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Biomedical subjects

S Scardi

Publications and source records attributed to S Scardi.

At least 55 records · Page 3Linked to original sources
PubMed1991

Prognostic value of total ischemic burden in patients with stable ischemic heart disease.

Patients with stable coronary artery disease commonly have transient myocardial ischemia with or without experiencing angina, but the prognostic implications of this "total ischemic burden" is still a matter of debate. We studied 112 consecutive patients with coronary artery disease, normal left ventricular function at rest and exercise-induced myocardial ischemia, a 24-hour ambulatory EKG was performed after drug withdrawal. The mean exercise duration was 572 +/- 192 seconds, with an ischemic threshold (ST depression = 1 mm) of 390 +/- 190 seconds). By Holter monitoring 30 patients had no ischemia and 82 (73%) had a total of 332 episodes of ST segment changes, the majority of which were asymptomatic (242/332, 73%). Among 82 patients with transient myocardial ischemia, 44 (54%) had only asymptomatic episodes. Nine patients (11%) complained of angina coincident to ST changes. Twenty-nine patients (35%) had both painful and painless ST segment alterations. All patients were prospectively followed-up while on conventional medical therapy. During a mean follow up of 25 +/- 10 months cardiac events occurred in 31 patients; there were 5 cardiac deaths, 3 non-fatal myocardial infarctions, 2 hospitalization for unstable angina and 21 revascularization procedures (PTCA or CABG). By multivariate analysis the number of stenotic vessels on coronary angiography was predictive of the events during the follow-up (p = 0.03), while other demographic, clinical, ergometric and angiographic variables were not influential. Event-free survival was similar for all subsets of transient myocardial ischemia (silent, symptomatic, or none).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Dynamic electrocardiogram in chronic atrial fibrillation treated with digitalis].

To assess heart rate variability in chronic atrial fibrillation, 60 patients (20 men, 40 women: mean age 63 +/- 8 years: NYHA 2.0 +/- 0.5) with various cardiac conditions were investigated with 24-hour Holter monitoring during daily life. Twenty-five healthy subjects (5 men, 20 women: mean age 55 +/- 9) were considered as the control group. All patients had "controlled" heart rate (50-90 bpm) on basal ECG, normal hematological and thyroid hormone values, and took digoxin alone (mean dosage 0.22 +/- 0.05 mg). Mean digoxin plasma levels were 0.88 +/- 0.48 ng/ml. Maximum, minimum and average heart rate were quite good during the night but too high during the daytime and far higher than those observed in healthy subjects. In fact, up to 82% of patients (at 9 a.m.) had a maximum heart rate higher than 115 bpm. Pauses between 2.0 and 3.0 sec occurred in 40 out of 60 patients (66%). No patients had pauses longer than 4.0 sec. In our experience, patients in chronic atrial fibrillation "controlled" with digoxin alone showed a daytime heart rate which was often too high. We suggest 24-hour Holter monitoring to detect subgroups that may be treated successfully with digoxin associated with calcium-antagonists or beta-blockers.

Aged↗
PubMed1990

Myocardial infarction following sublingual administration of isosorbide dinitrate.

A 78-year-old with healed septal necrosis suffered a recurrent myocardial infarction of the anterior wall following the administration of isosorbide dinitrate 5 mg sublingually. After detailing the course of events, we discuss the role of paradoxical coronary spasm and hypotension-mediated myocardial ischemia occurring downstream to significant coronary arterial stenosis in the pathophysiology of acute coronary insufficiency.

Administration, Sublingual↗
PubMed1990

Transient myocardial ischaemia: a multivariate analysis on clinical, angiographic and ergometric variables.

The availability of ambulatory ECG monitoring allows identification of transient myocardial ischaemia, the clinical relevance of which is currently being investigated. Ninety-four consecutive patients with ischaemic heart disease and a positive exercise test (greater than or equal to 1 mm ST-segment depression) were studied to evaluate the prevalence of transient myocardial ischaemia (either painless or painful) during 24-h dynamic electrocardiogram (ECG) and the clinical, angiographic and ergometric variables predicting its appearance. Two-hundred-and-eighty-one episodes of transient electocardiographic myocardial ischaemia were recorded in 69 patients (73.4% of all patients). Transient myocardial ischaemia was more frequent, although not significantly so, in patients with diabetes, with previous myocardial infarction, or with multivessel disease. When tested by multivariate analysis, neither the clinical variables nor the severity of coronary artery disease allowed prediction of the occurrence of transient myocardial ischaemia during dynamic ECG. The duration of exercise testing up to the ischaemic threshold (ST-segment depression = 1 mm) and the peak heart rate during exercise were more accurate predictors of transient myocardial ischaemia (P = 0.019 and 0.012 respectively). Patients with transient myocardial ischaemia had a lower ischaemic threshold (355 +/- 175 vs 498 +/- 150 s, mean +/- SD, P = 0.001) despite a lower peak heart rate (129 +/- 18 vs 137 +/- 12 beats min-1, P = 0.047) than patients without transient myocardial ischaemia. In conclusion, exercise testing may help select patients for examination by dynamic ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1990

[Silent myocardial infarct as a main manifestation of systemic lupus erythematosus].

Myocardial infarction has rarely been reported in patients with systemic lupus erythematosus but may develop late in the disease usually as a result of severe and accelerated atherosclerosis or coronary arteritis. A 32-year-old man with untreated and unrecognized systemic lupus erythematosus, in the absence of conventional coronary risk factors (except family predisposition) and definite extracardiac manifestations of systemic lupus erythematosus had a silent myocardial infarction early in the course of the disease. A coronary arteriogram revealed multiple stenosis of the left anterior descending artery and critical stenosis of the right coronary artery. It is our belief that lupus vasculitis is a likely contributing factor in the development of obstructive coronary disease in this patient.

Adult↗
PubMed1990

[Evaluation of exercise test reproducibility in patients with ischemic cardiopathy].

We evaluated the repeatability of some measurements taken during the bicycle ergometer exercise test (exercise duration, heart rate and pressure rate product at angina and ST segment depression times) in 166 consecutive non-selected ambulatory patients with proven ischemic heart disease. One hundred and sixty-six patients with history of angina and/or myocardial infarction performed three exercise tests within seven days of wash-out. Eighty-six (58.1%) of these experienced angina and ischemic ST segment depression during all three tests (group 1), and 80 (48.2%) finished at least one test without angina or ST segment depression (group 2). The degree of angina (according to Canadian Cardiovascular Society classification) was higher in the first group than in the second one; on the contrary, exercise duration as well as pressure rate product at ischemic threshold, heart rate and pressure rate product at the onset of angina were significantly lower (0.001 less than p less than 0.05) in the former group. In group 1, we analyzed ergometric parameter measurement "repeatability" during the three consecutive exercise tests. The analysis of variance for repeated measurements showed that exercise duration and pressure rate product values at ischemic threshold did not vary significantly in the three tests, while other ergometric parameters showed a greater variability (0.001 less than p less than 0.05). Age, previous myocardial infarction or rest angina, the number of critically stenotic coronary vessels and the ejection fraction did not condition the repeatability of the test. In conclusion, in our population of non-selected ischemic patients only 52% developed angina and ischemic ST segment depression during all three exercise tests performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Chronic treatment after acute myocardial infarction: which drug for which patient? Nitrates.

Nitrates are beneficial in post-myocardial infarction patients with stable, unstable, and Prinzmetal's variant angina and as adjunctive therapy in congestive heart failure. They are available in multiple formulations that differ in chemical structure, pharmacokinetics, onset and duration of activity, and peak effect; all of these variables may condition the choice of nitrate preparation and routes of administration. Other conditions, such as different types of angina, intensity of symptomatology, psychological attitude, patient's compliance, and cost of treatment, have to be taken into account. The potential problem of nitrate tolerance requires further evaluation and can be prevented or reversed with intermittent-dosing regimens. Up-to-date nitrates continue to be a mainstay in the treatment of patients with myocardial infarction, especially if complicated by painful or silent ischemia.

Acute Disease↗
PubMed1989

[Apical hypertrophic cardiomyopathy: variability of bidimensional echocardiographic and electrocardiographic expression].

Apical hypertrophic cardiomyopathy is characterized by primary hypertrophy of the myocardium which is localized exclusively at the apex of the left ventricle. Previous studies have indicated that apical hypertrophic cardiomyopathy is characterized by a unique combination of cross-sectional echocardiographic and ECG findings ("giant" T wave inversion and high R wave voltage in the precordial leads). The aim of this study was to evaluate the possible relation between apical hypertrophy, quantitatively defined by cross-sectional echocardiography, and ECG findings in patients with apical hypertrophic cardiomyopathy. We studied 13 pts with apical hypertrophic cardiomyopathy, 10 men and 3 women (aged between 11 and 73 years, mean age 47). Apical hypertrophy was assessed quantitatively by determinating the muscle cross-sectional area in the apical region. From the end-diastolic apical 4 chamber view, endocardial and epicardial contours were digitized in order to obtain the muscle cross-sectional area of the left ventricle. The walls of the left ventricle were then divided into 3 regions (basal, mid-ventricular, apical). Final values of planimetered muscle areas are given as the average of the calculations obtained blindly and independently by 4 observers. The comparison between cross-sectional echocardiographic and electrocardiographic findings showed that patients with giant T wave inversion (T wave greater than 10 mm) and high R wave voltages (R greater than wave 25 mm) had a more severe degree of apical hypertrophy. However there was no complete agreement between cross-sectional echocardiographic and electrocardiographic findings. This study in fact demonstrates a wide variation in the degree of severity of apical hypertrophy among patients with apical hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Acute effects of felodipine in exertional angina pectoris.

To investigate the antianginal efficacy, duration of action and tolerability of 2 doses of the new calcium antagonist felodipine, 15 patients (14 men and 1 woman, mean age 62 years) with stable exertional angina pectoris and angiographically demonstrated coronary artery disease were randomly given felodipine, 5 and 10 mg, and placebo on 3 different days. A bicycle ergometer exercise test was performed 3 and 10 hours after dosing. In comparison with placebo, felodipine 5 and 10 mg significantly increased resting heart rate and decreased resting systolic and diastolic blood pressure 3 hours after administration (p less than 0.001). Ten hours after administration, only supine systolic blood pressure was still significantly lower (p less than 0.001). Anginal (time to mild chest pain) and ischemic (time to 1 mm ST depression) thresholds, as well as duration of exercise and total work at peak exercise, were higher in comparison with placebo at 3 and 10 hours (p less than 0.001). In comparison with the lower dose, 10 mg felodipine induced a decrease in supine (p less than 0.05) and sitting (p less than 0.01) systolic blood pressure at rest and an increase in total work to anginal threshold (p less than 0.01), as well as in total work and duration of exercise at peak exercise (p less than 0.05). These results suggest that a single administration of felodipine, 5 and 10 mg, may improve exercise capacity over a 10-hour period in patients with stable exercise-induced angina due to atherosclerotic heart disease.

Angina Pectoris↗
PubMed1988

Individual responses to transdermal nitrates after chronic administration in angina pectoris.

The aim of this study was to investigate whether, and to which extent, sustained treatment with transdermal nitroglycerin plasters may lead to the development of tolerance in patients with effort-induced angina pectoris. Ten patients, all men, mean age 62.7 years, took part in a double-blind, cross-over, acute study, comparing the transdermal therapeutic system of nitroglycerin 10 mg/24 hours with placebo. Patients were then treated for 1 month with the active drug in single-blind condition, and finally they took part in a further acute study identical to the first. Cycloergometric exercise tests were carried out 4 hours after dosing. In comparison with placebo, the active drug significantly (P less than 0.01) increased ischaemic threshold (ST depression = 1 mm) after both acute (from 299 +- 92 to 413 +- 120 sec) and chronic treatment (416 +- 107 sec). The same results were obtained for exercise duration to peak exercise (acute study: from 336 +- 65 to 482 +- 90 sec; chronic treatment: 466 +- 118 sec). The final acute study confirmed the stability of angina, showing that the improvement in exercise tolerance after chronic treatment was entirely due to the pharmacological effect of the drug. In terms of single patient response to the active treatment, 7 of the 10 patients showed an improvement in exercise tolerance after both acute and chronic treatment, while in 3 patients no antianginal effect was observed. These results suggest that nitrate tolerance cannot be considered an inevitable finding in patients chronically treated with transdermal patches.

Administration, Cutaneous↗
PubMed1988

[Reoperation in patients with heart valve prostheses. Analysis of risk factors affecting perioperative mortality].

Sixty-two patients with at least one prosthetic heart valve each underwent a total of 70 reoperations. Their cases were analysed with special regard to the risk of perioperative mortality and to the factors affecting that risk. The age of the patients studied was 47 +/- 14.6 years (mean +/- 1 SD), and 4.75 +/- 4 years had elapsed since their previous operation. A total of 85 prostheses were implanted at the time of initial surgery. Forty-nine of those were mitral, 28 were aortic, and 8 were tricuspid prostheses. There were 48 mechanical valves, 24 bioprostheses and 13 Carpentier rings (9 of the latter being mitral and 4 tricuspid). At reoperation (n = 70) 95 valves required treatment. Eighteen patients died following their first reoperation (18/62, 29%), and two more died after a second reoperation (2/8, 25%). Actuarial probability of hospital survivors being alive 8-9 years following reoperation was 47 +/- 15%. It was found by multiple regression analysis that the duration of cardiopulmonary bypass (p less than 0.01), surgical priority (p less than 0.05) and the patient's age (p less than 0.05) were the only independent predictors of hospital death. A review of the literature and our own results suggest that surgical problems encountered with reoperation have unfavourably affected surgical results in the past. Objective risk factors are currently more related to the operative outcome. For these to be neutralised, patients with dysfunctioning prosthetic heart valves should be operated at an early stage before they reach a critical one. Only patients with stable, mild dysfunction unlikely to worsen acutely may probably be followed-up safely.

Actuarial Analysis↗
PubMed1988

Exercise-induced intermittent angina and ST-segment elevation in Prinzmetal's angina.

A patient with primary angina showed intermittent ST elevation (with and without chest pain), during two exercise tests performed on consecutive days; the same ST changes were also seen during the recovery phase. The electrocardiographic changes recorded in this patient may be considered an example of myocardial response to spasm-related ischemia.

Angina Pectoris, Variant↗