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Biomedical subjects

A Salvi

Publications and source records attributed to A Salvi.

At least 73 records · Page 4Linked to original sources
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

Two-dimensional echocardiography during endomyocardial biopsy.

53 consecutive and unselected patients undergoing endomyocardial biopsy (EMB) had concomitant two-dimensional echocardiographic (2DE) and fluoroscopic control during 62 biopsy procedures (49 of the right, 13 of the left ventricle) in order to assess the capacity of 2DE to identify biopsy site, to allow a selective biopsy in different areas of the ventricles and to foresee a positive sampling. The echocardiographic documentation of a close contact of the bioptome tip with the ventricular wall was compared with the presence of endomyocardial tissue in the forceps of the bioptome. Contact of the bioptome tip with the endocardium was visualized in 86% of the right ventricular biopsies and in 85% of the left ventricular biopsies. Under 2DE monitoring it was possible to change the site of biopsy and selected areas were easily sampled. In a subgroup of 29 biopsies prospectively studied to assess the ability of 2DE to foresee positive sampling, the 2DE forecast was confirmed in 93% of the right and in 100% of the left ventricular samples. The apical view was more commonly used because it provides a good visualization of the bioptome tip and of intracardiac structures without interfering with concomitant fluoroscopic control. Our results suggest that 2DE monitoring during EMB may: 1) provide definite forceps position during the procedure in a large number of patients; 2) guide the bioptome to obtain samples from different and/or selected sites of the ventricles; 3) foresee a positive samples.

Biopsy↗
PubMed1986

Arrhythmias in dilated cardiomyopathy.

Sixty-five patients with dilated cardiomyopathy underwent 24 hour electrocardiographic monitoring: 62 (95.4%) showed ventricular arrhythmias and 52 (80%) complex ventricular arrhythmias (multiform ventricular extrasystoles, paired ventricular extrasystoles and ventricular tachycardia). Complex ventricular arrhythmias correlated significantly with some haemodynamic indices of ventricular dysfunction: patients with multiform and paired ventricular extrasystoles and with ventricular tachycardia had lower values of ejection fraction (31.9 +/- 11.8%, P = 0.002) and of cardiac index (2.9 +/- 0.7 litres/min/m2, P = 0.029) than the others (41.1 11.1% and 3.5 +/- 0.9 litres/min/m2 respectively). Patients were followed for a period of 30 +/- 18 months (20 days to 64 months). During follow-up 19 died and mortality was higher among patients with multiform and paired ventricular extrasystoles and/or ventricular tachycardia. Complex ventricular arrhythmias are frequent in dilated cardiomyopathy: ventricular tachycardia and multiform and paired ventricular extrasystoles seem to be related to a more depressed ventricular function and to a poor prognosis. The importance of antiarrhythmic treatment in these patients has still to be evaluated.

Adolescent↗
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↗
PubMed1985

Acute rickettsial myocarditis and advanced atrioventricular block: diagnosis and treatment aided by endomyocardial biopsy.

A case of acute advanced atrioventricular block in a young patient is described. An endomyocardial biopsy performed to confirm myocarditis showed findings compatible with rickettsial endomyocarditis. Treatment with tetracycline was therefore started and a rapid remission of the atrioventricular block was observed. Healing of the disease was subsequently documented by a second endomyocardial biopsy. The rickettsial etiology was confirmed by the results of serial serum titers against Proteus OX-19. Endomyocardial biopsy may be clinically indicated for the diagnosis of advanced atrioventricular block in young patients and may help in their optimal treatment.

Acute Disease↗
PubMed1985

Morphological findings in apparently idiopathic ventricular tachycardia. An echocardiographic haemodynamic and histologic study.

In order to investigate the anatomic substrate of 'idiopathic' ventricular tachycardia (VT) 10 patients with chronic recurrent VT and no apparent sign of heart disease underwent an echocardiographic, haemodynamic and histologic study (5 males, 5 females: mean age = 40 +/- 11 years). In the patients with a left bundle branch block morphology of VT (7 cases), four showed findings compatible with an arrhythmogenic right ventricular dysplasia or a right ventricular cardiomyopathy. In the other three all examinations were normal with the exception of endomyocardial biopsy, which showed slight non specific changes in two. Of the remaining 3 cases (characterized by a right bundle branch block morphology of VT or by the presence of polymorphic VT) one had histologic evidence of myocarditis while another developed dilated cardiomyopathy. Macroscopic and/or microscopic ventricular abnormalities are frequently found in patients with VT which appears idiopathic. In these cases myocardial disease is frequently progressive, despite optimal control of VT.

Adult↗
PubMed1985

[Unstable angina with recurrent episodes of transient elevation of the ST segment: role of transluminal percutaneous angioplasty].

Transluminal angioplasty was performed as an urgent treatment in 9 patients with unstable angina, refractory to medical therapy and ST elevation during pain. All had a coronary stenosis greater than 50% (89 +/- 12%; range 60-99%). The left anterior descending coronary artery was affected in 6 patients, the right coronary artery in 1 patient, the circumflex in 1 patient and 1 patient had two stenosis on both the left anterior descending and the first diagonal branch. A reduction of the luminal stenosis greater than 20% was obtained in all (residual stenosis 30 +/- 11%; range 11-40%). During a follow-up of 6-20 months, two patients only showed recurrence of chest pain. A maximal ergometric test was negative in all patients after 1, 3 and 6 months. A second arteriography, performed in 7 patients after 3-6 months, demonstrated a mean stenosis of 35% (range 30-40%). Transluminal coronary angioplasty is a feasible and effective therapeutic approach in patients with unstable angina and ST elevation, when a significant coronary stenosis is present.

Adult↗
PubMed1985

[Negativity of myocardial scintigraphy with technetium-pyrophosphate in a case of primary cardiac amyloidosis].

We describe herein the case of a 62-year-old man affected by congestive heart failure of obscure origin, in which the clinical history, the electrocardiographic and echocardiographic findings were compatible with the diagnosis of amyloid cardiomyopathy. Cardiac catheterization disclosed a restrictive physiology. Tc-99m-pyrophosphate myocardial scintiscan was negative despite the markedly increased left ventricular wall thickness on echocardiographic examination. A definite diagnosis was obtained by means of endomyocardial biopsy.

Amyloidosis↗
PubMed1985

[Endomyocardial biopsy: experience with 156 patients].

Transcatheter endomyocardial biopsy (EMB) is a well known technique but its clinical value is still controversial. Our experience in the first 156 patients studied, in whom 182 EMB were performed, is reported and particular attention is given to the clinical value of the biopsy. Complications were observed in 7 patients and left ventricular EMB appeared to be more complicated (2/23) than right ventricular EMB (5/159). The clinical value of EMB was well documented (63.5%) in patients with congestive heart failure and a dilated heart (group 1) in whom a fairly high presence of myocarditis (17.5%), in different stages, was observed (13/74 patients). In patients with congestive failure and a restrictive/constrictive physiology (group 2), with angina and normal coronary arteries (group 3) and with acute advanced atrio-ventricular block and young age (group 5) the clinical value of EMB was good (85.7%, 58.3% and 60.6% respectively). The clinical value of EMB was on the contrary poor in patients with idiopathic ventricular arrhythmias (group 4) and in an heterogeneous group of patients (group 7), where EMB was mainly performed to exclude myocarditis. EMB had no clinical value in patients with aortic or mitral incompetence (group 6) studied according to a research protocol. EMB is a safe procedure which provides useful clinical informations in more than 50% of patients studied. The fairly high incidence of myocarditis (25 out of 156 patients studied) and the protean clinical presentations of the disease are stressed.

Angina Pectoris↗
PubMed1985

Cardiac amyloidosis: five cases diagnosed by endomyocardial biopsy.

Between October 1974 and December 1985, 350 patients have been subjected to endomyocardial biopsy (EMB). Five of these subjects clinically presented restrictive cardiomyopathy symptoms. EMB revealed diffuse cardiac amyloidosis. Light-electron-microscopic and morphometric data have been reported. The role of EMB in the diagnosis of cardiac disease is also emphasized.

Amyloid↗