats; the mean heart rate was of about 60 per minute. 2D echocardiogram disclosed akinesia of the apical segments of the inferior septum and anterior and infero-lateral walls. Pulsed and continuous wave Doppler showed mild to moderate mitral and tricuspid systolic regurgitation and diastolic regurgitation through both atrioventricular valves. The diastolic regurgitation always occurred during prolonged diastoles, soon after the blocked P waves. The possible mechanism of this finding and its clinical significance are discussed, drawing the conclusion that the atrioventricular diastolic regurgitation is not diagnostic of a specific valvular disease but can be secondary to other conditions, especially the atrioventricular block.
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The purpose of this investigation was to compare the Ejection Fraction values simultaneously obtained with the Nuclear Stethoscope and with Cineangiography, in 25 patients (17M-8W) subjected to diagnostic cardiac catheterization. In all patients the determination of Ejection Fraction with the Nuclear Stethoscope always preceded the Cineangiography. Ejection Fraction values obtained with Nuclear Stethoscope change from 32 to 75%; those calculated with Cineangiography, between 18 and 88%. ⋯ There was a direct relationship between Ejection Fraction determined by the Nuclear Stethoscope and Cineangiography (r = 0.93; p less than 0.001). In the obtained results the Authors point out that the Ejection Fraction with Nuclear Stethoscope gives assurance in most patients, although in some particular conditions Nuclear Stethoscope provides Ejection Fraction values which differ from those obtained with Cineangiography. They conclude that Nuclear Stethoscope, for its safe, repeating and simple application, is a methodology of useful employment for Ejection Fraction determination in the single patient, which allows a correct definition of the prognosis and a conforming therapeutic strategy.