Electrocardiographic pattern combined with echocardiographic wall motion abnormalities in stress related cardiomyopathies: clinical and pathophysiological insights.

We report five cases of stress related cardiomyopathies that occurred in post-menopausal women (age range from 49 to 90) consecutively admitted to our Department in the last year in different clinical settings: typical anginal pain, carotid endarterectomy, pulmonary edema, cardiogenic shock, and severe asthenia. Apical left ventricular involvement was observed in three patients in conjunction with ECG mild ST segment elevation in anterior precordial leads resembling acute anterior myocardial infarction; isolated mid ventricular dysfunction was present in two patients in conjunction with ST segment depression in the anterior precordial leads. The ECG evolved showing T wave inversion in four cases and normalized in one.

Kounis syndrome in a patient with ovarian cancer and allergy to iodinated contrast media: report of a case of vasospastic angina induced by chemotherapy.

We report the case of a 71-year-old woman with previous coronary angioplasty, ovarian cancer with multiple metastases and allergy to iodinated contrast media, who developed vasospastic angina after several treatments with cisplatin and cyclophosphamide, so that we considered this as a case of "allergic angina" or Kounis syndrome (type II variant). The patient underwent standard anti-ischemic therapy with nitrates, calcium blocking agents and enoxaparin so having an uneventful outcome.

Tako-tsubo syndrome: report of a case with mild electrocardiographic changes but with multiple wall motion abnormalities.

We report the case of a 60-year-old woman admitted to our hospital for typical chest pain with only mild ST segment depression in the anterior precordial leads but with left ventricular akinesia of the mid-infero-postero-lateral segments with sparing of the base and of the apical septum. Coronary angiography was normal and the patient was dismissed from our hospital after echocardiographic normalization in spite of persistent ECG repolarization changes. We conclude that echocardiographic examination allows recognition of atypical forms of "tako-tsubo" disease in presence of only subtle and non-specific repolarization changes.

Pulmonary embolism after brain hemorrhage in a hypertensive patient: the therapeutic dilemma.

Massive pulmonary embolism is a life-threatening condition to be treated with anticoagulants or even thrombolytic agents in selected cases. However, these drugs are controindicated after a recent hemorrhagic episode. We report the case of a 46-year-old patient with uncontrolled systemic hypertension who was affected by severe spontaneous cerebral hemorrhage and left hemiparesis.

Is transesophageal echocardiography useful in planning surgery of mediastinal thymomas? Transesophageal investigation of a mediastinal thymoma.

Thymomas are the commonest tumors arising in the anterior mediastinum, sometimes representing an incidental finding at radiological examination. Surgery of these neoplasms must be planned after accurately assessing the invasive or non-invasive nature of the mass. In the present case this could be achieved also by submitting the patient to transesophageal echocardiography which could accurately exclude infiltration of heart walls.