Long-term outcome in symptomatic carotid sinus hypersensitivity.

Between 1982 and 1988, we observed 312 patients who were affected by syncope or presyncope and whose spontaneous symptoms could be reproduced by means of carotid sinus massage (CSH); no other definite cause of syncope could be identified. The clinical outcome during a 2- to 8-year follow-up period (mean 44 +/- 24 months) was assessed in 262 of them (mean age, 71 +/- 11 years; 183 men) and was compared with that of a group of 55 patients who were affected by unexplained syncope (control patients) who were matched 4:1 for age and sex with CSH patients. CSH patients had an overall mortality rate of 7.

Carotid sinus massage, eyeball compression, and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects.

To verify the role of abnormal neural mechanisms in unexplained syncopes, we evaluated the results of carotid sinus massage (CSM), eyeball compression (EBC), and head-up tilt test (HUT) in the basal state (B) and during isoproterenol infusion (ISO) in: (1) 100 consecutive patients affected by syncope which, despite careful cardiovascular and neurologic examination, was of uncertain origin (age 60 +/- 18 years; 54 men) and (2) 25 healthy subjects matched 4:1 with the patients of the previous group. All the patients underwent CSM and EBC in the supine and standing position for 10 seconds and HUT at 60 degrees for 60 minutes; if HUT-B was negative (68 cases), it was repeated during ISO (1 to 5 micrograms/min) infusion. In the patients with uncertain syncope, spontaneous symptoms were fully reproduced in 49%, 16%, 32%, and 16% of cases respectively by means of CSM, EBC, HUT, and HUT-ISO; overall positivity for at least one test was observed in 79% of cases.

Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome.

It is generally accepted that a positive response to carotid sinus massage (CSM) or head-up tilt (HUT) in patients affected by syncope suggests a reflex cause of the syncope. To study the role of the autonomic nervous system in causing syncope in the sick sinus syndrome (SSS), CSM and HUT were performed in 35 consecutive patients (20 men, mean age 70 +/- 9 years) with syncope and SSS. Results were compared with those in 35 patients affected by syncope that, despite careful cardiovascular and neurologic examination, were of uncertain origin (21 men; mean age 68 +/- 9 years) and with those of 35 subjects without syncope (20 men; mean age 69 +/- 10).

A comparison of metoprolol OROS with antenolol in the treatment of effort angina pectoris: a randomized double-blind study.

The antianginal efficacy of metoprolol OROS has been investigated in comparison with that of atenolol in a multicenter double-blind cross-over trial carried out in patients with stable effort angina. OROS (ORally OSmotic) is a new semi-permeable delivery system with very slow osmotic release of the active drug, which is maintained at virtually constant plasma levels throughout the 24 hours. At the end of a 2-week run-in period, 53 patients with chronic coronary artery disease and documented ischemia during bicycleergometric exercise test were given, on double-blind condition, metoprolol OROS 21/285 and atenolol 100 mg in random order for 4 weeks each.

Validation of a method for choice of pacing mode in carotid sinus syndrome with or without sinus bradycardia.

A new method for selection of the pacing mode in 60 consecutive patients with severe cardioinhibitory or mixed carotid sinus syndrome was prospectively validated. DDD pacing was preferred for 26 patients with: (1) the cardioinhibitory form and who had symptomatic pacemaker effect; (2) mixed type I form, (cardioinhibitory and vasodepressor) with symptomatic pacemaker effect, ventriculoatrial conduction or orthostatic hypotension; (3) mixed type II; or (4) severe bradycardia. VVI pacing was selected in the remaining 34 patients without these symptoms.

Pacing for carotid sinus syndrome and sick sinus syndrome.

The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia less than 50 beats/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS).

[Carotid sinus syndrome and sick sinus syndrome: 2 frequent and distinct indications for pacemaker implantation].

Unlabelled: At present, patients affected by carotid sinus syndrome and, more general by speaking, by vasovagal syncopes, are being considered more and more for pacemaker implant. However, neither the real incidence of the carotid sinus syndrome or its relation with the sick sinus syndrome with which it is often associated or even confused is precisely known. Of a total of 298 consecutive pacemaker implants, 36 (12%) were executed for carotid sinus syndrome, 33 (11%) for sick sinus syndrome and 24 (8%) for both.

[The choice of stimulation mode in patients with cardioinhibitory or mixed carotid sinus hypersensitivity, with or without associated sinus dysfunction].

In this prospective study, we evaluated pacing therapy in 60 consecutive patients affected by syncopes or pre-syncopes and cardioinhibitory or mixed carotid sinus hypersensitivity. We preferred DDD/DVI pacing for the 26 patients who had: 1) the cardioinhibitory form and presence of symptomatic pacemaker effect, or 2) the mixed type I form and presence of symptomatic pacemaker effect, ventriculo-atrial conduction, or orthostatic hypotension, or 3) the mixed type II form, or 4) the presence of severe sinus bradycardia. We preferred VVI mode in the other 34 patients.

Hemodynamic changes during acetate dialysis, bicarbonate dialysis and hemofiltration.

Twenty uremic patients submitted to three different dialytic procedures (6 patients to acetate dialysis, 8 patients to bicarbonate dialysis, 6 patients to hemofiltration) were monitored in respect to the hemodynamic parameters recorded with a thermistor Swan-Ganz catheter. During acetate dialysis there was an increment of cardiac index (CI) up to positive values (+4.8%), while resistance index (RI) decreased progressively until it reached -16.

Biofiltration in chronic uremia: evaluation of long-term efficiency and hemodynamic tolerance with Swan-Ganz catheter.

Biochemical data and clinical tolerance were evaluated in eight uremic patients treated by Biofiltration (BF) for 5-20 months. In four patients hemodynamic parameters were monitored with a Swan-Ganz catheter during a session of BF. BF provides long-term biochemical safety and improved tolerance to fluid removal.

Effects of two doses of the fixed-combination chlorthalidone and slow-release metoprolol on blood pressure at rest and during exercise: a multicenter study.

To assess the efficacy and tolerability of two doses of chlorthalidone (CHL) and slow-release (SR) metoprolol (MET) given in fixed combination (standard dose: CHL 25 mg and MET 200 mg; lower dose: CHL 12.5 mg and MET 100 mg), a multicenter (5 Centers), double-blind, between-patients study was planned. Seventy-three mild to moderate hypertensive patients, 45 males and 28 females, aged 25-68 years (mean 51.

[Cardioinhibitory carotid sinus hypersensitivity in subjects with symptomatic sinus dysfunction].

Cardioinhibitory carotid sinus hypersensitivity is present in about one third of patients affected by sinus dysfunction. Aim of the study was to evaluate whether carotid sinus hypersensitivity is related to a well defined (intrinsic or extrinsic) sinus node damage. Fifty-four patients with ecg signs of sinus dysfunction underwent an electrophysiological study and carotid sinus massage.

[Intermittent atrio-ventricular block induced by exertion. Description of 3 cases].

Three patients with 1:1 atrio-ventricular conduction at rest developed fixed 2nd or 3rd degree atrio-ventricular block during exercise testing. In all patients electrophysiologic study documented block distal to the atrioventricular node. The exercise induced block probably occurred because of increased atrial rate and abnormal refractoriness of the His-Purkinje conduction system.

[Association of the carotid sinus syndrome and orthostatic hypotension. Another potential cause of the failure of VVI electrostimulation].

The systolic blood pressure was measured during clinostatism and 15'', 1', 5' after standing in 101 patients with carotid sinus syndrome and in 101 controls matched for age, sex, and prevalence of organic heart disease. In the carotid sinus syndrome group we observed a greater systolic blood pressure reduction from the supine to standing position (20 +/- 19 vs 14 +/- 11 mmHg), a lower orthostatic pressure (111 +/- 23 vs 120 +/- 21 mmHg) and a greater incidence of orthostatic hypotension (defined as a blood pressure reduction greater than or equal to 50 mmHg or greater than or equal to 20 mmHg when orthostatic pressure was lower than 100 mmHg) (35% vs 17%). Twenty-three carotid sinus syndrome patients received a VVI pacemaker for control of their symptoms; after a mean follow-up of 12.

[Cardioinhibitory reflex provoked by stimulation of carotid sinus in normal subjects and those with cardiovascular disease].

The normal range and the reproducibility of the cardioinhibitory carotid sinus reflex were studied in 288 apparently healthy subjects of different ages (aged from 17 to 84 yrs., 156 males, 132 females). In each subject we chose the longest RR interval as an activation index of the reflex obtained by carotid sinus massage; its mean value increased slightly with advancing age.

[Myocardial infarction induced by vincristine in patients with Hodgkin's lymphoma. Description of 2 cases and review of the literature].

Five patients with lymphoma and Vincristine induced myocardial infarction are described in the medical literature. We report two new cases, in whom an anterior myocardial infarction developed few hours after the second administration of the drug. In the reported cases a strict cause-to-effect relationship between the drug and acute myocardial infarction seems indicated by: the striking temporal coincidence between Vincristine administration and onset of chest pain; the additional myocardial infarctions in patients in whom the treatment was continued after the first event; the nearly constant absence of important coronary risk factors and the young age of the patients, making preexisting coronary atherosclerosis unlikely.

[Limitations of the stress test in the diagnosis of the sick sinus syndrome].

Exercise stress test in patients with sick sinus syndrome helps to evaluate the heart rate response to the increased sympathetic and to the decreased parasympathetic discharge. Aim of our study was the assessment of the diagnostic accuracy of exercise stress test in this condition. To do so, we measured the heart rate at peak stress in 18 patients with sick sinus syndrome (16 men and 2 women aged 51-78 years, mean 68).

[Influence of beta block and autonomic nerve block on the recovery time of the sinus node in sick sinus syndrome and carotid sinus syndrome].

In order to evaluate the relative role of the automatic nervus system and of the intrinsic electrophysiologic properties on the sinus node function, we measured the corrected sinus node recovery time before and after autonomic nervous system blockade in 24 patients. Fourteen had a sick sinus syndrome, five had a carotid sinus syncope, two had syncope of unknown origin associated with bradycardia. Beta blockade was obtained by infusing metoprolol intravenously at a dosage of 0.

Systolic time intervals as possible predictors of pressure response to sustained beta-adrenergic blockade in arterial hypertension. A within-patient, placebo-controlled study.

Systolic time intervals (STI) were recorded at rest and during isometric exercise (IHG) in 20 hypertensive outpatients, WHO Stage 1 or 2. In a double-blind crossover study, slow-release metoprolol 200 mg once daily and matched placebo were given for 4 weeks each, at the end of a 2-week placebo washout. Blood pressure and STI were taken in the last day of washout and of either crossover period.