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C Pandullo

Publications and source records attributed to C Pandullo.

At least 37 records · Page 2Linked to original sources
PubMed1990

Myocardial infarction following sublingual administration of isosorbide dinitrate.

A 78-year-old with healed septal necrosis suffered a recurrent myocardial infarction of the anterior wall following the administration of isosorbide dinitrate 5 mg sublingually. After detailing the course of events, we discuss the role of paradoxical coronary spasm and hypotension-mediated myocardial ischemia occurring downstream to significant coronary arterial stenosis in the pathophysiology of acute coronary insufficiency.

Administration, Sublingual↗
PubMed1990

Transient myocardial ischaemia: a multivariate analysis on clinical, angiographic and ergometric variables.

The availability of ambulatory ECG monitoring allows identification of transient myocardial ischaemia, the clinical relevance of which is currently being investigated. Ninety-four consecutive patients with ischaemic heart disease and a positive exercise test (greater than or equal to 1 mm ST-segment depression) were studied to evaluate the prevalence of transient myocardial ischaemia (either painless or painful) during 24-h dynamic electrocardiogram (ECG) and the clinical, angiographic and ergometric variables predicting its appearance. Two-hundred-and-eighty-one episodes of transient electocardiographic myocardial ischaemia were recorded in 69 patients (73.4% of all patients). Transient myocardial ischaemia was more frequent, although not significantly so, in patients with diabetes, with previous myocardial infarction, or with multivessel disease. When tested by multivariate analysis, neither the clinical variables nor the severity of coronary artery disease allowed prediction of the occurrence of transient myocardial ischaemia during dynamic ECG. The duration of exercise testing up to the ischaemic threshold (ST-segment depression = 1 mm) and the peak heart rate during exercise were more accurate predictors of transient myocardial ischaemia (P = 0.019 and 0.012 respectively). Patients with transient myocardial ischaemia had a lower ischaemic threshold (355 +/- 175 vs 498 +/- 150 s, mean +/- SD, P = 0.001) despite a lower peak heart rate (129 +/- 18 vs 137 +/- 12 beats min-1, P = 0.047) than patients without transient myocardial ischaemia. In conclusion, exercise testing may help select patients for examination by dynamic ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1990

[Evaluation of exercise test reproducibility in patients with ischemic cardiopathy].

We evaluated the repeatability of some measurements taken during the bicycle ergometer exercise test (exercise duration, heart rate and pressure rate product at angina and ST segment depression times) in 166 consecutive non-selected ambulatory patients with proven ischemic heart disease. One hundred and sixty-six patients with history of angina and/or myocardial infarction performed three exercise tests within seven days of wash-out. Eighty-six (58.1%) of these experienced angina and ischemic ST segment depression during all three tests (group 1), and 80 (48.2%) finished at least one test without angina or ST segment depression (group 2). The degree of angina (according to Canadian Cardiovascular Society classification) was higher in the first group than in the second one; on the contrary, exercise duration as well as pressure rate product at ischemic threshold, heart rate and pressure rate product at the onset of angina were significantly lower (0.001 less than p less than 0.05) in the former group. In group 1, we analyzed ergometric parameter measurement "repeatability" during the three consecutive exercise tests. The analysis of variance for repeated measurements showed that exercise duration and pressure rate product values at ischemic threshold did not vary significantly in the three tests, while other ergometric parameters showed a greater variability (0.001 less than p less than 0.05). Age, previous myocardial infarction or rest angina, the number of critically stenotic coronary vessels and the ejection fraction did not condition the repeatability of the test. In conclusion, in our population of non-selected ischemic patients only 52% developed angina and ischemic ST segment depression during all three exercise tests performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Apical hypertrophic cardiomyopathy: variability of bidimensional echocardiographic and electrocardiographic expression].

Apical hypertrophic cardiomyopathy is characterized by primary hypertrophy of the myocardium which is localized exclusively at the apex of the left ventricle. Previous studies have indicated that apical hypertrophic cardiomyopathy is characterized by a unique combination of cross-sectional echocardiographic and ECG findings ("giant" T wave inversion and high R wave voltage in the precordial leads). The aim of this study was to evaluate the possible relation between apical hypertrophy, quantitatively defined by cross-sectional echocardiography, and ECG findings in patients with apical hypertrophic cardiomyopathy. We studied 13 pts with apical hypertrophic cardiomyopathy, 10 men and 3 women (aged between 11 and 73 years, mean age 47). Apical hypertrophy was assessed quantitatively by determinating the muscle cross-sectional area in the apical region. From the end-diastolic apical 4 chamber view, endocardial and epicardial contours were digitized in order to obtain the muscle cross-sectional area of the left ventricle. The walls of the left ventricle were then divided into 3 regions (basal, mid-ventricular, apical). Final values of planimetered muscle areas are given as the average of the calculations obtained blindly and independently by 4 observers. The comparison between cross-sectional echocardiographic and electrocardiographic findings showed that patients with giant T wave inversion (T wave greater than 10 mm) and high R wave voltages (R greater than wave 25 mm) had a more severe degree of apical hypertrophy. However there was no complete agreement between cross-sectional echocardiographic and electrocardiographic findings. This study in fact demonstrates a wide variation in the degree of severity of apical hypertrophy among patients with apical hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Acute effects of felodipine in exertional angina pectoris.

To investigate the antianginal efficacy, duration of action and tolerability of 2 doses of the new calcium antagonist felodipine, 15 patients (14 men and 1 woman, mean age 62 years) with stable exertional angina pectoris and angiographically demonstrated coronary artery disease were randomly given felodipine, 5 and 10 mg, and placebo on 3 different days. A bicycle ergometer exercise test was performed 3 and 10 hours after dosing. In comparison with placebo, felodipine 5 and 10 mg significantly increased resting heart rate and decreased resting systolic and diastolic blood pressure 3 hours after administration (p less than 0.001). Ten hours after administration, only supine systolic blood pressure was still significantly lower (p less than 0.001). Anginal (time to mild chest pain) and ischemic (time to 1 mm ST depression) thresholds, as well as duration of exercise and total work at peak exercise, were higher in comparison with placebo at 3 and 10 hours (p less than 0.001). In comparison with the lower dose, 10 mg felodipine induced a decrease in supine (p less than 0.05) and sitting (p less than 0.01) systolic blood pressure at rest and an increase in total work to anginal threshold (p less than 0.01), as well as in total work and duration of exercise at peak exercise (p less than 0.05). These results suggest that a single administration of felodipine, 5 and 10 mg, may improve exercise capacity over a 10-hour period in patients with stable exercise-induced angina due to atherosclerotic heart disease.

Angina Pectoris↗
PubMed1988

Individual responses to transdermal nitrates after chronic administration in angina pectoris.

The aim of this study was to investigate whether, and to which extent, sustained treatment with transdermal nitroglycerin plasters may lead to the development of tolerance in patients with effort-induced angina pectoris. Ten patients, all men, mean age 62.7 years, took part in a double-blind, cross-over, acute study, comparing the transdermal therapeutic system of nitroglycerin 10 mg/24 hours with placebo. Patients were then treated for 1 month with the active drug in single-blind condition, and finally they took part in a further acute study identical to the first. Cycloergometric exercise tests were carried out 4 hours after dosing. In comparison with placebo, the active drug significantly (P less than 0.01) increased ischaemic threshold (ST depression = 1 mm) after both acute (from 299 +- 92 to 413 +- 120 sec) and chronic treatment (416 +- 107 sec). The same results were obtained for exercise duration to peak exercise (acute study: from 336 +- 65 to 482 +- 90 sec; chronic treatment: 466 +- 118 sec). The final acute study confirmed the stability of angina, showing that the improvement in exercise tolerance after chronic treatment was entirely due to the pharmacological effect of the drug. In terms of single patient response to the active treatment, 7 of the 10 patients showed an improvement in exercise tolerance after both acute and chronic treatment, while in 3 patients no antianginal effect was observed. These results suggest that nitrate tolerance cannot be considered an inevitable finding in patients chronically treated with transdermal patches.

Administration, Cutaneous↗
PubMed1988

Exercise-induced intermittent angina and ST-segment elevation in Prinzmetal's angina.

A patient with primary angina showed intermittent ST elevation (with and without chest pain), during two exercise tests performed on consecutive days; the same ST changes were also seen during the recovery phase. The electrocardiographic changes recorded in this patient may be considered an example of myocardial response to spasm-related ischemia.

Angina Pectoris, Variant↗
PubMed1987

Ventricular arrhythmias in dilated cardiomyopathy: efficacy of amiodarone.

Sixty-five patients with dilated cardiomyopathy were studied by means of 24-hour ECG monitoring. Ventricular arrhythmias were present in 62 (95.4%), of whom 52 (80%) showed a complex form (multiform ventricular extrasystoles, pairs, and ventricular tachycardia). Forty-one patients, presenting with complex ventricular arrhythmias, received antiarrhythmic treatment with amiodarone (600 mg/day in the first week, 400 mg/day in the second week, and 200 to 400 mg/day chronically), and were then controlled with periodic 24-hour ambulatory monitoring. A significant reduction in the number of ventricular extrasystoles was seen in over 70% of patients during a 3-year period. There was also a significant decrease in the incidence of complex ventricular arrhythmias (particularly of ventricular tachycardia). Adverse effects were noted in 23 patients, but only four had to stop treatment. During the follow-up period, 19 patients died: 14 of heart failure, four of sudden death, and one of a noncardiac cause; all patients who died suddenly were not treated with amiodarone (p = 0.022). Complex ventricular arrhythmias are frequent in dilated cardiomyopathy and it is suggested that amiodarone is effective in short- and long-term control of these arrhythmias.

Adolescent↗
PubMed1987

Hypertrophic cardiomyopathy associated with myotonic muscular dystrophy (Steinert's disease).

A 52-year-old man with myotonic dystrophy and first degree atrioventricular block, right bundle branch block and left anterior hemiblock was shown by echocardiographic examination to have hypertrophy of the posterior segment of the septum and of the anterior left ventricular wall. Myocardial involvement in this patient may represent the full expression of a genetic defect involving both skeletal and myocardial striated tissue.

Cardiomyopathy, Hypertrophic↗
PubMed1987

[Natural history of patients with isolated atrial fibrillation].

Sixty three patients (pts) (aged less than or equal to 50 years) with a history of "lone" atrial fibrillation (AF) and normal heart size at radiological examination were followed-up for a mean period of 95 months (range 1-360). The arrhythmia remained paroxysmal in 43 pts, became chronic in 13, while in 7 could not be reverted to sinus rhythm at the time of first observation. Clinical examination was normal in 58 pts; in 23 echocardiography disclosed mild abnormalities. In 2 pts auscultation revealed a mid-systolic apical click, i n one a mid-systolic murmur and in 2 click and murmur together. These findings were correlated to slightly pathological echocardiographic patterns. M-mode and B-mode echocardiography yielded normal results in 35 pts and showed minor pathological findings in 28 (16 with paroxysmal AF and 12 with chronic AF). Thyroid hormones, tested in 58 pts, were within normal limits in 53, showed decreased T4 in 2 and increased T3 in 3 (2 of whom in treatment with amiodarone). During the follow-up period, no patient had a deterioration of the clinical status from the cardiovascular point of view. However, one patient suffered an episode of cerebral embolism, with rapid resolution, and one a cerebral transient ischemic attack. In conclusion "lone" AF has a favourable prognosis and systemic anticoagulation is not indicated, particularly in the absence of left atrial dilatation.

Adolescent↗
PubMed1986

[Hemodynamic and anti-angina effects of transdermal nitroglycerin after acute and chronic administration. Additive effect of sublingual isosorbide dinitrate].

To evaluate the acute and chronic anti-anginal efficacy of a Transdermal Therapeutic System, releasing 10 mg of nitroglycerin over 24 hours (TTS 10), and possible additional effects of isosorbide dinitrate 5 mg (ISDN) sublingually (s.l.), ten patients with stable exercise-induced angina pectoris and pathological coronary angiography were studied. The protocol of the trial consisted of an initial acute study, carried out in double-blind conditions and following a cross-over design, to compare TTS 10 and placebo. Cycloergometric exercise tests were performed on the first and second day, 3 hours after dosing. After a 30 minute rest period, a sublingual 5 mg dose of ISDN was given and 15 minutes later a further exercise test was carried out. Subsequently, patients received TTS 10 in single-blind conditions for 16 days. On the 15th and 16th day, stress test was repeated, 3 hours after the application of active plasters and, 30 minutes later, a further exercise test was performed, 15 minutes after a sublingual dose of ISDN 5 mg or placebo, given in double-blind conditions and in randomized sequence. After acute and chronic administration, TTS 10 significantly improved exercise tolerance in comparison with placebo. During the first acute study, ISDN 5 mg s.l., led to a significant reduction in systolic BP, a reflex increase in heart rate and a further improvement in exercise tolerance, whether patients were on placebo or TTS.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1986

Reperfusion ventricular arrhythmias during intracoronary thrombolysis.

While coronary reperfusion arrhythmias are well defined in animal models, their prevalence and predisposing factors are still uncertain during pharmacologic coronary reperfusion in patients with acute myocardial infarction. In 80 patients, who underwent this procedure and had a continuous electrocardiographic monitoring (associated with a Holter recording in 34), 6 patients developed ventricular fibrillation. Ventricular fibrillation was the terminal event in 2/19 non-reperfused patients. The other episodes of ventricular fibrillation (controlled with DC countershock) occurred within 5 minutes and 3 minutes after angiographic documentation of coronary reperfusion. Ventricular fibrillation was observed in 4/10 patients with a residual stenosis less than or equal to 80% but in no case among the 39 patients with a residual stenosis greater than 80% (P = 0.01). Holter recordings in 19 reperfused patients showed ventricular tachycardia or accelerated idioventricular rhythm at reperfusion in 8/10 patients with a coronary stenosis less than or equal to 80% and only in 3/9 with a higher degree stenosis (P less than 0.05). Reperfusion ventricular fibrillation was found to occur in 8.1% of patients. A residual stenosis of 80% or less was found to be a predisposing factor in the occurrence of ventricular fibrillation, ventricular tachycardia or accelerated idioventricular rhythm at reperfusion.

Adult↗
PubMed1986

[Recurrent alveolitis caused by amiodarone].

More recently a few cases of pulmonary toxicity due to amiodarone administration and reversed following drug discontinuation and corticosteroid therapy have been reported. An unusual case of recurrence of amiodarone pulmonary toxicity is described. After receiving amiodarone 1.200 mg/week for 6 month a 54-year-old woman showed clear signs of pulmonary alveolitis with ray signs of diffuse pulmonary infiltrates. The pulmonary symptoms recurred after discontinuing corticosteroidis 17 months after amiodarone was stopped and were associated with a persistent amiodarone level in broncho alveolar lavage. Only after 20 months the complete resolution of pulmonary symptoms was achieved.

Amiodarone↗
PubMed1985

Effect of a new transdermal therapeutic system containing nitroglycerin on exercise capacity in patients with angina pectoris.

In a double-blind, within-patient, randomized, placebo-controlled, acute study, the effects at rest and on exercise capacity of two doses of a new transdermal therapeutic system (TTS), releasing respectively 10 and 20 mg of nitroglycerin (NTG) over 24 hours, were assessed in 15 outpatients with stable exercise-induced angina pectoris. A symptom-limited exercise test was performed 4 and 24 hours after the application of each system. In comparison with placebo, both TTS-NTG doses induced a statistically significant (p less than 0.01) increase in total duration of exercise, in exercise duration to 1 mm ST segment depression, in maximal workload and in total work performed, at both 4 and 24 hours after dosing. Furthermore, both TTS-NTG doses induced a significant rise in the pressure-rate product, both 4 and 24 hours after dosing (p less than 0.01 and p less than 0.05, respectively). No statistical difference was found between the two doses of active drug in any of the above-mentioned evaluation parameters. The only unpleasant side effect was the typical nitrate headache, which occurred in 11 of 15 patients. In conclusion, a single application of TTS-NTG, 20 cm2 or 40 cm2, may improve exercise capacity over a 24-hour period in patients with stable exercise angina due to atherosclerotic heart disease.

Administration, Topical↗
PubMed1985

[TTS-nitroglycerin and slow-release metoprolol: efficacy in patients with stable exercise-induced angina].

The antianginal efficacy of slow-release metoprolol (SRM) alone and associated to a transdermal therapeutic system containing nitroglycerin (TTS-TNG), was investigated in 10 patients with chronic, stable exertional angina and angiographic evidence of obstructive coronary artery disease, by means of a double blind, cross-over trial. Each patient performed a symptom-limited exercise test 4 and 24 hours after single blind placebo on day 1, and double blind SRM (200 mg) alone or SRM plus TTS-TNG, on days 3 and 5, in a randomized sequence. The protocol of Redwood was employed. Compared to the beta-blocker alone, the combined administration of SRM and TTS-TNG was associated to a significant increase in mean exercise duration 4 hours (528 +/- 180 vs 412 +/- 110 sec.; p less than 0.001) and 24 hours (432 +/- 115 vs 391 +/- 100 sec.; p less than 0.05) after drug administration. A significant increase in mean total work performance 4 hours (4626 +/- 1070 vs 3272 +/- 803 kgm; p less than 0.01) and 24 hours (3445 +/- 1045 vs 2941 +/- 773 kgm; p less than 0.01) after drug administration was observed as well. During placebo all the tests were stopped due to angina associated with ST depression greater than or equal to 1 mm. Conversely, the test was terminated due to fatigue by 8 patients at 4 hours and 5 patients at 24 hours after combined therapy, and respectively by 5 and 1 patient after SRM alone. No side effects were observed after the administration of SRM alone, whereas 5 patients complained of mild headache after SRM and TTS-TNG.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1985

[Congenital aneurysm of the left atrial appendage].

Congenital aneurysm of the left atrial appendage is a rare anomaly, usually presenting in adult life. We report the case of a 31-year-old woman with a marked prominence of the upper left heart border at the chest X-ray in whom the diagnosis of congenital aneurysm of the left atrial appendage was confirmed by cross-sectional echocardiography and computed tomography. Up to few years ago angiography was considered the method of choice in establishing the diagnosis. Cross-sectional echocardiography has recently become a safe and reliable method for diagnosing congenital aneurysm of the left atrium and should be considered in any case with abnormality of the profile of left atrium on the chest radiography.

Adult↗