bluuebunny/crossref_metadata_2025_split huggingface dataset:
STELLATE GANGLION BLOCK: CLINICAL MONITORING AFTER INJECTION
Authors: Giuranna M , Freschini M , Notaristefano F , Barengo A , D‘Ammando M , Del Papa M , Zingarini G , Russo G 
Published: May 2024

Abstract

70–year–old man with chronic coronaric syndrome (CABG x 6 in 2006) and HFrEF. ICD implant in primary prevention in 2011. He was admitted for arrhythmic storms refractory to IV lidocaine therapy. Following sedation with midazolam, a left stellate ganglion block was performed using the ultrasound–guided lateral approach, injecting 200 mg of Lidocaine and 200 mg of Mepivacaine. After a few minutes, there was the appearance of anisocoria, different thermotouch in the upper limbs, ptosis, dysphonia, as an effect of local anesthetics on the sympathetic nervous system fibers and on the recurrent laryngeal nerve, near the stellate ganglion. At the same time, the arrhythmias did not recur. Among the rare complications described in the literature (usually transient) arising after stellate ganglion block for the treatment of various chronic pain syndromes or refractory ventricular arrhythmias, we find: hoarseness, stridor, confusion, cough, severe hypertension, subdural/intrathecal block with respiratory arrest, loss of consciousness and paralysis of the four limbs, epileptic seizures, transient locked–in syndrome, headache, visual hallucinations, myoclonus, Horner‘s syndrome, diaphragmatic palsy (phrenic nerve injury), allergic reactions, bleeding and hematoma formation, dural puncture, pneumothorax, local infections. Serious adverse effects described include cases of death or tetraplegia following epidural abscess. For this reason, it is of utmost importance monitoring after the procedure and the availability of the equipment necessary for a possible resuscitation to avoid long–term of sequelae.

Conclusion
In cases of arrhythmic storm refractory to antiarrhythmic therapy, percutaneous stellate ganglion block is an effective and safe procedure and serious complications are rare.
THE CONUNDRUM OF DRUG INTERACTIONS AND HOLTER MONITORING: LAMIN GENE MUTATION DISCOVERED BY A TORSADE DE POINTES EPISODE FOLLOWED BY OUT–OF–THE–HOSPITAL RESUSCITATION
Authors: Malavasi M , Notarianni G , Pontillo D , Luciani M , Petrungaro M , Zampi G , Sommariva L 
Published: May 2024

Abstract
The prolongation of the QTc interval on the electrocardiogram is known to be associated with an increased risk of developing life–threatening ventricular arrhythmias such as torsades de pointes (TdP). QTc values exceeding 500 ms can double or even triple the risk of TdP. Many drugs, including amiodarone and some SSRI antidepressants like paroxetine, can prolong the QTc interval. A 57–year–old patient experienced cardiac arrest during an overnight Holter recording prescribed to exclude brady–tachy syndrome in the presence of persistent atrial fibrillation. ECG ambulatory monitoring revealed significant bradycardia with the onset of idioventricular rhythm, followed by TdP triggered by premature ventricular contractions, subsequently degenerating into ventricular fibrillation. The patient was resuscitated by family members and later by emergency medical personnel using 3 DC shocks, leading to the restoration of spontaneous circulation. The patient was transferred to the cardiology intensive care unit where a coronary angiography showed normal results. Blood tests indicated low potassium levels (3.3 mEq/L), with a moderately reduced left ventricular ejection fraction at 45%. The patient was discharged after ICD implantation and during the diagnostic follow–up the genetic testings for long QT syndrome were negative, but showed a mutation of the LMNA lamin A/C gene. During the two months previous to hospital admission, the patient had complained of fatigue in the presence of atrial fibrillation with a low ventricular response. Nonetheless, she had been prescribed oral amiodarone to optimize the chances of successful electrical cardioversion, in combination with paroxetine that the patient was already taking at home. The combination of these two drugs and the patient‘s idiopathic bradycardia contributed to a marked prolongation of the QT interval, leading to TdP degenerated into ventricular fibrillation. This case, notable for the prolonged recording of ventricular fibrillation and subsequent resuscitation chest compressions during a Holter monitoring, suggests caution in the use of antiarrhythmic drugs unless strongly indicated in the presence of potentially ominous drug interactions. It is encouraging to note how the widespread adoption of cardiopulmonary resuscitation culture has enabled individuals who might not have otherwise received medical attention to be effectively resuscitated.
BIOCLINICAL, PSYCHO–SOCIAL–RELATIONAL AND NURSING–SENSITIVE OUTCOMES (NSOS) IN CARING FOR PATIENTS WITH ACUTE CORONARY SYNDROME
Authors: Danesi S , Simonetti M , Candelori L 
Published: May 2024

Abstract
Patients with ACS represent a highly complex situation that requires management using a multidisciplinary approach. Nursing plays a crucial role in the evaluation, monitoring, intervention planning and educational process to achieve optimal results for the pre–established objectives. One important aspect is analysing and measuring care performance, i.e. outcome indicators that reflect the quality of care. The objective of this study was to monitor nursing–sensitive outcomes (NSOs) to enable critical areas to be identified, care improvement to be implemented, and patient health needs to be adequately met. The study was organised as a retrospective observational review of data extracted from electronic medical records (eMRs) on total admissions to the Hospital‘ s Coronary Intensive Care Unit (CICU) in 2023. A validated checklist was used to study the following elements: bioclinical aspects, pain scale, fall risk, pressure ulcer risk, degree of autonomy, and tromboembolic and haemorrhagic index. The following psyco–social–relational variables were collected: level of education, loneliness index, and counselling and health education activities. Total admissions were 652, with 7 beds, an average stay of 2.79 cases, a bed turnover rate of 88.86, cardiac markers at 100%, NPRS assessed at 96%, Conley scale at 91%, Braden scale at 90%, Barthel index at 93%, CHA2DS2–VASc score of 95%, and Killip classification and GRACE score of 92%. The level of education was 45%, and the loneliness index was found to be 12% in patients aged &gt;85 years. Counselling was recorded in 50% of cases, and the educational aspect involved 62%. The clinical audit enabled assessment of the appropriateness of the care processes, the identification of critical issues and missed nursing care, as well as aspects which need to be improved through clinical governance with structured briefings.
LONG–TERM OUTCOME OF MITRAL VALVE REPAIR WITH TAILOR–MADE POSTERIOR FLEXIBLE BAND
Authors: Olivieri G , De Chiara B , Settepani F , Abrami G , Biolcati M , Grieco M , Moreo A , Russo C 
Published: May 2024

Abstract

Background and Aim
Mitral valve repair commonly involves the fixation of the annulus to restore optimal diameters. In specific features (normal LV and annulus dimensions), the implementation of posterior rings reduce recurrent MR, avoiding possible systolic anterior motion development. Aim of our study was to evaluate the long–term outcome of patients undergoing mitral repair with a tailor–made posterior band.

Methods
Retrospective and prospective single centre analysis. Inclusion criteria: age &gt; 18 years; mitral valve repair with posterior leaflet resection and implantation of posterior flexible band; surgery from 2003 to 2021. End–points: freedom from mitral valve re–operation, freedom from recurrence of mitral regurgitation grade &gt; II and overall survival at follow–up. Data obtained from regional database, clinical outpatient assessments and phone calls. Institutional ethical committee board approval.

Results
289 patients, 109 females (37.7%), were included. Median age was 64 years (IQR 56–71). Sternotomy was the preferred surgical approach (225 pts, 77.8%) while 64 patients underwent mini–thoracotomy (22.1%). 74 (25.6%) patients required combined procedures: CABG, PFO closure and LAA exclusion were the most popular with 21, 20, and 18 cases respectively (6.3, 6 and 5.4%). In–hospital mortality was 0.01% (3 patients). Major post–operative complications (AKI, prolonged ventilation, major injection, severe bleeding, stroke) occurred in less than 5% of the patients. Median follow–up is 11.1 years (IQR 4.7–15.2). Freedom from re–operation is 98.6±0.7%, 97.3.±1.2% and 77.7±8.5% after 1, 10 and 18 years, respectively. Freedom from recurrence of MR grade &gt; II is 98.5.±0.7%, 95.7.±1.5% and 83.8±4.6% at 1, 10 and 18 years, respectively. Overall survival at follow–up is 97.5±0.9%, 83.1.±2.7% and 55.6±8.7% at 1, 10 and 18 years, respectively.

Conclusion
In our experience mitral valve repair with tailor–made posterior flexible band is a safe and reproducible surgical technique, both isolated or as a combined procedure. Outcomes are positive and encouraging with a satisfactory low rate of re–operation and recurrent mitral regurgitation grade II or more at long–term follow–up. Data of a larger population are required to confirm the positive results of our single centre study.
EXPLORING THE 12 LEAD ECG CHARACTERISTIC OF PAEDIATRIC AND YOUNG ADULT CARRIERS OF DESMOPLAKIN GENE VARIANTS
Authors: Montuoro S , Imperatore G , Moscatelli S , Field E , Kaski J 
Published: May 2024

Abstract

Background and Aim
The DSP gene (locus. 6p24.3) encodes desmoplakin, a quintessential desmosomal protein for cellular adhesion, particularly within cardiac tissues. DSP gene variants can cause dilated cardiomyopathy, non–dilated left ventricular cardiomyopathy (NDLVC) and arrhythmogenic righ ventricular cardiomyopathy (ARVC), cardiac conditions known to trigger malignant ventricular arrhythmias and cause sudden cardiac death in young individuals. Nevertheless, the electrocardiographic (ECG) patterns in children carrying DSP variants are underexplored.

Methods
A retrospective analysis was conducted involving paediatric DSP gene variant carriers (&lt;/=18 years), followed at Great Ormond Street Hospital from 2006 to 2023. Their 12–lead ECGs were characterised and compared with those of an age and gender–matched healthy control group (χ2, p–value&lt;0.05).

Results
25 DSP carriers (64% females; 12.6±4 years) were identified [including 4 (16%) with an overt cardiomyopathy phenotype] and compared to 25 healthy matched controls (12.7±4.3years). Compared to the control group, DSP carriers exhibited a higher prevalence of low QRS voltages (72% vs 44%, p= 0.041), QRS notching (72% vs 26%, p= 0,014) and flattened T waves (72% vs 52%, p= 0,026). All 4 patients with an overt cardiomyopathy phenotype had widespread low QRS voltages and QRS fractionation, as well as flattened/inverted T waves, particularly in the inferior and lateral leads.

Conclusion
Predominant ECG features observed in paediatric patients with DSP gene variants included low QRS voltages, QRS notching, and flat or inverted T waves. Our findings suggest that ECG features may precede the development of an overt cardiomyopathy phenotype in children with DSP variants, but further studies with larger cohorts are needed to confirm this and to determine their prognostic significance.
BRUGADA SYNDROME: NEWEST DATA ON RISK STRATIFICATION
Authors: Massara M , Casella M , Dello Russo A 
Published: May 2024

Abstract

Background
Brugada Syndrome (BrS) is a rare genetically based channelopathy responsible for malignant arrhythmias and sudden cardiac death (SCD) in young adults.

Objectives
The aims was to evaluate prognostic indicators useful for accurate arrhythmic risk stratification in BrS by studying genetic, clinical, anamnestic, instrumental parameters, and those derived from electrophysiological study (EPS) and intracavitary mapping.

Materials and Methods
209 patients with Brugada type 1 were recruited between 01/01/2018 and 01/10/2023.

Results
In the first study, predictive factors related to high arrhythmic risk from the data obtained for the total population of 209 Brugada patients enrolled in our case series include a positive history of cardiogenic syncope (p value 0.000041), having had a resuscitated cardiac arrest (p value 0.00025), presenting positive EPS for inducibility of ventricular tachycardia (p value 0.00032), having a family history of sudden cardiac death (p value &lt; 0.00001), and presenting positive cardiac mapping and MRI for pathological alterations (both with p value &gt; 0.00001). From the data obtained for the subset of 80 Brugada patients with ICD in our case series, predictive factors related to high arrhythmic risk are different from the previously analyzed population: presenting spontaneous type 1 ECG (p value 0.0015), having had a resuscitated cardiac arrest (p value 0.014028), having a family history of sudden cardiac death (p value &lt; 0.00001), and presenting positive mapping, genetics, and cardiac MRI for pathological alterations. Positive EPS and syncope in this subset do not appear to be risk factors, unlike the population of all 209 enrolled patients.

Conclusions
Multiparametric scores, including the mentioned markers, have been introduced in clinical practice for a better approach in selection. However, new markers are needed to improve risk stratification in BrS patients, especially those in the so–called "gray zone" with intermediate risk. In the future, it will be evaluated through experimental models and genotype–phenotype integration whether such electrical heterogeneity is also associated with specific genetic or structural abnormalities and may represent a new therapeutic target for etiological treatment in BrS patients. In conclusion, there is an urgent need to develop new methods for risk stratification in Brugada syndrome that are sufficiently sensitive, specific, reproducible, and easy to apply.
MYOCARDIAL AND PERICARDIAL DISEASES INCIDENCE IN COVID
Authors: Fazio G 
Published: May 2024

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), also referred to as COVID–19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID–19 are widely variable and range from asymptomatic infection to multi–organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID–19 infection. The guidelines for the diagnosis of COVID–19 introduced the echocardiogram for diagnosis of carditis in these patients.

Purpose
In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonostic certification that performed echocardiogram, and subdivided the incidence of carditis depend on the period and the possible subtype of the covid (alpha, beta, gamma, delta, epsilon).

Methods
From March 2020 to October 2022 we enrolled in this epidemiological evaluation 1540 patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centres on the major islands to perform a return to play agonist certificate. Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12–67 years). None presented a risk factor of a cardiac disease.

Results
The incidence of Echocardiographic abnormality was 3,2% in our population The kind and the incidence of alteration was showed in table 1, and consist in dilated cardiomiopathy (0,4%), regional cinetic dysfunction (0,4%), pericardial effusion (1,9%), aspecific alterations (0,2%). Based on the period we evaluated the incidence of the echocardiographic alterations during the seasons and in corralation of variant of COVID . The results was showed in figure 1.

Conclusions
Based on our evalution the incidence of echocardiographic findings in COVID was 3,2% in all period, with a progressive reduction long the time, from alpha variant to epsilon variant.
EFFECTIVENESS AND SAFETY OF HALF–DOSE THROMBOLYSIS IN INTERMEDIATE–HIGH RISK PULMONARY EMBOLISM: A RETROSPECTIVE, SINGLE CENTER EXPERIENCE
Authors: Zagarese G , Santori V , Giatti S , Marcantoni L , Maddalozzo A , Pastore G , Valenza S , Bertola S , Ribichini F , Zanon F , Picariello C 
Published: May 2024

Abstract

Background
Current guidelines recommend full–dose systemic thrombolysis for acute pulmonary embolism (PE) in high–risk or hemodynamically unstable intermediate–high risk (IHR– PE) patients. Recent trials suggest that a low, half dose (50 mg) of tissue plasminogen activator (HDrtPA) could be a safe, effective alternative with low bleeding risk. We aimed to evaluate whether HDrtPA in IHR–PE could improve right heart function echocardiographic parameters and NT–proBNP levels at discharge, in comparison to unfractionated heparin (UFH) alone.

Methods
We retrospectively analyzed ninety IHR–PE consecutively admitted to our Intensive Cardiac Care Unit between January 2016 and May 2023. HDrtPA patients (Group A, n=28) received low–dose thrombolytic therapy (0,6 mg/kg, max. 50 mg in 1 hour) plus UFH. Group B included patients were treated with UFH alone. Primary endpoint was an improvement between admission and discharge of tricuspid annular plane systolic excursion (TAPSE), tricuspid velocity (TV), RV– arterial coupling (TAPSE/PASP or pulmonary artery systolic pressure), basal right ventricle diameter (RVD), and NT–proBNP levels. Secondary endpoint involved assessing the occurrence of mortality and bleeding events. Linear regression models were used with Inverse Probability Weighting propensity scores. Due to the low occurrence of death events, this endpoint was investigated only through descriptive statistics.

Results
Mean age was 73.48 ± 12.49 (mean ± Sd) and n=43 (47.8%) were males (table 1). Group A had improvement of TAPSE/PASP (+0.16, p=0.006, CI 95%: 0.06; 0.27), RVD (–6 mm, p=0.001, CI 95%: –8.61; –3.58), TAPSE (+2.6 mm, p=0.003, CI 95%: 0.77; 4.49) and TV values (–0.46 m/s, p=0.018, CI 95%: –0.8; 0.09), while the decrease in NT–proBNP values (–2048 pg/ml) did not achieve statistical significance (p=0.382, CI 95%: –7101.17; 2413.45). No significant increase in major bleedings was observed between groups (Group A: 3.5%, Group B: 0%) with an acceptable number of minor bleedings (Group A: 25%, Group B: 1.6%). Death occurred in 3 patients in group A (10%) and 1 patient in group B (1.6% – table 2).

Conclusions
In selected IHR–PE patients, administration of HDrtPA seems to improve right ventricular function, dimensions and RV–arterial coupling in comparison to UFH alone, with an acceptable bleeding and mortality risk. These results should be confirmed in randomized, prospective trials to allow HDrtPA to be fully included in future guidelines.
CARDIOVASCULAR CONSIDERATIONS IN ANTIDEPRESSANT THERAPY: SINUS ARREST DUE TO SERTRALINE
Authors: Scollo C , Rossi D , D‘Andria R , Magnano R , Pezzi L , D‘Alleva A , Genovesi E , Verrengia E , Duronio G , Forlani D , Vitulli P , Gallina S , Paloscia L , Di Marco M 
Published: May 2024

Abstract
A 39–year–old Caucasian woman with a silent cardiac anamnesis and no family history of cardiovascular diseases, and a history of mood disorder treated with Sertraline for about 1 month, went to the Emergency Department reporting several syncopal episode, all with rapid and complete recovery of consciousness. In the Emergency Department, another syncopal episode occurred in the supine position, characterized by sinus bradycardia evolving into a brief asystole, with spontaneous restoration of normal sinus rhythm. Admitted to the Cardiovascular Intensive Care Unit, the patient showed no abnormalities in laboratory testsas well as in echocardiography results. The patient received appropriate hydration, and home medication was discontinued. A non–contrast head CT scan showed no acute lesions. Cardiac MR revealed normal morpho–functional findings, with no evidence of myocardial edema or pericardial effusion and no pathological late gadolinium enhancement areas. Brain MRI demonstrated normal anatomical and functional findings, with no signal abnormalities. Considering the patient‘s young age and the suspicion of an iatrogenic origin of the rhythm disorder, the decision to postpone pacemaker implantation was made, and cardiac electrical activity was monitored using a loop recorder. At the one–month follow–up, the patient, who had been off Sertraline since admission, was in good health, reporting no further syncopal or pre–syncopal episodes. Loop recorder monitoring revealed no significant arrhythmias. The only relevant anamnestic data was the use of Sertraline, and the application of the Adverse Drug Reaction Probability Scale suggests that the iatrogenic origin of this event as a pharmacological adverse effect is at least probable (score: 7). Limited literature connects Sertraline directly to documented cases of asystole, but reports indicate that drugs in the same pharmacological class may induce cardiac rhythm disturbances, including tachyarrhythmias and bradyarrhythmias. This case draws attention to sinus arrest during sertraline therapy and how an appropriate pharmacological washout led to the resolution of the pathology.
A CASE REPORT OF HEART FAILURE WITH IMPAIRED EJECTION FRACTION DUE TO DILATED CARDIOMYOPATHY IN A YOUNG PATIENT
Authors: Minichiello S , Bianchino G , Botticella F , Di Gianni A , Dragonetti C , Foffa A , Gualdiero P , Lo Conte C , Manganelli G , Pellecchia V , Ambrosini V 
Published: May 2024

Abstract
A 30–year–old female, with no prior history of heart disease sought medical treatment for increasing shortness of breath, oedema in the lower limbs, abdominal enlargement from seven days. She had was adopted, was a smoker, no use of illicit drugs. Her heart rate was 90 per minute, she had bilateral pitting oedema to mid–shin, her blood pressure was 100/70mm Hg, there were no signs of jugular venous hypertension, the pulmonary and cardiac auscultations were normal. She had ascites and her liver was palpable 3cm below the right costal margin. Her ECG had shown sinus rhythm, heart rate of 92bm, PR interval of 160ms, left bundle branch block (QRS duration of 130ms). Her echocardiogram showed severe global left ventricular dysfunction with left ventricular (LV) ejection fraction (EF) 18% using the apical biplane Simpson’s rule, GLS WAS –4.3%, her right ventricle was dilated and impaired (TAPSE 1,6cm). Her BNP was 2393,90pg/ml. To exclude coronary artery disease, especially congenital coronary artery disease a coronary CT angiography (CTA) was performed. The coronary CTA scan showed normal findings. Cardiac MRI showed severe impairment of both left and right ventricular systolic function with a pattern of gadolinium enhancement negative for necrosis or fibrosis. The patient, after being initially treated with large doses of diuretics and levosimendan, was promptly treated with sacubitril valsartan, empaglifozin, bisoprolol, spironolactone plus vericiguat with rapid titration to maximal tolerated dose. About 1 week later her symptoms began to subside and the patient was discharged in a stable condition. She was referred for consideration of cardiac transplantation and cardiac resynchronisation therapy defibrillator; blood samples for genetic pathology research were taken. A program of serial echocardiograms was introduced, every 30 days, and was observed after 2 months. At follow up our patient had an impressive improvement in terms of improved quality of life, NYHA functional class (from III to I), and performance capacity. A new echocardiographic assessment had shown an LVEF of42% with GLS of–12%. Conclusions: Four pillars of heart failure therapy and vericiguat addiction with rapid titration represents a safe and effective strategy for the treatment of cardiac decompensation with reduced FE. Basal / 60 day EF % 18 /42 GLS % –4.3/ –12.0 E/A 5 /2,1 BNP pg/ml 2393.90 / 889.90 TAPSE cm/s 1.6 / 2.1