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Biomedical subjects

F Camerini

Publications and source records attributed to F Camerini.

At least 91 records · Page 5Linked 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

[Cardiac amyloidosis. Invasive and noninvasive diagnosis].

Aim of this study is the analysis of clinical, morphologic and haemodynamic features of cardiac amyloidosis. Cardiac amyloidosis was demonstrated histologically in 7 of our patients: in 6 by endomyocardial biopsy during cardiac catheterization, in one at autopsy. The clinical picture was characterized in every patient by signs and symptoms of congestive heart failure. The electrocardiogram showed several non specific signs: low voltage of the QRS complexes, both in peripheral (4/7) and precordial leads (7/7 cases); marked leftward and upward deviation of the QRS axis (6/7 cases); first degree A-V block (5/7); abnormal Q waves (7/7). M-mode and two-dimensional echocardiography invariably demonstrated a typical pattern: a non dilated left ventricle with thickened and hyper-refractile walls, and usually a slight-moderate diffuse hypokinesia. Other common features were a thickening of right ventricular walls, interatrial septum, and atrioventricular and semilunar valves. Computerized analysis of the M-mode tracings disclosed a marked impairment of the indexes of both systolic and diastolic ventricular function in all patients. By correlating electrocardiographic and echocardiographic data, we found in every case a striking disproportion between the low QRS voltage and the high muscle cross-sectional area (an echocardiographic index of left ventricular mass): this pattern appears to be highly suggestive of infiltrative heart disease. Cardiac catheterization (performed in 6 cases) showed an increase of left ventricular (6/6) and right ventricular (5/6) end-diastolic pressure, with a dip plateau pattern in some cases (4/6 of the left, 2/6 in the right ventricle). The cardiac index was decreased in 3/6 cases. Left ventricular angiography confirmed the echocardiographic data of normal volumes and a slight-moderate decrease of the ejection fraction. We conclude that cardiac amyloidosis usually mimics a restrictive cardiomyopathy (severe congestive heart failure with increased ventricular filling pressures, in the absence of severe systolic ventricular dysfunction). This disease can be suspected clinically by the correlation of the clinical, electrocardiographic and echocardiographic data. The final diagnosis requires an endomyocardial biopsy.

Adult↗
PubMed1987

[Ambulatory ECG in cardiomyopathies].

DILATED CARDIOMYOPATHY - Conduction and rhythm disturbances are frequent findings in dilated cardiomyopathy. 65 patients with dilated cardiomyopathy underwent 24-hour electrocardiographic monitoring: 95.4% showed ventricular arrhythmias, 80% complex ventricular arrhythmias and 44% runs of non-sustained ventricular tachycardia. Over 1000 ventricular extrasystoles in 24 hours were present in 44% of cases. Ventricular tachycardia and multiform and paired ventricular extrasystoles correlated significantly with the severity of cardiac dysfunction and with a worse prognosis. Patients undergoing antiarrhythmic therapy (amiodarone) showed a significant reduction in the number of ventricular extrasystoles and in the incidence of complex ventricular arrhythmias. HYPERTROPHIC CARDIOMYOPATHY - The high incidence of arrhythmias, particularly ventricular arrhythmias (approx. 70% of cases) in hypertrophic cardiomyopathy is well recognized: episodes of ventricular tachycardia are present in 20% of cases and are related to an elevated risk of sudden death. Antiarrhythmic treatment with amiodarone significantly reduces the number of ventricular extrasystoles and the episodes of ventricular tachycardia, may prevent sudden death and improve survival. RESTRICTIVE CARDIOMYOPATHY - Very little information is present in literature concerning this extremely rare form, in which every type of rhythm and conduction disturbance has been observed. CONCLUSIONS - Electrocardiographic monitoring is nowadays a very important tool in the management of cardiomyopathy patients, to identify possible patients at risk and to monitor the antiarrhythmic treatment.

Amiodarone↗
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

[The electrocardiogram in dilated cardiomyopathy].

The electrocardiogram (ECG) of 80 patients with dilated cardiomyopathy was studied. An abnormal ECG was present in 100% of our patients, and in 25% it was the first sign of the disease. Thirty-eight cases (47.5%) showed left atrial enlargement, 22 (27.5%) prolonged PR interval, 33 (41.2%) left bundle branch block, 15 (18.7%) abnormal Q waves, 9 (11.2%) primary S-T and T changes. There were significant differences in ejection fraction and in left ventricular end-diastolic volume between patients with right bundle branch block (p less than 0.05 and p = 0.05 respectively). Patients were followed for a period of 29.5 +/- 28.8 months (min. 2 days, max. 10 years): during the observation period the ECG showed in 28 cases an increasing left ventricular conduction delay and a leftward shifting of mean QRS axis. Patients with left ventricular conduction delays showed a worse prognosis. ECG in dilated cardiomyopathy is a nonspecific but sensitive tool, which may be related to different degrees of myocardial impairment and may be useful in the definition of a prognostic profile.

Adolescent↗
PubMed1986

Hemodynamic evaluation of ibopamine in patients with refractory congestive heart failure.

Ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-methyldopamine, was investigated at doses ranging from 1.09 to 2.34 mg/kg in 12 patients suffering from refractory congestive heart failure. In 7 patients ibopamine produced favorable effects, increasing cardiac index (+35%), stroke volume index (+27%), stroke work index (+30%) and decreasing systemic vascular resistances (-15%), total pulmonary resistances (-20%), pulmonary arteriolar resistances (-28%), whereas in 5 patients it was ineffective. Transient adverse reactions occurred in 3 patients.

Adult↗
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↗
PubMed1986

[Hemodynamic effects of molsidomine in chronic congestive heart failure].

Acute haemodynamic effects of molsidomine, antianginal drug with vasodilator properties, were evaluated in 12 male patients with chronic congestive heart failure in New York Heart Association functional class 3 or 4 (mean age 56 +/- 7 years; ischemic heart disease in 8 cases, dilated cardiomyopathy in 3 cases, heart disease of combined aetiology in 1 case). After sublingual molsidomine (4 mg: 6 cases; 8 mg: 6 cases) the following haemodynamic changes were observed: mean right atrial pressure - 35% (p less than 0.01), left ventricular filling pressure -30% (p less than 0.01), total pulmonary resistance -33% (p less than 0.01), pulmonary arteriolar resistance -32% (p less than 0.01), cardiac index -6% (p less than 0.05), stroke volume index -12% (p less than 0.05), stroke work index +18% (p less than 0.01), heart rate -6% (p less than 0.01), double product -10% (p less than 0.01) (Fig. 3). Peak haemodynamic effect was reached between 30 and 90 minutes, lasting till 180 minutes. Molsidomine acutely reduced preload, did not show side effects and was well tolerated. These results suggest that molsidomine might be used in the treatment of chronic congestive heart failure, especially if characterized by an increased right and left ventricular filling pressure.

Administration, Oral↗
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

[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↗