The study reported that in patients with late post-stroke seizures, phenobarbital prolonged QTc interval more so than levetiracetam.

We describe a case of a 56 year-old man with a history of chest pain. No evidence of myocardial ischemia or arrhytmias was observed. Echocardiographic examination in Emergency Department evidenced aortic root dilatation. Angio CT excluded aortic dissection. Trans esophageous Echocardiography (TEE) correctly identified an arterial fistula between the right coronary artery and superior vena cava, confirmed by angio CT 3-D reconstruction and coronarography. The definitive diagnosis was made after integrated approach (using TTE, TEE, CT, coronarography). The anatomic features of the fistula and the aortic root were examinated. Actually the patient is being followed with serial clinical and echocardiography examination for monitoring hemodynamic overload by fistula and size of aortic root for potential surgical correction. Current literature for incidence, diagnosis and the treatment of coronary fistulas is discussed.

IntroduzioneL'ischemia cerebrale è tra le principali cause di mortalità e morbilità nei paesi industrializzati, essendo responsabile del 10-12% di tutti i decessi e di un elevato numero di invalidità permanenti [1]. Le forme cardioemboliche, secondarie a fibrillazione atriale (FA), cardiopatia ischemica, valvulopatia reumatica, protesi valvolari, cardiopatie congenite ed endocarditi sarebbero responsabili di circa il 30-35% delle sindromi cerebrovascolari acute [2]. Tuttavia in una significativa percentuale dei casi, soprattutto nei giovani, gli episodi ischemici cerebrali non sono riconducibili a nessuna di tali alterazioni: si parla in questi casi di Stroke / TIA criptogenici [3]. In tali pazienti sono state frequentemente segnalate anomalie cardiache rappresentate dall'aneurisma del setto interatriale (ASA) e dal forame ovale pervio (FOP) [4]. L'ASA è un'alterazione costituita da un'abnorme estroflessione del setto interatriale che coinvolge prevalentemente la regione della fossa ovale, ma che può interessare anche tutto il setto, con diversa morfologia in relazione al variare delle pressioni esistenti nelle cavità atriali, potendosi mostrare come una sacculazione sinistra o destra concava fissa o più frequentemente fasicamente mobile [5][6].L'ASA è un'entità ad oggi ancora non ben definita: non univoci ne sono i criteri diagnostici, incerta ne è la prevalenza in popolazioni non selezionate, non definitivamente chiarito è il suo ruolo nelle sindromi ischemiche cerebrali/sistemiche, nella sua Cerebral ischemia is among the principal causes of mortality and morbidity in industrialized countries being responsible of 10-12% of all deaths and of an elevated number of permanent disability. The cardioembolic forms may be responsible of the 30-35% of cerebrovascular acute syndrome, nevertheless in a significant percentage of cases, especially among young people, cerebral ischemic episodes are not induced by these cardiembolic forms: these cases are defined as cryptogenetic stroke/TIA. In these patients cardiac abnormalities represented by an aneurysm of the interatrial septum (ASA) and by a patent foramen ovale (PFO) have been frequently observed. The purpose of our prospective study was to evaluate, through transthoracic ecocardiography and tissue harmonic imaging (ETT-THI), the prevalence of ASA in the general population (group A) and the prevalence of ASA-FOP in a subgroup of patients with recent episode of cryptogenetic ischemic stroke/TIA (group B). We studied in a prospective manner from January 1 2003 to October 31t 2004 n. 5.631 patients. The presence of ASA was found in 3,2% of patients of group A, while in patients of group B we identifyed an ASA in 32% and a POF in 42% of the cases. Using a ETT-THI, our study shows in a wide range of a non selected population a prevalence of ASA greater than in previous studies. Such high prevalence in the general population of patients submitted to echocardiography and the higher frequency in subjects with recent cryptogenetic stroke, suggests to search carefully these ab...

ARTICOLO ORIGINALEL'ipertrofia ventricolare sinistra è un fattore di rischio indipendente di mortalità cardiovascolare 1 ed il suo ruolo di predittore di eventi si mantiene in alcune categorie di pazienti, tra i quali gli emodializzati, nei quali è stata evidenziata una correlazione inversa tra massa cardiaca e sopravvivenza che, a cinque anni dall'inizio del trattamento, è del 85% in pazienti con geometria ventricolare normale, del 67% in pazienti con rimodellamento concentrico, del 52% e 48% nei pazienti con ipertrofia ventricolare rispettivamente concentrica ed eccentrica. [2][3][4][5][6] Anche lo studio dei marcatori sierici di danno miocardico è oggi oggetto di grande interesse e studio. La troponina cardiaca (Troponina T e I) si dimostra un marcatore sensibile di danno miocardio ed ipertrofia cardiaca, correlandosi alla massa ventricolare sinistra. 7-10 Sebbene esistano evidenze di un aumento della sua concentrazione nel siero di pazienti con insufficienza renale cronica in fase dialitica senza segni o sintomi di malattia cardiaca, la maggior parte degli studi ne rileva l'importanza come marcatore indipendente nella predizione di eventi cardiovascolari. 11,12 Scopo di questo lavoro è stato quello di studiare mediante ecocardiografia, in un gruppo di pazienti emodializzati, i patterns cardiaci geometrici, la fun- Results: Eccentric hypertrophy was the most frequent pattern (n=17; 55%), followed by normal cardiac geometry (n=7; 23%), and concentric hypertrophy (n=5; 16%). Only 6% of pts (n=2) showed concentric remodelling. Systolic dysfunction was present in terms of endocardial parameters in 3 pts (9%) (fractional shartening <25%, EF<50%), but in terms of midwall myocardial shortening in 51% (n=16). Diastolic dysfunction was present in 87% (n=27) with a pattern of impaired relaxation (in 5 without left ventricular hypertrophy). E/A was negatively correlated with age (r=-0.41, p=0.02); DTE was positively correlated with posterior wall thickness (r=0.36, p=0.05) and interventricular septum thickness (r=0.45, p=0.01); cardiac troponin was positively correlated with age (r=0.50, p=0.00), left ventricular mass (r=0.41, p=0.02), posterior wall thickness (r=0.41; p=0.02) and interventricular septum thickness (r=0.39, p=0.03) but not with diastolic dysfunction parameters. No significant difference was found in terms of duration of dialysis between patients with normal left ventricular geometry and those with left ventricular hypertrophy, but a significant difference in age was found (p=0.03). Pts with diastolic dysfunction had more frequent hypotensive episodes during dialysis (p <0.01).Conclusion: Impaired geometry and cardiac function is frequently observed in pts undergoing hemodialysis. Diastolic dysfuction is associated to a geometric pattern of left ventricular hypetrophy, although it can be an isolated initial manifestation of myocardial damage. Depressed midwall myocardial shortening can discriminate left ventricular dysfunction better than traditional endocardial systolic indexes.

ObjectivesThe UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE).Methods and resultsCardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6–495.1, P &lt; 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74–1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87–1.11; P = 0.80)] or TTS [IRR 1.66(0.80–3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period.ConclusionsThe data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.