Giuseppe Dattilo

ST-segment elevation and diminution of prostate-specific antigen in a patient with coronary spasm and without significant coronary stenoses

Many patients with acute coronary syndrome (ACS) had no culprit lesion. Coronary spasm is a frequent cause of ACS and should regularly be considered as a differential diagnosis. Prostate-specific antigen (PSA) is an established marker for detection of prostate cancer. Both elevated as well as diminished PSA have been reported during acute myocardial infarction(AMI) and our preliminary observations have concluded that when elevation of PSA occurs during AMI, coronary lesions are frequent and often more severe than when a diminution of PSA occurs. Moreover, our preliminary observations have concluded also that when elevation of prostate-specific antigen occurs during AMI, it seems to relate to a higher occurrence of major adverse cardiac events in the first 8 days after AMI than when a diminution of PSA occurs. We present a case of ST-segment elevation in a patient with diminution of PSA, coronary spasm and without significant coronary stenoses. Our report extends the evaluation of PSA during ACS.

Changing axis deviation during atrial fibrillation

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of changing axis deviation during atrial fibrillation in a 63-year-old Italian woman. Also this case focuses attention on changing axis deviation.

Changing axis deviation and acute myocardial infarction

Changing axis deviation has been rarely reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also rarely reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of changing axis deviation in a 77-year-old Italian woman admitted to the Cardiology Unit with an acute myocardial infarction. Also this case focuses attention on changing axis deviation and acute myocardial infarction.

Acute myocardial infarction and left bundle branch block with changing axis deviation

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a LBBB with changing QRS morphology and changing axis deviation. There are several possible explanations for the intermittent shift in the QRS axis in the presence of complete left bundle branch block. The most plausible explanation is the coexistence of left posterior hemiblock and predivisional left bundle branch block. We present a case of a left bundle branch block with changing axis deviation in a 93-year-old Italian woman admitted to the Cardiology Unit with an acute myocardial infarction.

Intermittent changing axis deviation during acute myocarditis.

It has been rarely reported intermittent changing axis deviation also during atrial fibrillation and also during atrial flutter. Intermittent changing axis deviation during acute myocardial infarction and changing axis deviation associated with atrial fibrillation and acute myocardial infarction too have been also rarely reported. Conduction system disturbances have been described during acute myocarditis and it has been suggested that myocardial interstitial edema is implicated in the conduction disturbances that occur in acute myocarditis. Usually, edema is located in the epicardial layer of ventricular wall during acute phase of focal myocarditis and it cant be associated with clear evidence of wall motion abnormalities. It has also been described in a work the report of sequences of alternatively normal and Wenckebach beats with alternate and progressive right bundle branch block interpreted as functional longitudinal dissociation in atrioventricular conduction axis during chronic chagasic myocarditis. We present a case of changing axis deviation during acute myocarditis in a 15-year-old Italian man. This case focuses attention on changing axis deviation during acute phase of focal myocarditis in absence of wall motion abnormalities.

Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant

Interatrial defects, ventricular septal defects, and patent ductus arteriosus can occur as part of more congenital cardiac malformations or as an isolate finding. We present a case of interatrial defect associated with ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant.

Myocarditis and cardiomyopathy HIV associated

Heart muscle involvement associated with human immunodeficiency virus (HIV) infection may present as myocarditis, dilated cardiomyopathy or as isolated left or right ventricular dysfunction. Histopathological and ultra structural findings with different degrees of cardiac-chamber dilation have been described and an important role of the cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) and IL-6 has been suggested. We present a case of myocarditis in a 47-year-old woman with HIV associated cardiomyopathy, focussing attention on heart muscle involvement in HIV disease.

Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis

After mechanical heart valve replacement use of unfractionated heparin is sometimes required because vitamin K antagonists are temporarily contraindicated or to prevent valve-associated thromboembolism until oral vitamin K antagonists take effect. Bridging therapy with a standardized low molecular weight heparin-based regimen has been reported effective and relatively safe in a large cohort of patients with mechanical heart valves. Many cases with mitral mechanical valve prostheses and treatment failure of low molecular weight heparin have also been reported as well as prosthetic valve thrombosis has been reported with adequate anticoagulation. A case has also been reported of well functioning Starr-Edwards aortic prosthesis without anticoagulation. We present a case of cardioembolic stroke in a patient with an aortic mechanical prosthesis in bridging therapy with a standardized low molecular weight heparin-based regimen. This case is illustrative of treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis.

Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation.

From time to time, it may be necessary to interrupt oral anticoagulant therapy in preparation for surgical procedures. In high-risk patients or for longer periods, unfractionated or low-molecular-weight heparin bridging treatment has been reported safe. This case focuses attention on treatment failure of low molecular weight heparin bridging therapy in a patient with atrial fibrillation.

Pericardial effusion associated with subclinical hypothyroidism

Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Subclinical hypothyroidism is defined by elevated serum levels of TSH with normal levels of free thyroid hormones. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. It has been reported that sub-clinical hypothyroidism is associated with both, a significant risk of coronary heart disease at baseline and at follow-up and that mortality from cardiovascular causes is significantly higher at follow-up. However subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications. Pericardial effusion can be present in systemic disorders including hypothyroidism. We present a case of subclinical hypothyroidism in a 41-year-old Italian woman with an ubiquitary pericardial effusion. Also this case focuses attention on subclinical hypothyroidism.