IL-3, expressed by activated T lymphocytes infiltrating early and advanced atherosclerotic plaques, may sustain the atherosclerotic process either directly, by activating SMC migration and proliferation, or indirectly, via VEGF production.

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Patients with aneurysmal subarachnoid haemorrhage (SAH) frequently have cardiovascular complications that include: blood pressure fluctuations, cardiac arrhythmias and ECG changes.ECG abnormalities, haemodynamic instability and pulmonary oedema, frequently associated with this pathologic condition, contribute to the morbidity and mortality of subarachnoid haemorrhage (SAH). Actually ECG changes occur in 50% to 100% of the patients during the acute stage of SAH, with the most common abnormalities involving the ST segment, T wave and QT interval. In most cases, these abnormalities are clinically inconsequential and are attributed to neurally mediated electrophysiological effects. Some SAH patients, however, show evidence of structural cardiac damage. ECG abnormalities which are indistinguishable from those due to acute myocardial infarction (ST segment elevation or depression) have occasionally been reported in SAH. These patients exhibited findings (which are completely reversible) similar to an acute myocardial infarction on ECG examination, as well as elevated cardiac enzymes and findings of left ventricular wall motion abnormalities, mostly anterior wall akynesis, causing the reduction of left ventricular ejection fraction. Occurrence of pulmonary oedema has been described in ten to 25% of SAH patients. Pulmonary oedema may be neurogenic or cardiogenic in origin and both are a consequence of increased adrenergic tone. There is evidence that the most important consequence of cardiovascular effects secondary to subarachnoid haemorrhage is increased susceptibility to sudden death. The increased adrenergic tone, due to high catecholamine levels and sympathetic cranial nerves stimulation can explain the origin of tachyarrhythmias. The mechanism proposed to explain the origin of bradyarrhythmias is an increased vagal tone. Ruolo del cardiologo nella gestione dell'emorragia subaracnoidea RIASSUNTO -I pazienti con emorragia subaracnoidea da aneurisma hanno frequentemente complicanze cardiovascolari: variazioni della pressione sanguigna, aritmie cardiache e modificazioni ECG. Le anomalie ECG, l'instabilità emodinamica e l'edema polmonare sono frequentemente associate a questo stato patologico, contribuiscono alla mortalità e morbilità dell'ESA. Le modificazioni ECG si presentano dal 50 al 100% dei pazienti durante la fase acuta dell'ESA, con le alterazioni più comuni a livello del segmento ST, dell'onda T, e dell'intervallo QT. Nella maggioranza dei casi queste anomalie sono clinicamente incoerenti e vengono attribuite ad effetti elettrofisiologici neuromediati. Alcuni pazienti con ESA, comunque, mostrano segni di danno cardiaco strutturale. Le anomalie ECG che sono indistinguibili da quelle dell'infarto miocardico acuto (innalzamento od abbassamento del tratto ST) sono state occasionalmente segnalate nell'ESA. Questi pazienti mostrano segni (completamente reversibili) simili ad un infarto miocardico acuto alRicevuto il 06.08.2002