Paroxysmal atrioventricular block and right coronary artery stenosis without acute myocardial infarction.

Paroxysmal atrioventricular block is an ill-defined entity, previously described in sporadic cases in association with vasovagal reaction, coronary angiography and distal conduction disease. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative. We present a case of paroxysmal atrioventricular block at monitor in a 44-year-old Italian man with right coronary artery stenosis and without acute myocardial infarction.

The obesity paradox and myocardial infarct size.

Objective: Obese subjects have a risk of death from cardiovascular disease higher than those with normal body weight. Obese patients, however, have a better outcome when undergoing coronary revascularisation, and when suffering from heart failure or chronic kidney disease. The term 'obesity paradox' underlines the divergence between increased risk and better outcome in sick obese patients.

Conduction disturbances and paroxysmal atrial fibrillation during acute inferior myocardial infarction.

Associated symptoms and conduction disturbances are reported during acute inferior myocardial infarction. Differentiation of right coronary artery from left circumflex artery occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction. Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction and the patients with paroxysmal atrial fibrillation probably should be targeted for earlier and more aggressive treatment.

Echocardiographic diagnosis of syndrome of left ventricular-right atrial shunt (Gerbode defect).

Left ventricular-to-right atrial communications are rare types of ventricular septal defect known collectively as the Gerbode defect. These defects are usually congenital and they have also been reported after bacterial endocarditis and after acute myocardial infarction. Echocardiography is the most useful diagnostic method.

Comprehensive recognition of double-site dynamic obstruction in hypertrophic cardiomyopathy by cardiac magnetic resonance and Doppler echocardiography.

The noninvasive assessment of the mechanisms that lead to left ventricular outflow obstruction in hypertrophic cardiomyopathy allows the correct clinical management and the most suitable medical or surgical treatment for these patients. We report the case of a male patient affected by hypertrophic obstructive cardiomyopathy, where an uncommon variety of double-site dynamic obstruction was recognized by an integrated evaluation with high-resolution Doppler echocardiography and cardiac magnetic resonance.

QT interval prolongation and torsade de pointes.

Torsade de pointes is a form of polymorphic ventricular tachycardia occurring in a setting of prolonged QT interval on surface electrocardiogram. Several drugs have been shown to prolong cardiac repolarization predisposing to torsade de pointes ventricular tachycardia. We present a case of torsade de pointes in a 72-year-old Italian woman in treatment with sotalol, sertraline, digoxin and acenocumarine.

Revelation of left atrial myxoma during acute myocardial infarction.

Primary tumors of the heart are rare. The majority of these tumors are benign, with myxomas located in the left atrium being the most common form. Almost all malignant tumors are sarcomas and occur preferentially in the right side of the heart.

Non compaction cardiomyopathy and Antiphospholipid syndrome: a catastrophic thromboembolic association.

We described a massive non compaction cardiomyopathy associated with Antiphospholipid syndrome in a 53-year-old male with many episodes of ischemic cerebral stroke complicated by functional disability, cognitive decline and vascular dementia. In our case, the association of massive non compaction cardiomyopathy and severe left ventricular dysfunction added to Antiphospholipid syndrome has showed a dramatic thromboembolic manifestation.

Atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block.

Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ecg shows an LBBB with changing QRS morphology and changing axis deviation. We describe a case of atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block in an 84-year-old Italian woman in the Cardiology Unit.

Q-wave prediction of myocardial infarct location, size and transmural extent at magnetic resonance imaging.

Objective: We investigated how pathologic Q waves or equivalents predict location, size and transmural extent of myocardial infarction (MI).

Methods: MI characteristics, detected by contrast-enhanced magnetic resonance imaging, were compared with 12-lead electrocardiogram in 79 patients with previous first MI.

Results: Q waves involved only the anterior leads (V1-V4) in 13 patients: in all patients MI involved the anterior and anteroseptal walls and apex; 81% of scar tissue was within these regions.

Statistical characterization of sicilian olive oils from the Peloritana and Maghrebian zones according to the fatty acid profile.

This paper deals with the characterization of 475 Sicilian virgin olive oils (VOO) produced in 10 different crop years (from 1993 to 2004), according to the cultivar and the geographical origin by means of multivariate statistical analysis applied to fatty acids. In particular, the studied VOOs came from the Peloritana and Maghrebian geological zones. The fatty acid composition was determined by using the official gas chromatographic method.

Relation of pain-to-balloon time and myocardial infarct size in patients transferred for primary percutaneous coronary intervention.

The paradigm of a shorter pain-to-balloon time decreasing extent of infarct size may be not completely true in transferred patients. This study evaluated the influence of pain-to-balloon time on infarct size as assessed by delayed enhancement magnetic resonance imaging in patients transferred from a peripheral hospital to a tertiary center for primary coronary angioplasty (percutaneous coronary intervention [PCI]). Sixty patients (40 men, 64 +/- 3 years of age) with first acute myocardial infarction were treated within <168, 168 to 222, 223 to 300, and >300 minutes.

The role of fouling mechanisms in a membrane bioreactor.

The present study has aimed to quantify the role of pore blocking and cake layer in a laboratory scale hollow fibre membrane module in submerged configuration, The membrane reactor (MBR) was fed with raw wastewater, only screened with a 2-mm sieve, collected from the Palermo WWTP. The MBR was characterised by an operating volume of 190 L and equipped with an aeration system located on the bottom of the reactor. The MBR operated for 65 days.

Performances of a granular sequencing batch reactor (GSBR).

Aerobic granulation in sequencing batch reactors is widely reported in literature and in particular in SBAR (Sequencing batch airlift reactor) configuration, due to the high localised hydrodynamic shear forces that occur in this type of configuration. The aim of this work was to observe the phenomenon of the aerobic granulation and to confirm the excellent removal efficiencies that can be achieved with this technology. In order to do that, a laboratory-scale plant, inoculated with activated sludge collected from a conventional WWTP, was operated for 64 days: 42 days as a SBAR and 22 days as a SBBC (sequencing batch bubble column).

Strain Doppler echocardiography can identify longitudinal myocardial dysfunction derived from edema in acute myocarditis.

Usually, during acute phase of focal myocarditis, edema is located in the epicardial layer of the ventricular wall and it can't be associated with clear evidence of wall motion abnormalities on echocardiography. Among many cardiac imaging techniques, only cardiac magnetic resonance (CMR) and computer tomography permit a direct detection of edema during acute myocarditis. We report a case where strain Doppler echocardiography was able to identify longitudinal segmental myocardial dysfunction derived from edema in acute phase of myocarditis.

Intramuscular hemangioma: recurrence risk related to surgical margins.

The best treatment for intramuscular hemangiomas is unclear in part because the outcome is variable, with recurrence rates ranging from 18% to 61%. This variance is due to deficiencies in previous reports such as an inadequate population size, lack of life table analyses, lack of uniform pathologic criteria, and loose or absent definition of surgical margins. Our goal was to address these deficiencies and support or refute previous results.

Atrial fibrillation with left bundle branch block and intermittent right axis deviation during acute myocardial infarction.

Rarely the ECG shows an LBBB with changing QRS morphology and changing axis deviation. The intermittent positive aspect of the neglected lead aVR indicates an intermittent right axis deviation in the presence of complete LBBB. An additional left posterior fascicular block accompanying predivisional LBBB is the possible explanation.

Pharmacological washout for the correct evaluation of the head-up tilt testing.

Head-up tilt testing is an important tool in the diagnosis of syncope. Several different protocols are in use. We describe the case of a 70-year-old Italian woman admitted to our observation.