Takotsubo cardiomiopathy after acute diarrhea.

Takotsubo cardiomyopaty is a recently described syndrome characterized by transient left ventricular dysfunction, mimicking an acute coronary syndrome and usually precipitated by a physical or emotional stress. We report the first case of Takotsubo cardiomyopathy after acute diarrhea in a man. It may be argued that severe diarrhea in predisposed individuals may cause an acute stress resulting in increased sympathetic activity leading to this syndrome. Probably the relationship between the adrenergic system and the heart is more complex than general thought and the stimuli which favor an autonomic imbalance and precipitate the syndrome are very disparate in clinical practice.

Midventricular dyskinesia during clozapine treatment?

This is the case of a young man suffering from schizophrenia and treated with clozapine. He developed acute heart failure associated with pericardial effusion and midventricular dyskinesia with severe systolic dysfunction and left ventricular dilatation at echocardiogram, readily resolved after the suspension of clozapine therapy. The segmental wall motion abnormalities observed at echocardiogram in this case are peculiar and have never been described before. The possible cardiotoxic effects of clozapine have been reported previously in the literature. Because of its serious potential side effects this drug is not considered the first choice for treatment of schizophrenia. Before beginning treatment, patients should undergo a cardiac evaluation, and they should also be periodically followed up with echocardiograms.

Unusual case of left ventricular pseudoaneurysm.

A 71 year-old man with a history of previous anterior myocardial infarction, triple coronary artery bypass graft and left ventricular (LV) aneurysmectomy was admitted to the cardiology unit for chest pain. Physical examination showed a pulsing mass in the left chest wall. Cardiac multislice computed tomography showed a rare case of LV pseudoaneurysm (6.3 x 6 x 10 cm) communicating by a fistulous trait (1 cm) with the left anterior chest wall (C7-C8), creating a subfascial mass (7.1 x 3.6 cm).

[Right ventricular pacing: a resource or a threat?]. / Pacing ventricolare destro: una risorsa o una minaccia?

Early after the beginning of the pacemaker era, endocardial right ventricular apex has been the most extensively used site for cardiac pacing because it was easily accessible and reliable in a long-term perspective. However many data have demonstrated that this kind of pacing is suboptimal from a physiologic point of view because it causes several adverse effects such as altered ventricular contraction geometry, mitral regurgitation, perfusion alterations and interference with myocardial ion channels which determine a worsening of left ventricular function. Several strategies have been proposed to solve these problems (alternative pacing sites, specific algorithms able to reduce the percentage of ventricular pacing) which are still under evaluation. In this review we analyzed the effects of right apical ventricular pacing and its possible alternatives.

[Guidelines for the performance of electrophysiologic study: are they still current?]. / Linee guida all'esecuzione dello studio elettrofisiologico: sono ancora attuali?

The aim of the present study was to reevaluate the indications to electrophysiological study after the observation of various clinical trials such as MADIT, AVID and MUSTT. In this perspective, the guidelines of 1995 surely appear to be outdated. The present paper concludes that the indications which still appear acceptable are those which support catheter ablation, those regarding syncope of unexplained origin and, until the conclusions of MADIT-II are universally accepted, the indication included in the MADIT study.