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Biomedical subjects

E Piccolo

Publications and source records attributed to E Piccolo.

At least 37 records · Page 2Linked to original sources
PubMed1990

Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study.

The vasovagal nature of syncope, which remained unexplained despite full clinical and electrophysiologic investigation, was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (17 men and 13 women, mean age 65 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5) episodes of syncope of unknown origin were studied. Head-up tilt test was considered positive if syncope developed in association with hypotension, bradycardia, or both. During baseline head-up tilt 15 patients (50%) had a positive response. Ten patients had a vasodepressor response (marked hypotension without marked bradycardia) and 5 had a mixed response (marked hypotension with marked bradycardia). None of 8 control subjects became symptomatic during the test. Baseline head-up tilt test was positively reproducible in 10 of 14 patients (71%). Nine of these 10 patients underwent serial head-up tilt tests after drug administration to determine the pathogenesis of vasovagal syncope. Atropine prevented tilt-induced syncope in 3 of 8 patients (37.5%), propranolol in 2 of 8 (25%) and etilephrine in 7 of 7 (100%). Seven patients received long-term drug treatment with drugs selected on the basis of acute drug testing. One responder to atropine received transdermal scopolamine and 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 12 months. Head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vasovagal reaction in patients with syncope of unknown origin. Withdrawal of alpha-sympathetic stimulation is a principal mechanism responsible for vasodilation and syncope during head-up tilt.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗
PubMed1990

Electrogenesis of the S1S2S3 electrocardiographic pattern. A study in humans based on body surface potential and right ventricular endocardial mapping.

To study the electrogenesis of the S1S2S3 pattern, seven patients had body surface potential mapping and endocardial mapping of inflow tract, outflow tract, and apex of the right ventricle. QRS duration was longer in S1S2S3 versus controls (94 +/- 14 vs. 84 +/- 14 msec). Surface mapping was similar in S1S2S3 patients and in controls during the first 30-40 msec of QRS, but S1S2S3 patients subsequently presented the following differences: (1) earlier time of onset (34 +/- 3 vs. 44 +/- 6 msec) and a lower voltage (1,242 +/- 468 vs. 1,649 +/- 31 mV) of peak positive anterior maximum; (2) earlier dorsal migration (45 +/- 3 vs. 55 +/- 7 msec) of the maximum; (3) a second peak positive maximum at 58 +/- 3 msec, located on the dorsal spine; (4) the appearance of a right subclavicular positive area at 51 +/- 6 msec, which in controls was absent or appeared later (66 +/- 7 msec). At the end of QRS, the maximum was located in all but two S1S2S3 cases on the upper sternum. Right ventricular endocardial mapping showed a similar activation time of the apex in S1S2S3 patients and controls, but in the former a significant inflow (56 +/- 21 vs. 36 +/- 9 msec) and outflow tract (79 +/- 13 vs. 39 +/- 8 msec) activation delay was documented. The data obtained using body surface potential mapping suggest that an anomalous wavefront rightward and superiorly oriented is present in the S1S2S3 pattern, which is able to oppose the electrical forces of ventricular free walls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Syncope of undetermined nature after electrophysiologic study. Usefulness of the head-up tilt test in the diagnosis of vaso-vagal origin and in the choice of treatment].

The vaso-vagal nature of syncopes which remained unexplained despite full clinical and electrophysiological investigation was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (16 men and 14 women, mean age 63.6 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5.1) episodes of syncope of unknown origin were studied together with 11 asymptomatic control subjects. Head-up tilt test was considered positive if syncope developed in association with hypotension and/or bradycardia. During baseline head-up tilt 15 patients (50%) showed a positive test, with vasodepressor response (marked hypotension without marked bradycardia) in 10 cases and with mixed response (marked hypotension with marked bradycardia) in 5 cases. None of the control subjects became symptomatic during the test. Mean time to syncope was 24.9 minutes. Baseline head-up tilt test was reproducibly positive in 10 out of 14 patients (71%). Eight of these 10 patients underwent serial head-up tilt tests after atropine (0.04 mg/Kg i.v. in 1 minute), propranolol (0.2 mg/Kg i.v. in 3 minutes) and etilefrin (15-30 mg/day orally for 2-3 days) to determine the pathogenesis of vaso-vagal syncope. Atropine prevented tilt-induced syncope in 3 out of 7 patients (43%), propranolol in 2 out of 7 (29%) and etilephrine in 6 out of 6 (100%). Seven patients were chronically treated with drugs selected on the basis of acute drug testing. One patient-responder to atropine received transdermal scopolamine and the other 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 7.7 months, except 1 who experienced another episode of syncope after having discontinued etilephrine 4 months before. These results suggest that: 1) head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vaso-vagal reaction in patients with syncope of unknown origin; 2) withdrawal of alpha-sympathetic stimulation is the principal mechanism responsible for vasodilation and syncope during head-up tilt; 3) alpha-sympathomimetic agents, such as etilephrine, are effective in preventing spontaneous episodes of vaso-vagal syncope during a short-term follow-up.

Adolescent↗
PubMed1990

[Empiric treatment with amiodarone in patients with sustained ventricular tachyarrhythmia. Results of a long-term follow-up].

The long-term follow-up of 52 pts (36 M, 16 F, mean age: 62 years) with sustained ventricular tachyarrhythmias (SVT) was analyzed to assess the efficacy and feasibility of empiric amiodarone treatment. Forty-five pts had organic heart disease (mean EF: 38.3%) and 7 pts no overt heart disease. Twenty pts suffered from syncope or cardiac arrest secondary to sustained ventricular tachyarrhythmias (mean: 2.35 episodes) and 32 did not. All pts were given amiodarone empirically (mean dose: 390 mg) and followed-up for a mean period of 29.5 months (range 1-137). Two pts (3.8%) died of non cardiac causes, 5 (9.6%) of non sudden cardiac death and 7 (13.4%) of sudden death. Fifteen pts (28.8%) experienced non fatal arrhythmic recurrences. Four out of 7 pts who died suddenly experienced non fatal arrhythmic recurrence before death. The actuarial incidence of cardiac death was 10.8, 22.7, 31.5, 31.5% at 1, 2, 3 and 5 years; the actuarial incidence of sudden death was 8.9, 12, 22.1, 22.1% at 1, 2, 3 and 5 years; the actuarial incidence of non fatal arrhythmic recurrences was 17.4, 26.3, 26.3, 26.3, 44.7% at 1, 2, 3, 4 and 5 years. Univariate analysis identified recent myocardial infarction, NYHA functional class, detection of frequent and/or repetitive premature ventricular contractions on Holter monitoring and non fatal arrhythmic recurrences as predictors of cardiac death (p less than 0.05), while only non fatal arrhythmic recurrences were associated with sudden death (p less than 0.05). Twenty-two pts (42.3%) developed side effects. Nine (17.3%) discontinued amiodarone: 6 pts (11.5%) because of side effects and 3 inadvertently.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study.

Fifty-eight patients (29 M, 29 F, mean age 60.8 +/- 16 years) with unexplained syncope at the end of a complete clinical and electrophysiological evaluation, were followed for a mean period of 36.6 +/- 20.5 months (median: 30.5 months). Structural heart disease was present in 32 patients (55.2%). The standard ECG was normal in 24 (41.4%) and showed sinus bradycardia (greater than 40 m-1) and/or first degree AV block and/or intraventricular conduction disturbances in 29 patients (50%). During follow-up, recurrences of syncope were observed in 11 of 43 untreated patients (25.6%), three of seven electrically treated patients (42.9%) and two of eight pharmacologically treated patients (25%). The cause of these recurrences was cardiac in one (1.7%), non-cardiac in 10 (17.2%) and remained undetermined in five (8.6%). Sudden death occurred in only one patient (1.7%), who was receiving chronic amiodarone therapy. These results indicate that (1) syncopal recurrences may occur in an appreciable percentage of patients with unexplained syncope and a negative electrophysiologic study during a relatively long-term follow-up, (2) syncopal recurrences, when they occur, are generally due to a non-cardiac cause, (3) sudden death is an occasional and rare event in this patient population and (4) empirical prophylactic treatment with a permanent pacemaker or antiarrhythmic drugs does not usually prevent complications during the follow-up.

Adult↗
PubMed1989

[Usefulness of transesophageal electrophysiological study during the ergometric test in the evaluation of supraventricular paroxysmal tachycardia occurring during exertion].

Transesophageal electrophysiologic study has recently been proposed for the evaluation of supraventricular arrhythmias. In this report we present 13 cases, with palpitations occurring only during effort, due to a suspected supraventricular tachycardia, in which the usefulness of the transesophageal electrophysiologic study performed during stress test was evaluated. Of these 13 patients, nine were male and four were female, mean age was 29 yrs. Twelve cases had no heart disease, one had a moderate mitral valve insufficiency. Nine cases had a normal ECG, four had a WPW pattern. In 9/13 cases no significant arrhythmia was ever documented, in 1/13 ventricular premature beats were present in the basal ECG, in 1/13 a atrial fibrillation and in 2/13 a supraventricular reciprocating tachycardia was recorded. In all cases a maximal exercise test and a 24-hour Holter monitoring were performed. In all pts a transesophageal electrophysiologic study was performed both at rest and during extra-stimuli and incremental atrial pacing. The end point of transesophageal study was the induction of a sustained (greater than 30") supraventricular tachycardia. RESULTS. Maximal exercise test was negative in 11/13 cases; it showed ventricular premature beats in one case and initiated a supraventricular tachycardia in one. The 24 hour Holter monitoring was negative in 12/13 cases while it showed frequent ventricular premature beats in one. Resting transesophageal electrophysiologic study revealed dual A-V nodal pathways in six pts: in one of them a junctional re-entry was induced; in two a single echo beat was observed, while in three no reentry was observed. In three cases a supraventricular tachycardia was induced which was sustained in one and unsustained (7" and 24") in two cases. In 4 cases transesophageal electrophysiologic study gave no information. Transesophageal stimulation during exercise induced a greater than 30" reciprocating tachycardia in all patients, at work loads of 30-180 watts. Six pts had an intranodal tachycardia (V-A less than 70 msec) a further six pts had a atrioventricular tachycardia involving a Kent bundle (V-A greater than or equal to 70 msec), which was concealed in two, and one had a atrial tachycardia. In four cases (3 with intranodal and 1 with atrioventricular tachycardia), exercise transesophageal study was repeated after chronic therapy with betablockers (sotalol 240 mg/die or metoprolol 200 mg/die). In all cases, after therapy, the induced tachycardia had a longer cycle and in two cases it was induced at a higher work load. In a further two cases flecainide (200 mg/die) was tested. In one case (with atrial tachycardia), the arrhythmia was no longer inducible after therapy, in another case (with intranodal tachycardia) the drug had no effect. CONCLUSIONS. In patients with paroxysmal supraventricular tachyarrhythmias occurring during effort the basal ECG is normal or shows a WPW pattern. The maximal exercise test and 24 hour Holter monitoring give no information in over 90% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[Hypokinetic cardiomyopathy. A possible result of myocardial contusion].

Myocardial contusion is a frequent complication of blunt chest trauma. Ventricular involvement is generally segmental and exhibits a favourable evolution. We describe the case of a 44-year-old male who suffered an acute blunt thoracic injury with a consequent stable worsening of his functional class. His first electrocardiographic examination 30 days after the trauma showed negative T wave in V3-V6 leads while one and two-dimensional echocardiography exhibited a diffuse damage of the morphology of the left ventricle and a lowering of the fractional shortening (FS) of its end-diastolic diameter (EDD): FS = 23%, EDD = 6.9 cm, diastolic eccentricity index = 65%, systolic eccentricity index = 70%. During a follow-up period of thirteen months ECG became normal after a short time while the echocardiogram maintained its initial abnormalities and the patient maintained his compromised functional class. We report this peculiar pattern of myocardial contusion evolution which has not previously been described.

Adult↗
PubMed1988

[Distributions, mean values and correlations of various coronary risk factors in a population of Veneto].

During the National Research Council (CNR) program called Atherosclerosis-Risk Factors 2 (ATS-RF2) a random sample of 1903 subjects (50.1% male) aged 20-59 years was examined in the general population of Mirano-Venice. Mean values of serum total cholesterol and triglycerides, body mass index, as well as systolic and diastolic blood pressure were assessed. On the whole these turned out to be higher in men and increased with age. The continuously distributed variables showed an approximately normal distribution and a close correlation. Comparing our results with those obtained by other Italian units co-operating in the same CNR program, different levels of serum total cholesterol and systolic blood pressure were observed. The overall risk factor pattern in northern Italian regions is closer to that reported in the literature for central European countries than to that of southern Italian regions. These findings might explain why mortality due to ischaemic heart disease is higher in northern Italy and becomes progressively smaller in central and southern Italy.

Adult↗
PubMed1987

[Diabetic cardiomyopathy: preclinical pathology disclosed by the increase in ventricular afterload].

In order to test the importance of the association of diabetes mellitus and arterial hypertension in generating morphological and functional changes of the left ventricle (LV) consistent with a cardiomyopathy, 37 patients, aged 27 +/- 6.7 years, were studied by standard and digitized M-Mode echo: eighteen of them were affected by diabetes mellitus, 11 by arterial hypertension, 8 by diabetes and hypertension. Each group was compared to the others and with a group of 14 normal subjects. In order to verify the importance of increased ventricular after-load in modifying ventricular performance of diabetic patients, changes of the peak rate of systolic and diastolic variation of LV diameter and changes of the peak rate of interventricular septum and posterior wall excursion (IVSE, PWE) were evaluated after methoxamine hydrochloride infusion in 8 diabetic and 6 normal subjects. In diabetics the ratio between ventricular thickness and diameter (h/r) was greater than normal subjects (p less than 0.02); this ratio resulted higher in patients with diabetic rhinopathy who also exhibited an isovolumic diastolic period longer than normal (p less than 0.02). Both h/r ratio and isovolumic diastolic period (IDP) were higher in diabetic-hypertensive group as compared to normals (p less than 0.001), strictly diabetic (p less than 0.01 and p less than 0.001) or hypertensive subjects (p less than 0.01). Diabetic-hypertensive group, exhibited a lowering of the systolic and diastolic peak rate of IVSE (p less than 0.01) as well as of systolic peak rate of PWE as compared to the other three groups (p less than 0.05).

Adult↗
PubMed1987

[The Italian Group for the Study of Streptokinase in Myocardial Infarct: Study of electrocardiographic changes].

The twofold purpose of the ECG sub-group study of G.I.S.S.I. (Gruppo Italiano per lo Studio della Streptokinasi nell'Infarto miocardico) is to evaluate whether exist different ECG evolution in pts with AMI treated with streptokinase (SK YES) and/or with coronary reperfusion (early CK peak) with respect to pts non treated with streptokinase (SK NO) and/or without coronary reperfusion (late CK peak) and to establish whether the ECG is useful to recognize the patients in which reperfusion occurs. Among 365 pts randomized for G.I.S.S.I., 209 pts with first myocardial infarction, admitted within 6 hours from the onset of pain, alive for at least 24 hours, were included. 98 were SK YES and 111 SK NO: 48 cases (group A) had the CK peak before 15th hour; 59 cases (group B) had the CK peak between 15th and 21th hour: 102 cases (group C) had the CK peak after 21th hour. In all the patients ECG was analyzed on admission and thereafter at 3rd, 6th, 9th, 12th, 24th hours and on 2nd, 3rd, 7th and 14th days. RESULTS--Anterior myocardial infarction--SK YES pts had in respected to SK NO pts a significantly lower sum of ST elevation on anterior leads (sigma ST increases V1-V6) at all times after admission starting from 6th hour. A similar behaviour was observed in groups A and B in respect to group C. SK YES pts when compared to SK NO pts had an earlier loss of the sum of R wave in anterior leads (sigma RV1-V6), although the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗