Biomedical subjects

P Menichelli

Publications and source records attributed to P Menichelli.

4 recordsLinked to original sources

PubMed1991

Cross-sectional echocardiography: a window on congestive heart failure in the elderly.

The value and limits of ultrasonic cardiac imaging in elderly patients with congestive heart failure (CHF) are not yet fully known. We report the results of an echocardiographic survey on 154 consecutive elderly persons with chronic CHF. The aim of this study was to establish the feasibility and the diagnostic yield of echocardiography in this population, and the relationship, if any, between left ventricular systolic function and main clinical parameters. Satisfactory cardiac imaging was achieved in 118 patients (77%). All patients had abnormal echocardiograms, although no single abnormal finding was present in all the cases. Echocardiography (ECHO) confirmed 147 previously diagnosed CHFs, and further detected a silent coronary artery disease in 26 cases, a valvular disease in 22, and an atrial septal defect in one patient. The most frequent findings were left ventricular (LV) mass increase and dilation (70% and 68%, respectively), and mostly degenerative valvular disease (40%). The LV ejection fraction was within normal limits in 44% of the cases. Although a depressed LV systolic function was more common among patients in III or IV NYHA class, no clinical parameters could identify the 52 patients with normal ejection fraction. Thus, ECHO could play a key role in evaluating CHF in elderly patients. In these patients, due to misleading signs and symptoms, and to multiple CHF etiologies, basic structural and functional features are frequently missed by clinical investigation, chest x-ray and electrocardiography.

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PubMed1991

[Cardiovascular therapy problems in the elderly patient].

The therapeutic management of elderly patients should be extremely careful, particularly in those over 75 years of age. As a matter of fact, in such patients a steep increase of the risk of comorbidity and of dependence has been evidenced. This implies a more complex therapeutic management, that must be oriented to the amelioration of quality of life more than to the resolution of the single pathologies. However, all the intervention trials so far conducted excluded such patients. Therefore, they cannot be considered representative of the geriatric epidemiological reality. As a result, there is virtually no useful information on the efficacy and safety of cardiovascular drugs in patients over 75 years of age. However, the following items should be pointed out: only drugs whose efficacy has been proved should be used, and only after a thorough diagnosis; a multidimensional evaluation should be performed, also addressing psychological, social, environmental and economical factors that could affect the clinical course; the risks and benefits of any therapy should be considered, particularly in the presence of comorbidity, as the number of assumed drugs directly correlates with the risk of developing adverse reactions; drugs should be dosed according to renal function and body weight, possibly starting with half the dosage of younger patients; after starting the therapy, patients should be kept under strict clinical control, and every new symptom should be considered an adverse reaction, unless it will not disappear after withdrawal of the drug; serum drug concentration should be monitored whenever possible, given its larger variability in advanced age.

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PubMed1990

[Heart aging and its clinical implications].

Aging-induced cardiac modifications are almost never different--at least qualitatively--from those linked to chronic pathologies that are usually found in advanced age. Due to many factors, as myocyte hypertrophy, increase in the amount of collagen and subepicardial fat accumulation, the aging heart increases its own weight. All cardiac structures undergo regressive modifications: valvular apparatus show fibrosis, collagen fragmentation, lipid accumulation and calcifications, the coronary arteries are characterized by tortuosity, minimal atherosclerotic lesions, calcium precipitates and--at least in animals--by an imbalance between the capillary bed extension and the myocyte hypertrophy. The most peculiar changes of interstitium, aside from fibrosis, are represented by lipofuscins and amyloid deposits. From a functional point of view, the aging heart does not show any substantial difference from the adult one in the basal state. Cardiac output seems to be maintained during exercise in the elderly. Nevertheless, such a result is achieved by an end-diastolic volume increase, instead of positive chronotropic and inotropic response and to the peripheral resistance decrease of the younger. This could be partly due to a damped cardiovascular response to sympathetic beta-receptor stimulation. The diastolic phase undergoes a progressive dysfunction, as its duration increases, the early filling falls and the atrial contribution plays a major role. The reduction of many mitochondrial enzymatic processes--such as fatty acid oxidation and oxidative phosphorylation--has been documented in animals, as well as transmembrane ionic fluxes alteration. The maximal oxygen consumption is progressively reduced, although this does not seem to be due to a cardiac performance impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1989

Verapamil disposition and cardiovascular effects in elderly patients after single intravenous and oral doses.

Pharmacokinetics and pharmacodynamics of verapamil were studied in 11 elderly subjects (age = 79.67 +/- 4.74 years) and in 11 middle-aged subjects (age = 45 +/- 11.37 years) following intravenous (IV), single oral, and long-term oral administration. Plasma verapamil concentrations were determined using high-pressure liquid chromatography (HPLC). Twenty-four hour dynamic Holter electrocardiographic (ECG) recordings were employed to study heart rate (HR) and P-R interval. No difference in plasma half-life, distribution volume, body clearance, and area under the curve (AUC) was observed between the two groups after IV and oral verapamil administration. Blood pressure (BP) and HR were significantly reduced after verapamil IV administration in the elderly group only (p less than 0.05, p less than 0.01, respectively). After single and long-term oral administration, variable HR and BP responses were observed in both groups. The P-R prolongation following both IV and single oral doses exhibited a delay with respect to the peak plasma concentration, inducing a definite hysteresis loop. The slope of P-R variations (using a linear pharmacodynamic model) was greater in the elderly both after IV and single oral verapamil administration, but statistical significance was obtained only after the single oral dose (p less than 0.05). In the elderly group, after long-term oral administration, there was a significant prolongation of the P-R interval (p less than 0.0001) with respect to the corresponding time point of the 24-hour predrug period. Such variations in pharmacodynamic parameters in the elderly did not, however, cause any clinical problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗