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Biomedical subjects

C Rusconi

Publications and source records attributed to C Rusconi.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Effectiveness and tolerability of simvastatin in patients with moderate-to-severe hypercholesterolemia. Results of a 12-month study].

Several epidemiological and clinical studies have underlined the close relationship between hypercholesterolemia and risk of coronary heart disease suggesting the opportunity of treating hypercholesterolemic patients according to their associated risk factors. Simvastatin, a drug for the treatment of hypercholesterolemia, is a competitive inhibitor of 3-Hydroxy-Methyl-Glutaryl-CoA reductase, the rate limiting enzyme in cholesterol biosynthesis. In the present study we have assessed the efficacy, safety and tolerability of simvastatin (10-20 mg) administered once daily for a period of 12 months to 50 patients with coronary heart disease (CHD) or at high risk for CHD according to the National Cholesterol Education Program. All patients underwent complete physical examination and laboratory safety tests (including blood cell count, liver function tests, creatine kinase and lipid profile) at baseline and every 6 weeks during treatment. Simvastatin was highly effective in reducing total and LDL cholesterol (-25% and -35% respectively). No significant effect on HDL cholesterol or triglycerides was obtained. Two patients were excluded after 6 weeks of treatment because of a serum creatine kinase increase (more than twice normal values). This was the only drug related side effect. In conclusion our data show that: a) simvastatin treatment is well accepted and compliance is good; b) the effect of simvastatin is evident after the first 6 weeks of treatment and is maintained during the whole treatment time; c) simvastatin is highly effective in lowering total and LDL cholesterol. When considering a patient who has had an atherosclerotic event the best deterrent to the occurrence of a subsequent event (secondary prevention) could be reduction of serum total and LDL cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticholesteremic Agents↗
PubMed1993

[Atrial septal aneurysm and associated anomalies. Personal experience with 38 cases].

We examined 38 patients discovered to be affected by an atrial septal aneurysm (ASA) during 4014 consecutive echocardiographic examinations on an adult population in an eighteen-month period. ASA is often associated with other abnormalities, mainly mitral valve prolapse (23%), followed by aortic or pulmonary regurgitation, interatrial septal defect, tricuspid valve prolapse. It has been hypothesized that ASA could be a trigger for cardiac arrhythmias or a source of emboli to various districts. However, in our population we were not able to find any patient complaining of significant ASA-related cardiac symptoms nor affected by complications such as cardiac arrhythmias or embolic phenomena. Therefore, in our opinion this entity could be defined as quite benign neither requiring pharmacological therapy nor anticoagulant prophylaxis unless such treatments are indicated by an associated pathology.

Adult↗
PubMed1992

Rate of progression of valvular aortic stenosis in adults.

Until recently the hemodynamic severity of valvular aortic stenosis (AS) was evaluated only by cardiac catheterization. Now, Doppler echocardiography allows a noninvasive and accurate assessment of AS severity and can be used to study its progression with time. The progression of AS was assessed during a follow-up period of 6 to 45 months (mean 18) by serial Doppler examinations in 45 adult patients (21 men and 24 women, mean age 72 +/- 10 years) with isolated AS. The following parameters were serially measured: left ventricular outflow tract diameter and velocity by pulsed Doppler, peak velocity of aortic flow by continuous-wave Doppler, to calculate peak gradient by the modified Bernoulli equation, and aortic valvular area by the continuity equation. At the initial observation, 13 of 45 patients (29%) were symptomatic (1 angina, 1 syncope and 11 dyspnea); during follow-up, 25 (55%) developed new symptoms or worsening of the previous ones (5 angina, 3 syncope and 17 dyspnea); 11 underwent aortic valve replacement and 3 died from cardiac events. Baseline peak velocity and gradient ranged between 2.5 and 6.6 m/s, and 25 and 174 mm Hg, respectively; aortic area ranged between 0.35 and 1.6 cm2. With time, mean peak velocity and gradient increased significantly from 4 +/- 0.7 to 4.7 +/- 0.8 m/s (p less than 0.01), and 64 +/- 30 to 88 +/- 30 mm Hg (p less than 0.01), respectively. A concomitant reduction in mean aortic area occurred (0.75 +/- 0.3 to 0.6 +/- 0.15 cm2; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Electrocardiogram ambulatory monitoring: technological evolution and current prospectives].

The value of ambulatory ECG monitoring in the investigation of arrhythmic or ischemic events with paroxysmal patterns is well-known and its use is widespread. More recently, technical advances in informatics and in ECG signal digitizing have rapidly developed the current available ambulatory ECG instruments, reducing the time necessary for pattern analysis meanwhile assuring acceptable accuracy and reliability of the results. ECG recording techniques other than traditional Holter monitoring are now available such as transtelephonic transmission of ECG signal recorded in real time or previously stored in solid state memory by intermittent recorders that can be switched on by the patients himself at the first prodroms or at the end of the event. These "loop recorders" make it possible to indefinitely extend ECG monitoring time, reducing costs and increasing record sensitivity in comparison to conventional Holter monitoring. Moreover, recent technological development of Holter monitoring makes it possible to perform heart rate variability analysis and late potentials research in addition to traditional analysis of cardiac rate and ventricular repolarization. Thus Holter recording may become, combined with other usual risk factors, a polyparametrical non invasive approach to sudden cardiac death risk assessment characterised by low cost/benefit ratio and by large screening capacity.

Arrhythmias, Cardiac↗
PubMed1992

[Thrombosis of the right atrial appendage. The two-dimensional echocardiographic aspect and the autopsy finding].

We report the case of an 80-year-old man affected by hypertensive cardiomyopathy and already admitted to our Division for recurrent episodes of heart failure. He was eventually hospitalized for septic shock secondary to disseminated pneumonia with concomitant left pleural effusion. At 2D-echo examination, a highly echo-reflectant mass was detected in the retrocardiac space. As the patient died notwithstanding the intensive pharmacological care, an autoptic procedure was performed which showed a massive thrombosis of the right atrial appendage. We discuss the 2D-echo imaging and advance a pathogenetic hypothesis after a review of the current literature.

Aged↗
PubMed1992

[A clinical case: coronary vasospasm induced by exercise after stopping nifedipine therapy].

A 60-year-old man with atypical chest pain not submitted to adequate diagnostic procedures was treated on an empirical basis with nifedipine 20 mg b.i.d. The patient was referred to our institution where a first symptom-limited exercise stress-test during treatment was performed; neither S-T alterations nor clinical symptoms were induced at the maximal tolerated work load. Therefore we suggested a short period of hospital stay to repeat the stress-test after a progressive tapering off of the drug with the aim of obtaining a more definite diagnosis. However the patient refused and an at-home nifedipine withdrawal was planned. Some days later a second test showed marked S-T segment elevation in leads V4 to V6; concomitant high-grade ventricular arrhythmias and anginal pain occurred. Both the ECG alterations and the clinical symptom promptly regressed interrupting the test and administering sublingual isosorbide dinitrate. A coronary angiography performed few days later showed only a single and no significant stenosis of the left anterior descending artery (60%). The clinical and electrocardiographic pictures were therefore attributed to stress-induced vasospastic ischemia. A week later a third maximal stress-test during further treatment with nifedipine was totally negative. The pathophysiological mechanisms of rest and stress-induced vasospastic angina and the usefulness of Ca-blocking agents are discussed.

Coronary Disease↗
PubMed1991

[Holter monitoring with a pill-shaped esophageal electrode].

This study analyzes the possibility of using an oesophageal lead in the ambulatory ECG monitoring in order to improve the diagnostic effectiveness of the method by reliable identification of atrial activity. The oesophageal Holter monitoring was performed on 19 patients (pts) (8 F and 11 M, aged 34 to 79 years). These patients posed precise diagnostic problems unsolved by previous conventional Holter recordings. The oesophageal Holter recording was carried out with a Spacelabs recorder, model 90205 with two channels. One electrode was positioned in the standard lead CM5 and the second in the oesophagus using an Esodyn 2 electrode with a dynamic configuration made by C.B-Bioelettronica (Calenzano, Florence). The oesophageal lead was connected with the recorder by filter model EHF-4. The electrode was swallowed by the patient and the best position regulated on the P diphasic deflection of the highest amplitude. The monitoring allowed correct identification of the P wave over a 24-hour period. The arrhythmia which required the oesophageal Holter monitoring was recorded again in 15 of 18 patients examined. In each of these cases it was possible to solve the diagnostic question. The following arrhythmias were found: constant time correlation between the P deflection and the QRS in accordance with a supraventricular tachycardia with intraventricular conduction delay (4 pts); A-V dissociation in accordance with a ventricular tachycardia (2 pts); pause caused by atrioventricular block 2:1 (1 pt), second degree sinus-atrial block (1 pt), blocked premature atrial beats (4 pts); premature ventricular and premature atrial beats with intraventricular conduction delay (3 pts).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The physiopathology of dual-chamber cardiac stimulation. Apropos a case with a dual-chamber pacemaker, left atrial standstill and heart decompensation].

The paper describes the clinical case of an elderly patient with heart failure, the possessor of a dual-chamber pacemaker programmed in DDD mode, in whom a complete interatrial block with left atrial standstill was diagnosed. The authors discuss the physiopathological aspect of the case which is a paradigmatic example of the problems related to dual-chamber pacing. In particular, the utility of an echo-Doppler assessment of the mechanical activity of the atria is emphasized together with a careful choice of the optimal atrioventricular delay in programming and the follow-up of dual-chamber pacing.

Aged↗
PubMed1991

[Hemodynamic response to high-dose nitroglycerin infusion in patients with severe heart failure after pretreatment and clinical stabilization].

It is a common opinion that the use of nitrates may have a harmful effect on cardiac output (CO) in patients (pts) with congestive heart failure (CHF) due to left ventricular (LV) dilatation and systolic dysfunction in whom previous treatment with diuretics and vasodilators considerably reduced LV filling pressure. The aim of the present study was to evaluate the effects on CO and LV filling pressure of high dose intravenous nitroglycerin (NTG) in eight pts with dilated cardiomyopathy and with CHF in functional class IV NYHA; they had previously undergone intensive treatment with diuretics and vasodilators, and at the time of the study were in stable clinical conditions. Hemodynamic monitoring was performed by Swan-Ganz catheterization and CO was determined by thermodilution. NTG was administered at increasing doses (maximal doses 350 +/- 220 microgr./m, range 100-800 microgr./m) until systolic arterial pressure (BPs) less than or equal to 85 mmHg and/or pulmonary capillary wedge pressure (PCWP) less than or equal to 4 mmHg. Our results showed that NTG caused a significant reduction of right atrial pressure (RAP, 4 +/- 3.5 vs -1 +/- 4 mmHg, p less than 0.001), systolic pulmonary artery pressure (36 +/- 8 vs 21 +/- 11 mmHg, p less than 0.001) and PCWP (16 +/- 5 vs 7 +/- 3 mmHg, p less than 0.001). LV transmural pressure (TMP) calculated as the difference between PCWP and RAP, showed a nonsignificant reduction from 12 +/- 5 to 8 +/- 3.75 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Adverse effects of drugs on serum lipids. Clinical implications].

High blood cholesterol levels are associated with an increased risk of coronary heart disease. Guidelines for the detection and treatment of patients with hypercholesterolaemia have been developed in the United States and in Europe. The causes of secondary hyperlipidaemia are generally well known, but not always diagnosed. A wide variety of drugs cause secondary hyperlipidaemia but the incidence of this event is infrequently recognised. This article focuses on those drugs that are known to have an adverse effect on the serum lipid profile and the clinical significance of this effect.

Adrenal Cortex Hormones↗
PubMed1991

[Estimation using unipolar transesophageal recording of the interatrial conduction time in patients with paroxysmal atrial flutter and fibrillation].

Twenty-three consecutive subjects (age 46.7 +/- 21, range 13-78) addressed to our attention for symptoms attributed to documented or suspected supra ventricular arrhythmias underwent transesophageal electrophysiologic study. On the basis of the preliminary investigations 15 proved free from organic heart disease, 2 were affected with ischemic heart disease (secondary angina), 6 with hypertensive cardiomyopathy. In each patient the sensibility, specificity and positive predictive value of the following reports regarding the occurrence of paroxysmal fibrillation and flutter (Ffap) were evaluated: a) echo reports of left atrial enlargement; b) ECG signs of atrial enlargement; c) interatrial conduction time (TCIA) assessed with unipolar transesophageal recording. As TCIA we adopted the time interval intercurrent from the first low-voltage deflection of the esophageal P wave (far field) and the apex of the intrinsecoid deflection of the same wave. TCIA proved significantly longer in the 12 patients affected with Ffap compared with those free from documented paroxysmal or inducible arrhythmias or affected with paroxysmal junctional reciprocating tachycardias: 76.6 +/- 11 vs 51.8 +/- 11.7; p less than 0.001. A TCIA greater than 63 msec characterizes with satisfactory sensibility and specificity the occurrence of Ffap: sens. 75%, spec. 91%, positive predictive value 90%. Echo and ECG reports of atrial enlargement behave as highly specific but not sufficiently sensitive indexes of the occurrence of Ffap: sens. 42%, spec. 100%, pos. pred. val. 100% and sens. 17%, spec. 100%, pos.pred.val. 100% resp. We concluded that TCIA is an index correlated with and predictive of the occurrence of Ffap in patients symptomatic for cardiopalmus or neurologic symptoms in the absence of other arrhythmias detectable with Holter monitoring which are able to produce clinical symptoms.

Adolescent↗
PubMed1989

Assessment of left ventricular filling in patients with systemic hypertension. A Doppler echocardiographic study.

To assess left ventricular (LV) diastolic function in patients with hypertension, a Doppler echocardiographic study of transmitral blood flow (TBF) was performed in 46 hypertensive patients (H), 18 without (H1) and 28 with (H2) left ventricular hypertrophy and in 25 age-matched normal subjects (N). All patients showed normal systolic function. The following indices of Doppler TBF were measured: peak flow velocity during early filling (Evel), atrial systole (Avel) and their ratio (E/Avel); area under early filling phase (Earea), area under atrial systole (Aarea), expressed as a percentage of total diastolic area and their ratio (E/Aarea); deceleration half-time (DHT) of early filling phase. When compared with N, H1 and H2 showed significant reductions in early filling indices and an increase in atrial contribution parameters. (Evel = 0.62 +/- 0.1(N), 0.52 +/- 0.1(H1) P less than 0.01, 0.44 +/- 0.1(H2) P less than 0.001; Earea = 56 +/- 5(N), 48 +/- 5(H1) P less than 0.001, 43 +/- 6(H2) P less than 0.001; Avel = 0.49 +/- 0.1(N), 0.59 +/- 0.1(H1) P less than 0.01, 0.69 +/- 0.14(H2) P less than 0.001; Aarea = 26 +/- 5(N), 41 +/- 4(H1) P less than 0.001, 47 +/- 7(H2) P less than 0.001). Also DHT was significantly prolonged, compared with N (80 +/- 12 msec), in H1 (90 +/- 12 msec, P less than 0.01) and H2 (105 +/- 20 msec, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗