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Biomedical subjects

L Galiuto

Publications and source records attributed to L Galiuto.

29 records · Page 2Linked to original sources
PubMed1997

Eosinophilic myocarditis manifesting as myocardial infarction: early diagnosis and successful treatment.

OBJECTIVE: To report a case of eosinophilic myocarditis with remarkable initial clinical manifestations and outcome. MATERIAL AND METHODS: A 67-year-old woman with hypertension and a history of asthma and drug hypersensitivity was referred to our institution with a diagnosis of acute myocardial infarction on the basis of severe chest pain, ST elevation on an electrocardiogram, and a slight increase in cardiac enzymes. Further diagnostic studies were performed. RESULTS: Echocardiography disclosed left ventricular dysfunction in conjunction with apical asynergy, thinning, and thrombus. The eosinophil count in the peripheral blood was increased only slightly. Coronary angiography showed normal arteries and prompted the performance of endomyocardial biopsy, which revealed active eosinophilic myocarditis. After corticosteroid therapy, global and regional left ventricular function returned to normal. CONCLUSION: This unusual clinical picture and outcome demonstrate that eosinophilic myocarditis may simulate acute myocardial infarction and should be considered in patients with a history of allergies or acute left ventricular dysfunction, even in the absence of pronounced eosinophilia in the peripheral blood. With appropriate medical therapy, recovery for these patients can be complete.

Acute Disease↗
PubMed1996

Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography.

The purpose of this study was to evaluate, in postinfarction dysfunctioning myocardium, the relative potential of myocardial contrast and low-dose dobutamine echocardiography in detecting myocardial viability, and the relation between microvascular integrity, contractile reserve, and functional recovery at follow-up. Twenty-four patients with recent myocardial infarction were studied before hospital discharge with low-dose dobutamine and myocardial contrast echocardiography. In the dysfunctioning infarct area, wall motion score index was calculated at baseline, during low-dose dobutamine, and at 3-month follow-up. Revascularization of the infarct-related artery was performed if clinically indicated. Eighteen patients (group A) had myocardial enhancement of the dysfunctioning infarct area at myocardial contrast echocardiography of >50%, whereas the remaining patients (group B) had an increase of < or = 50%. Wall motion score index was similar at baseline in groups A and B (2.6 +/- 0.4 and 2.8 +/- 0.2; p = NS), but it improved during low-dose dobutamine and at follow-up only in group A (1.9 +/- 0.9 and 1.9 +/- 0.7, respectively; p <0.001 vs baseline). In group B, wall motion score index was 2.7 +/- 0.4 with low-dose dobutamine and 2.8 +/- 0.2 at follow-up (p = NS vs rest). In identifying viable myocardial segments, myocardial contrast echo had 100% sensitivity and 46% specificity, whereas low-dose dobutamine echo had 71% sensitivity and 88% specificity. Thus, microvascular integrity after acute myocardial infarction is a fundamental prerequisite for ensuring myocardial contractile reserve and regional functional recovery. Myocardial contrast and low-dose dobutamine echocardiography have different, but complementary, diagnostic characteristics in detecting myocardial viability.

Aged↗
PubMed1996

Myocardial contrast echocardiography in acute myocardial infarction. Pathophysiological background and clinical applications.

Myocardial contrast echocardiography is a technique used in experimental and clinical settings in order to visualize the pattern of intramyocardial perfusion. In the acute phase of myocardial infarction, regional absence of flow during myocardial contrast echocardiography delineates the area at risk of necrosis, while the definitive non-perfused area expresses infarct size. Reopening the infarct-related artery, which may be achieved spontaneously by thrombolysis or percutaneous transluminal coronary angioplasty, is not a reliable indicator of intramyocardial reperfusion. If myocardial ischaemia due to coronary occlusion has been sufficiently prolonged and severe, not only myocyte viability, but also microvascular integrity is lost. Myocardial contrast echocardiography, using intracoronary injection of sonicated contrast medium, gives information about microvascular integrity and the effective presence of intramyocardial reflow. Anatomical integrity of microvasculature does not necessarily imply preserved function, and thus the microvessel vasodilating reserve may also be impaired. Myocardial contrast echocardiography has the potential to assess alterations in microvascular function, showing, in the myocardial area with reduced coronary reserve, a relatively reduced increase in echocontrast signal intensity when an intravenous vasodilator agent is administered.

Animals↗
PubMed1994

Clinical use of stress echocardiography: factors affecting diagnostic accuracy.

Stress echocardiography is frequently used for the diagnosis of coronary artery disease. Its diagnostic accuracy is strongly influenced by many variables including patient selection, type of stress procedure utilized, stress protocol, echocardiographic imaging modality, digital reviewing technology and expertise in performing and interpreting the examinations. All these must be taken into consideration when evaluating and comparing different studies presented in the literature, as well as in optimal organization (accurate selection of the appropriate stress modality and protocol execution, optimal use of technology, appropriate training of medical and non-medical personnel) of the laboratory involved in stress echocardiography.

Adult↗
PubMed1994

[Assessment of viable myocardium after infarction with transesophageal echocardiography and myocardial echocontrastography].

Left ventricular recovery of dysfunctioning but viable myocardium can occur only in tissue in which both myocardial contractile reserve and microvascular integrity are preserved. Recent studies have demonstrated that both inotropic stimulating echo tests and myocardial contrast echocardiography can be used to assess myocardial viability in post-myocardial infarction patients. Therefore we performed a transesophageal and myocardial contrast echocardiographic evaluation of post-myocardial infarction patients to assess: the respective accuracy of post-extrasystolic potentiation and low-dose dobutamine (5 and 10 mcg) during transesophageal echocardiography in eliciting contractile reserve, and the potential of myocardial contrast echocardiography in predicting later functional recovery. Results of our studies showed comparable effects of low-dose dobutamine (5 mcg) and post-extrasystolic potentiation in increasing myocardial thickening while low-dose dobutamine (10 mcg) had a greater potential in eliciting residual contractility. Lastly, myocardial contrast echocardiography provided a clear spectrum of intramyocardial perfusion patterns in dysfunctioning areas but did not accurately correlate with later functional recovery as better predicted by low-dose dobutamine in the same segments. In conclusion, these methods represent the preferred choice of studying the perfusion-contraction match in viable myocardium thus playing an important role in prognostic and therapeutic strategies in myocardial infarction patients.

Echocardiography↗
PubMed1994

Infective endocarditis: prevention, diagnosis and management.

Infective endocarditis remains an important problem and the means of prevention are still insufficient. The causal bacteria have changed very little, but the incidence of nosocomial infections and endocarditis complicating intravenous drug abuse are increasing. The distinction between subacute and acute clinical presentations remains appropriate. Cardiac and neurological complications are frequent and carry a high risk of mortality. The diagnosis is obtained by the integration of clinical data and the results of blood cultures. Echocardiography is extremely useful for detecting vegetations, and for assessing the haemodynamic consequences and specific cardiac complications. Risk stratification can be obtained by correct integration of multiple parameters. The causal agent should be identified before the initiation of antimicrobial therapy. Surgery is frequently required, and should be performed rapidly when indicated.

Adult↗
PubMed1993

[Multiplane transesophageal echocardiography in the study of expansive mediastinal processes compressing the right heart: a report of clinical cases].

In order to assess the role of multiplane transesophageal echocardiography in detecting mediastinal masses and in evaluating the manifestations of cardiac compression due to tumoral growth, 3 cases of patients with right ventricular outflow obstruction are presented. In each of these patients transesophageal echocardiography provided an accurate evaluation of the hemodynamic consequences of the tumoral process.

Adolescent↗
PubMedDate not supplied

Double-chambered right ventricle: echocardiographic features.

Double-chambered right ventricle is an uncommon congenital heart disease, studied mostly by angiography, characterized by the division of the right ventricular cavity into two different pressure chambers. To analyze the anatomic features of this disease, data from 13 patients examined by echocardiography at the Mayo Clinic were reviewed. Despite the anatomic variety of this abnormality, two main types were identified. In the first type, intraventricular obstruction was due to an anomalous muscle bundle crossing the right ventricular cavity from the interventricular septum to the parietal wall. In the second type, no anomalous bundles were identified, and interventricular obstruction was due to marked parietal and septal hypertrophy. The main interventricular gradient was higher in the first type, and a ventricular septal defect was found to be associated more commonly with the second type.

Adolescent↗