Gregoriana Zanini

Homocysteine and Heart Failure: An Overview

An elevated plasma level of homocysteine (HCY) is associated with increased risk of thrombotic and atherosclerotic vascular disease. Several studies and recent patents have demonstrated that hyper-homocysteinemia (HHCY) is an independent risk factor for vascular disease. An elevated homocysteine level has been also reported to be a risk factor for the development of congestive heart failure (CHF) in individuals free of myocardial infarction. Animal studies showed that experimental HHCY induces systolic and diastolic dysfunction, as well as an increased BNP expression. Moreover, hyperhomocysteinemic animals exhibit an adverse cardiac remodeling characterized by accumulation of interstitial and perivascular collagen. The mechanisms leading from an elevated HCY level to reduced pump function and adverse cardiac remodeling are a matter of speculation. Existing data indicate that direct effects of HCY on the myocardium, as well as nitric oxide independent vascular effects, are involved. Preliminary data from small intervention trials have initiated the speculation that HCY lowering therapy by micronutrients may improve clinical as well as laboratory markers of CHF. In conclusion, HHCY might be a potential etiological factor in CHF. Future studies need to explore the exact pathomechanisms of HHCY in CHF. Moreover, larger intervention trials are needed to clarify whether modification of plasma HCY by B-vitamin supplementation improves the clinical outcome in CHF patients.

Right Ventricular Thrombus and Pulmonary Thromboembolism/Thrombosis in Behçet's Disease: A Case Report

Behçets disease (BD) is a multisystemic, chronic, inflammatory disease of unknown origin characterized by alternation of exacerbation and quiescence phases. Cardiac involvement in BD is infrequent. We report a case of a young man with BD with right ventricular thrombus and pulmonary thromboembolism. A 20-year-old man was admitted to our hospital with a 6-month history of dyspnea at rest, asthenia, and fever. Transthoracic echocardiography showed right wall thickened and presence of floating masses in the right outflow tract. Transesophageal echocardiography confirmed the presence of diffuse thrombosis in the right ventricle, with mobile ramifications in its outflow tract. Cardiovascular magnetic resonance and computed tomography of heart confirmed the presence of thrombi, the increased thickness of endocardiac tissue, and altered cardiac wall signal transmission. Computed tomography scan showed multiple pulmonary thrombi. Myocardial biopsy specimen showed diffused subendocardial thrombosis with damage of cardiac myocytes and presence of granulocytes. Six months after discharge, no cardiac masses were detected by transthoracic echocardiography. However, a few weeks after this last echocardiogram, the patient was again hospitalized for a new episode of acute pulmonary embolism. The patient was discharged with increasing dose of oral anticoagulant, with no evidence of cardiac masses at transthoracic echocardiography and thrombosis at computed tomography. The patient is still healthy on anticoagulant, immunosuppressive, and steroid therapy. This case provides a rare example of BD, in which we found-at the same time-heart and pulmonary manifestations, with the presence of right ventricular thrombus and pulmonary thrombi in situ.

Infectious endocarditis during pregnancy, problems in the decision-making process: a case report

Infective endocarditis in pregnancy has a low incidence, often being associated with a previous history of rheumatic or congenital heart disease. In most reports the disease tends to run a subacute course and to appear more frequently in the third trimester of pregnancy. We present the case of a 36-year-old woman with large vegetations on the mitral valve due to infective endocarditis detected at the 32nd week of her first pregnancy. The difficulties in selecting the appropriate management strategy, particularly optimal time and mode of delivery, optimal time and type of valve surgery, are emphasized.

Brugada syndrome phenotype cardiac arrest in a young patient unmasked during the acute phase of amiodarone infusion: disclosure and aggravation of Brugada electrocardiographic pattern

We report a case of an outpatient cardiac arrest due to ventricular fibrillation and resuscitated with external automated defibrillator shocks in which acute amiodarone infusion unmasked a Brugada phenotype electrocardiographic pattern. Possible interferences by this drug and suitable therapeutic actions are discussed.

Diagnosis of Cor Triatriatum Sinister in Patient with Pulmonary Edema and Severe Pulmonary Arterial Hypertension: Assessment by Three‐Dimensional Transesophageal Echocardiography

(Echocardiography 2011;28:E198‐E201)

Electrocardiographic changes in hiatal hernia: a case report

We describe the case of a 78-year-old woman admitted to our department for suspected silent myocardial ischaemia with the evidence of T wave inversion in anterior lead. All the instrumental exams excluded inducible myocardial ischaemia. A gastroscopy showed a moderate hiatal hernia. We postulate that electrocardiogram modification could be attributed to hiatal hernia.

Cardiovascular Risk Factors, Diet and Lifestyle among a Group of Italian Young Adults Students

The prevalence of cardiovascular disease has shown a marked increase over the last decade, representing the leading cause of death in the United States of America but also in Italy. Cardiovascular diseases recognize a multifactorial etiology: age, obesity, distribution of body fat, cigarette smoking, sedentary lifestyle, high blood pressure, dyslipidemia. In recent years has been paid particular attention to the cardiovascular risk factors prevention particularly in adulthood (> 30 years old). The aim of our study was to evaluate the lifestyle in young subjects (20 years old) particularly in a group of students of the Valle Sabbia (a mountain zone in the North of Italy) using dedicated questionnaire, anamnesis, physical examination and blood tests + ECG.

Seaweed floating in the pericardium: a rare case of primary dedifferentiated liposarcoma

Primary cardiac tumors are uncommon and primary liposarcoma of the pericardium is extremely rare. We describe the case of a 55-year-old Caucasian woman without significant medical history, who presented with 3weeks complain of dyspnea, peripheral edema, and gain weight. Echocardiography revealed a huge pericardial mass confirmed by computed tomography and by magnetic resonance. The lesion was primitive of the pericardium but the surgery was not able to cut it off because of the absence of cleavage planes. Histopathologic analysis detected a dedifferentiated liposarcoma. Mediastinum compression syndrome brought the patient to the exitus in a few days.

Tricuspid valve myxoma in a patient with congestive heart failure

Myxomas are the most frequent benign primary cardiac tumours (50% of benign heart tumours). This kind of tumour is most likely to be localized in the left atrium, followed by the right atrium, right ventricle and left ventricle. Quite exceptional is the presence of a myxoma originating from the tricuspid valve or from the Eustachian valve. We describe the case of a woman with moderate dyspnoea of unknown origin and the presence of tricuspid myxoma who underwent tricuspid valve curettage.

A case report of alveolar haemorrhage associated with severe thrombocytopenia induced by abciximab infusion in a patient with an acute coronary syndrome

Dr. Vizzardi: We describe the case of a man, 55 years old, who was admitted to our Intensive Coronary Unit for severe chest pain. The past history included smoking and hypertension, while there was a family history of coronary artery disease. At the time of admission the blood pressure was 120/ 60 mmHg and the heart rate was 78 beats per minute. The electrocardiogram showed ST segment elevation in the anterior leads, and a transthoracic echocardiogram (TTE) revealed anterior septal and anterior wall akinesis with a severe systolic dysfunction (ejection fraction of 30%). After treatment with aspirin, beta-blockers, nitrates and heparin plus a bolus and continuous infusion of abciximab, the patient underwent coronary angiography showing total occlusion of the left anterior coronary artery. A successful angioplasty was performed. In order to reduce the risk of acute thrombotic reocclusion of the culprit artery, abciximab infusion was continued. After 6 h, the patient developed severe dyspnea and tachypnea. The pulse oximetry revealed a severe oxygen desaturation of 88% with 100% FiO2, Laboratory tests showed severe thrombocytopenia (platelets 5,000 mm) and a significant drop in hemoglobin levels (3.1 g/dl). A Chest radiograph revealed new bilateral diffuse lung opacities infiltrates (Fig. 1). The anticoagulation therapy was stopped immediately, and the patient was transfused with platelets and packed red blood cells. We observed a rapid improvement in the platelet count and hemoglobin values (respectively of 145,000/mm and 13 g/dl). The erythrocyte sedimentation rate and others autoimmune serology tests were negative. The Chest X-ray studies showed a progressive and complete resolution of the alveolar infiltrates; therefore after ten days clopidogrel (75 mg/die) and aspirin (100 mg/die) were restarted. Before discharge, a TTE revealed only moderate left ventricular systolic dysfunction (EF 45%).