Panminerva medica
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Review
Clinical approach to the patient with Brugada Syndrome: risk stratification and optimal management.
The Brugada Syndrome (BrS) is an inherited cardiac ion channel disorder associated with increased risk of ventricular arrhythmias and mortality. Diagnosis is based on a characteristic electrocardiographic (ECG) pattern of coved type ST-segment elevation >2 mm followed by a negative T-wave in ≥1 of the right precordial leads V1 to V3. Since the first description of BrS, the definition of disease and underlying pathophysiological mechanisms have been significantly improved in recent years. ⋯ There is more information about patients who would need an implantable cardiac defibrillator for the primary prevention of sudden cardiac death (that is, those with spontaneous Type I Brugada ECG pattern and arrhythmia-related syncope), but currently published data concerning asymptomatic patients with Brugada ECG pattern and other less-well defined presentations are conflicting. Whereas the role of cardiac defibrillator in patients with Brugada Syndrome is clear, optimal use of catheter ablation and antiarrhythmic drug therapy needs to be further investigated. In this review, we summarize current evidence and contemporary management of patients with BrS.
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Chronic diseases and frailty represent the clinical expressions of the accumulations of biological deficits that occur with aging. However, when addressing chronic diseases, the evaluation of frailty is yet far to be part of routine clinical practice. Frailty and chronic diseases are often treated as different identities. ⋯ For these reasons, a different pathway of care for older patients with frailty and chronic diseases seems necessary. An assessment of frailty should be simple and not time consuming in order to address patient's needs and expectations, evaluating the social background, lifestyle and priorities. Empowering the patient implies a personalized evaluation and the development of individualized management plans which would ultimately lead to a reorganization of the health care provision and eventually increase quality of life in the elderly multimorbid frail patient.
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Chagas disease (CD) is an emerging infection in Italy as the consequence of the huge immigration from Latin American countries observed during the last ten-fifteen years. However, the interest of Italian researchers on CD dates back to the '80-90s of the last century with studies conducted in collaboration with Brazilian and Argentinian colleagues by Italian cardiologists and pathologists. ⋯ As observed in Latin America about 30% of screened subjects in Italy are affected by cardiac or digestive forms of CD. More than 20% of subjects treated with benznidazole discontinued it permanently due to adverse events.
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Conflicting information exists about whether sex differences modulate outcome in patients with coronary artery disease (CAD). Our aim was to analyze baseline characteristics, medical management, risk factor control, and long-term outcome according to gender in patients with stable CAD. ⋯ In contemporary practice, women with stable CAD had a poorer control of cardiovascular risk. However, at 5-year follow-up, cardiovascular outcomes were similar for both genders.