[Endothelium and regulation of vascular function].
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Coronary Circulation↗
Biomedical subjects
A Buffon
Publications and source records attributed to A Buffon.
[Therapy of microvascular angina].
The treatment of microvascular angina (anginal pain resulting from myocardial ischemia due to dysfunction of small coronary arteries) is empiric and often ineffective at present. The poor knowledge of the pathophysiologic mechanisms responsible for the microvascular dysfunction and the possible heterogeneous nature of the disease limit the possibility of a rational therapeutic approach to these patients. The failure of traditional antiischemic therapy is confirmed by the frequent unresponsiveness of angina and by the reduced exercise tolerance with administration of sublingual nitrates. Despite that, beta-blockers and calcium-antagonists, when given either alone or in combination, are beneficial in the control of symptoms in some patients. Alternative forms of treatment, based on some pathophysiological hypotheses and clinical observations, include xanthine derivatives, ACE-inhibitors, alpha-blocking agents, imipramine and, in women, oestrogens. The actual clinical usefulness of these drugs, however, is questionable at present, as their efficacy should be evaluated with more adequate studies in the future.
Adrenergic alpha-Antagonists↗
Cardiac biopsy in patients with "primary" atrial fibrillation. Histologic evidence of occult myocardial diseases.
Fourteen patients (ten men and four women; mean age, 37 years) with lone atrial fibrillation (AF) (1 to 18 months' duration) were evaluated by thyroid function tests, two-dimensional echocardiography, hemodynamics, coronary angiography, and left ventricular endomyocardial biopsy, because of unresponsiveness to the usual antiarrhythmic therapy. The results of the T3, T4, TSH, and TRH tests were normal in all patients; cardiac valves and ventricular and atrial sizes (left atrium less than 40 mm) were within the normal limits; also normal were LVEDP (less than or equal to 10 mm Hg) and EF (greater than 0.50). Histologic findings were abnormal in all cases, with three patients showing cardiomyopathic changes, three other patients showing active myocarditis (lymphocytic in two and eosinophilic in one), and eight patients with nonspecific necrosis or fibrosis or both. Steroids (prednisone; 50 mg/m2 of body surface area daily) used in addition to antiarrhythmic therapy in patients with eosinophilic and lymphocytic active myocarditis were able to cause reversion to sinus rhythm, while the other patients continued to have AF. This study documents that occult myocardial diseases (myocarditis, cardiomyopathy, and nonspecific necrosis or fibrosis) can underlie "primary" AF. The addition of steroids to antiarrhythmic therapy in patients with refractory AF and histologic evidence of active myocarditis seems to be useful in controlling the arrhythmia.
Adult↗
Anomalous coronary arteries: a report of 2 cases of single coronary artery.
One patient with chronic exertional angina, not significant electrocardiographic signs of myocardial ischemia at exercise stress test and recent onset of angina at rest underwent coronary arteriography. A second one with known severe aortic stenosis underwent cardiac catheterization and coronary arteriography because of effort chest pain and syncope. A single coronary artery originating respectively from the right and from the left sinus of Valsalva but without significant coronary stenosis was detected in both patients. This entity is a quite uncommon finding of relevant interest if surgical treatment is required and good prognosis if not associated with additional cardiac anomalies.
Cardiac Catheterization↗
Fatal measles myocarditis.
A case of fulminant measles myocarditis is reported. Diagnosis has been obtained at autopsy, due to absence of skin rash, by identification of measles giant cells in the myocardium and by positive reaction of myocardial tissue to measles-specific immunoperoxidase. Unusual outcome is interpreted as due to defective cell-bound immunity and extentive involvement of myocardial microcirculation.
Acute Disease↗
Hypertrophic cardiomyopathy mimicking athlete heart: risk of progression and opportunity for a bioptical approach.
A case of hypertrophic cardiomiopathy (HCM) mimicking athlete heart, is reported. Performing competitive activity was followed by progression of HCM to cardiac dilation and hypokinesis so that transplant was needed at young age. The Authors suggest a more aggressive approach possibly inclusive of cardiac biopsy when doubtful cases of athlete heart require permission for competitive sports.
Adult↗