Left Ventricular Remodeling after Myocardial Infarction: From Physiopathology to Treatment.

Myocardial infarction (MI) is the leading cause of death and morbidity worldwide, with an incidence relatively high in developed countries and rapidly growing in developing countries. The most common cause of MI is the rupture of an atherosclerotic plaque with subsequent thrombotic occlusion in the coronary circulation. This causes cardiomyocyte death and myocardial necrosis, with subsequent inflammation and fibrosis. Current therapies aim to restore coronary flow by thrombus dissolution with pharmaceutical treatment and/or intravascular stent implantation and to counteract neurohormonal activation. Despite these therapies, the injury caused by myocardial ischemia leads to left ventricular remodeling; this process involves changes in cardiac geometry, dimension and function and eventually progression to heart failure (HF). This review describes the pathophysiological mechanism that leads to cardiac remodeling and the therapeutic strategies with a role in slowing the progression of remodeling and improving cardiac structure and function.

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava and Discrete Subaortic Stenosis Diagnosed in a Patient with Sick Sinus Syndrome: A Case Report and Brief Review of the Literature.

A persistent left superior vena cava (PLSVC) is the most frequent anomaly of the venous drainage system. While both a right and left superior vena cava (SVC) are usually present, a unique, left-sided SVC, also known as an isolated PLSVC, accounts for only 10-20% of cases. It is frequently associated with arrhythmias and other congenital cardiac anomalies. Though it is usually an asymptomatic condition, it may pose significant problems whenever central venous access is needed. We report a case of an isolated PLSVC that was diagnosed incidentally during pacemaker implantation for sinus node dysfunction. The venous anomaly was associated with subvalvular aortic stenosis determined by a subaortic membrane; this particular association of congenital cardiovascular anomalies is a rare finding, with only a few cases reported in the literature. We aim to highlight the clinical and practical implications of this condition, as well as to discuss the embryonic development and diagnostic methods of this congenital defect.

Fast Progressing His-Purkinje Conduction Disturbances in a Myotonic Dystrophy Pacient.

Myotonic dystrophy leads to multiple systemic complications and the age of death is earlier in myotonic dystrophy patients than in the general population. These patients have a high frequency of sudden death related to respiratory failure, cardiac arrhythmias and in particular to cardiac conduction disturbances. Prophylactic pacemaker implantation should be considered in asymptomatic myotonic dystrophy patients, which in the early stages of disease present minor conduction disturbances in 12-leads ECG. Even if the rate of progression of conduction abnormalities is usually slow, fast progression has been often observed thus making the clinical course of individual patients rather unpredictable.

Does Phantom Tumor Really Exist?!

Localized interlobar effusion in congestive heart failure (known as phantom tumor or vanishing tumor of the lung) is an uncommon entity. We report a case of a 61-year-old man who presented to the Emergency Departament with a two week history of dyspnoea, palpitations, dry cough and intermitent anterior chest pain. A posteroanterior chest radiography showed a nodular mass in the medium third of the right hemithorax suggestive of a pulmonary tumor. With this supposition of diagnosis, the patient was admitted to the Pneumology Departament for further investigations. Left ventricular systolic dysfunction was identified on the echocardiographic examination, in the presence of atrial flutter with 2 to 1 block. Lateral chest X-ray confirmed the presence of a pleural effusion with complete regression of "the lung tumor" after ten days of congestive heart failure treatment, avoiding other expensive and unnecessary investigations.

Comparison Between Alprostadil and Iloprost in Intravenous Treatment of Patients With Chronic Peripheral Arterial Disease.

INTRODUCTION: chronic peripheral arterial disease (PAD) seems to be a "rediscovered" pathology nowadays, brought into spotlight by its strong correlation with other signifi cant cardiovascular disorders. OBJECTIVES: to sustain a real benefi t from treatment with i.v. prostaglandins (PG) in PAD patients and to directly compare the currently used PG: alprostadil and iloprost. METHOD: open, non-randomized cohort study, with placebo group ("classical therapy") reviewing 615 PAD patients with therapeutic approach during 2003-2012 period, divided in 3 subgroups: "classical" therapy; "classical" therapy + iloprost; "classical" therapy + alprostadil; patients with Burger's disease were excluded; multiple factor analysis with statistical results inserted. RESULTS: clear domination of male gender patients, with older female gender patients (p.0.001); smoking like major risk factor in male and in all patients (p< 0.0001); 124 patients underwent angiography . CONCLUSION: a real improvement in the clinical status of patients receiving i.v. prostaglandin therapy with no diff erences between genders, diabetic and non-diabetic patients; alprostadil seems better than iloprost.