bluuebunny/crossref_metadata_2025_split huggingface dataset:
P299 CONDUCTION DISORDERS AS THE FIRST HALLMARK OF ISOLATED CARDIAC SARCOIDOSIS IN A HIGHLY ACTIVE INDIVIDUAL: A CASE REPORT
Authors: Albani S , Muccioli S , Mabritto B , Scacciatella P , Musumeci G 
Published: May 2022

Abstract
A 45–year–old highly active Caucasian individual was admitted to the emergency department complaining of slightly reduced physical performances: he reported a lack of increase of heart rate beyond 80–100 bpm at fitness tracker monitoring during physical activity during the previous week. He used to train 3–4 times/week. He had no previous medical concerns and he didn’t take any medication. Basal electrocardiogram (ECG) showed 2:1 atrioventricular block (AVB) and left axis deviation, with the exception of his 2:1 AVB, the other features on the ECG are common training related changes. Transthoracic echocardiogram was normal. Treadmill exercise test revealed paroxysmal 2:1 AVB and Mobitz I AVB at peak effort, then first degree AVB and isolated and coupled right infundibular premature ventricular complexes (PVC) in the recovery phase: exercise related AV–conduction improvement suggested supra–nodal AVB. Cardiac magnetic resonance (CMR) imaging reported two areas of late gadolinium enhancement (LGE) with midwall/subepicardial distribution: the first one in the basal anterior septal wall extending to basal anterior wall and the second one involving the basal and medium segment of inferior septum and inferior wall. LGE quantification was 6.0 g/m2 (9.5%). Short tau inversion recovery (STIR) acquisitions were negative for oedema (Figure 1). Subsequent FDG–PET imaging confirmed high uptake in the basal anterior septal wall, the anterior wall and in the basal inferior septal area (Figure 2). No other organ involvement was detected. Considering the FDG–PET, LGE and AV–conduction abnormalities, the patient was clinically diagnosed with symptomatic isolated CS. However, a definitive histologic diagnosis was not possible as no myocardial biopsy was performed. High dose corticosteroid therapy was startedand after few days of treatment ECG monitoring revealed an imrovement of cardiac conduction. The treadmill test was repeated and showed conduction improvement during effort, however the test was suspended due to the occurrence of ventricular couples and ventricular bigeminy during effort. For arrhythmic risk assessment, electrophysiological study (EPS) was performed and no arrhythmias were induced. We decided to defer ICD implantation. However, a loop–recorder for continuous arrhythmias monitoring was implanted. At three months, a new CMR was performed and was identical to the previous one, with no significant LGE reduction or increase detected.
P305 ACUTE MYOPERICARDITIS IN 2021: COVID19 RELATED?
Authors: Pasquero M , Ruffini S , Astegiano M , Franco E , Moretti C 
Published: May 2022

Abstract
The term myopericarditis is used when there are primarily pericarditis symptoms with myocardium involvement as evidenced by cardiac biomarker elevation or imaging studies revealing normal wall motion. We report a case of a young 23–years old man, who presented to the Emergency Department with fever and diarrhea lasting 5 days followed by acute chest pain, modified by trunk position. The electrocardiogram (ECG) showed diffuse inferior and anterolateral ST–segment elevation. No signs of hemodynamic instability were detected. Laboratory tests showed WBC 8840/mmc, CRP 53,2 mg/L, TnT 986 ng/L, a mildly altered liver function with AST 92 UI/L, ALT 88 UI/L, GGT 82 UI/L and an altered pancreatic function with amylase 190 UI/L, lipase 267 UI/L. Naso–pharyngeal swab was negative. The patient received COVID–19 mRNA vaccination 4 months before symptoms, with high immune response, detected with IgG dosage (465 BAU/ml). Ecocardiography showed a left ventricle with normal size, function, and segmental contractility. Valvular apparatus in normal range. Hyper–refraction of the posterior pericardium with minimal effusion. The diagnosis of acute myopericarditis was glaring and we treated the patient with high dosage of non–steroidal anti–inflammatory drugs, colchicine and ACE Inhibitors, based on the increased troponin levels (nadir 1439 nl/L), in order to prevent the possible cardiovascular remodeling. On laboratory testing, the deepening of the main causes of viral or autoimmune myopericarditis did not clarify the etiopathogenesis. No arrhythmias occurred on ECG monitoring. Cardiac MRI showed multiple areas of altered signal (T2) and altered uptake in lateral and inferior ventricular segments and in adjacent pericardium. The pain was gone in two days and left ventricle function was still preserved upon discharge. In conclusion we report a successful treatment of acute myopericarditis of unknown pathogenesis, in a healthy young man. As there are described cases of myopericarditis and myositis associated with COVID–19 in the absence of respiratory symptoms, and others related to SARSCoV2 mRNA vaccination, we dutifully excluded both.
P311 TAKOTSUBO CARDIOMYOPATHY RELATED TO MRNA SARS–COV2 VACCINE
Authors: Ricci G , Citarelli G , De Laura D , Degennaro L , Ligurgo L , Sassara M , Corriero F , Musci S , Desario P , Rutigliano D , Basso P , Parisi G , Buquicchio F , Conca C , Disabato M , Caldarola P 
Published: May 2022

Abstract
54–year–old woman with a family history of systemic sclerosis, with no significant cardiological history. She underwent anti–Covid vaccination in February and March 2021 with Spikevax (Moderna) and a booster dose (Spikevax) on 09/12/21. A few hours after this last administration, the patient presented with palpitations, asthenia, and intermittent chest tightness. In the following days, because of dyspnea for mild exertion, she went to the emergency department. ECG showed low QRS voltages in the peripheral leads, poor septal r wave growth and negative T waves in inferior leads and from V3 to V6. Echocardiography showed akinesia of apical and middle segments, LVEF 40%, mitral obstructive systolic anterior motion, moderate mitral regurgitation and mild pericardial effusion. In blood tests: increase in myocardiospecific enzymes and NTproBNP, modest increase in indices of inflammation. The patient was admitted to Cardiology Unit, where coronary angiography showed coronary arteries free from stenosing lesions and Takotsubo–like appearance on ventriculography. Cardiac MRI confirmed alterations in parietal kinetics, hyperintensity in the STIR sequences referable to apical and middle segments edema compatible with Takotsubo cardiomyopathy (CMT). Capillaroscopy excluded scleroderma pattern. The patient presented a progressive reduction of troponins and, the echocardiogram before discharge showed improved LV systolic function, regression of mitral obstructive systolic anterior motion with reduction of mitral regurgitation. Rare case reports of CMT after influenza vaccination [1] and a similar case to the one we described after Spikevax vaccine [2] and ChAdOx1 nCov–19 (AstraZeneca) [3] have been presented in the literature. The underlying pathophysiological mechanism appears to be related to a stress–induced systemic reaction with a predominantly adrenergic sympatho–vagal imbalance [4]. In this clinical setting, cardiac MRI can offer added value in the diagnostic process, especially to exclude post–vaccine myocarditis, which in our case seemed unlikely given the immediate onset of symptoms.
P313 TAKOTSUBO SYNDROME – FOCAL VARIANT
Authors: Manca F , Cocco D , Pistis L , Serra E , Loi B , Corda M , Pilleri A 
Published: May 2022

Abstract
Takotsubo syndrome (TTS) is a cardiomyopathy induced by physical and/or emotional stress, characterised by transient changes of the regional motion generally extending beyond the territory distribution of one single coronary vessel. The classic form of TTS presents, in 43.7% of cases, with ST segment elevation and in about 80% with cardiac apical ballooning. In 1.5% of TTS cases, however, regional changes in motion are observed which may mimic an acute coronary syndrome. We describe the case of a 77–year–old woman with hypertension and hypercholesterolemia. The patient came to the ER due to polytrauma secondary to an accidental fall. During hospitalisation, the patient complained of a sudden onset of a retrosternal aching chest pain radiating to the back and right shoulder, associated with neurovegetative symptoms. An electrocardiogram showed a normofrequent sinus rhythm and T–negative waves in the infero–lateral region. Upon cardiology consultation, a transthoracic echocardiogram was performed showing a left ventricle with akinesia of the middle and apical segments of the inferolateral wall with compensatory hyperkinesis of the other segments. When an acute coronary syndrome was suspected, urgent coronary imaging was performed, showing coronary arteries without significant stenosis, while ventriculography confirmed the alterations in ventricular motion. Blood chemistry tests showed a phasic increase in myocardial necrosis enzymes and, in particular, in HS troponin values (max value 2714 ng/L). Therapy with an ace–inhibitor and a beta blocker was introduced; seriate echocardiographic controls showed a progressive normalisation of the alterations in motion. A TTS diagnosis was therefore made, according to InterTAK 2018 diagnostic criteria. This case is of particular interest as it is a prime example of a rare variant of TTS: the clinical presentation, the ECG alterations and the regional akinesia may lead to a clinical suspicion of ACS. A good knowledge of the TTS, including the focal variant, enables the cardiologist to make a correct diagnosis and to initiate suitable therapy.
P315 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN A PATIENT WITH TAKAYASU’S ARTERITIS: THE CORONARY VASOSPASM AS A MISSING LINK BETWEEN THE IMMUNE SYSTEM AND ACUTE PSYCHOLOGICAL STRESS
Authors: Mapelli M , Pires I , Amelotti N , Guglielmo M , Conte E , Agostoni P 
Published: May 2022

Abstract

Background
Takayasu’s arteritis (TA) is a systemic inflammatory disease that affects aorta and its major branches. There are several cardiac manifestations of TA and, recently, an association with Takotsubo syndrome (TTS) was reported

Case Presentation
A 58–year–old Caucasian female, with history of severe asymptomatic aortic regurgitation (AR) with a recently documented normal LV systolic function and TA in remission under corticosteroids, was admitted in the emergency department with chest pain following an acute intense stressful event. ECG showed sinus tachycardia, T wave inversion in left precordial and lateral leads, and a QTc of 487 ms (Figure 1). Laboratorial evaluation presented high–sensitivity troponin I of 3494 ng/L and B–type natriuretic peptide of 4759 pg/mL. The transthoracic echocardiogram revealed severe dilation of LV with moderate systolic dysfunction, due to apical and midventricular akinesia (“apical ballooning” pattern), and severe AR (Figure 2). The coronary angiography showed normal coronary arteries. An acetylcholine provocative test showed spasm of both the left anterior descending and circumflex arteries, accompanied by chest pain and ST depression in ECG, reverted after intracoronary nitrates administration (Figure 3). The patient was switched to diltiazem and heart failure drug therapy was started. A cardiac magnetic resonance revealed severe dilation of the LV, apical hypokinesia, ejection fraction to 53%, signs of myocardial edema and increased extracellular volume in apical and mid–ventricular anterior and anterolateral walls, and absence of myocardial late gadolinium enhancement, compatible with TTS. Patient was discharged clinically stable, without signs of HF, with progressive reduction of troponin and BNP. A final diagnosis of myocardial infarction with nonobstructive coronary arteries (MINOCA) due to TTS and coronary vasospasm in a patient with TA was done

Discussion
TA is a rare disease and there are reports of its association both with TTS and coronary vasospasm. Besides that, coronary vasospasm may also be involved in the pathophysiology of TTS. Moreover, in this patient we could not exclude the role coronary diastolic hypoperfusion due to AR in the elicitation of coronary vasospasm. Therefore, although the mechanisms behind these pathologies are not yet fully studied, this case supports their relationship

Conclusion
We presented a case of a patient with TA admitted with MINOCA due to TTS and coronary vasospasm
P318 RIGHT HEART CHANGE IMPACTS ON SURVIVAL IN PATIENTS AFFECTED BY CARDIAC AMYLOIDOSIS: A SINGLE CENTRE STUDY
Authors: Cicco S , Solimando A , Susca N , Inglese G , Melaccio A , De Fazio G , Vacca A , Ria R 
Published: May 2022

Abstract
Amyloidosis is due to deposition of an excessive amount of protein in tissues. Cardiac Amyloidosis (CA) is an inauspicious prognostic factor and leading sudden death. We retrospectively analyzed 135 systemic amyloidosis, admitted between 1981 and 2019. 54 patients (46.30% F, aged 63.95±12.82) presented CA at baseline. In 53 patients, it was associated with a multiorgan involvement, while in one there was a primary myocardial deposition. We compared this group with the 81 patients (49.30% F, aged 58.33±15.65) who did not meet criteria for CA. CA presented a decreased SBP (p = 0.036), while nCA had an increased proteinuria (p = 0.02). TnI and NT–proBNP were significantly increased compared to nCA (p = 0.031 and p = 0.047, respectively). In CA patients we found an increased LDH compared to nCA (p = 0.0011). CA patients were also found to have an increased interventricular septum thickness compared to nCA (p = 0.002), a decreased Ejection Fraction (p = 0.0018) and Doppler velocity E/e’ ratio (p = 0.0095). Moreover, CA patients had an enhanced right atrium area (p = 0.0179), right ventricle basal diameter (p = 0.0112) and wall thickness (p = 0.0471) compared to nCA, and an increased inferior cava vein diameter (p = 0.0495) as well. TAPSE was the method chosen to evaluate systolic function of the right heart. In CA subjects very poor TAPSE levels were found compared to nCA patients (p = 0.0495). Additionally, we found a significant positive correlation between TAPSE and lymphocyte count (r = 0.47; p = 0.031) as well as Gamma globulins (r = 0.43, p = 0.033), Monoclonal components (r = 0.72; p = 0.047) and IgG values (r = 0.62, p = 0.018). CA patients had very poor survival rates compared to controls (30 vs. 66 months, p = 0.15). Mean survival of CA individuals was worse also when stratified according to NT–proBNP levels, using 2500 pg/mL as class boundary (174 vs. 5.5 months, respectively p = 0.013). In much the same way, a decreased right heart systolic function was correlated with a worse prognosis (18.0 months median survival, not reached in subjects with higher values than 18 mm, p = 0.0186). Finally, our data highlight the potential prognostic and predictive value of right heart alterations characterizing amyloidosis, as a novel clinical parameter correlated to increased LDH and immunoglobulins levels. Overall, we confirm the clinical relevance of cardiac involvement suggests that right heart evaluation may be considered as a new marker for clinical risk stratification in patients with amyloidosis.
P321 CASE REPORT AND LITERATURE REVIEW: THE HAPPINESS FOR ITALY’S VICTORY AT THE EUROPEAN SOCCER CHAMPIONSHIPS COSTS AN “HAPPY HEART SYNDROME”
Authors: Fazzini L , Caggiari L , Raffo A , Spissu M , Contini F , Pittau R , Montisci R 
Published: May 2022

Abstract

Patient Presentation
A 52 y/o female with history of arterial hypertension, diabetes mellitus, Bentall‘s previous intervention, presented to emergency department complaining dyspnea and oppressive chest pain which arose during celebrations for Italy‘s victory at the European soccer championship. According to increase in cardiac troponin level and ECG findings of subendocardial ischemia she was admitted to our Coronary Care Unit for acute coronary syndrome suspicious.

Management
transthoracic echocardiography (TTE) showed reduced left ventricle ejection fraction (LVEF 37%) with apical and left ventricle medium segments akinesis associated with basal segments hyperkinesis with typical apical ballooning aspect. According to these findings, Takotsubo syndrome (TTS) suspicious overtook acute coronary syndrome. Despite low probability of coronary disease, she underwent coronary angiography which was normal. Eight days later, TTE showed completely recovery with normal LVEF. At the routine blood test we found not known hyperthyroidism without detectable antibodies; thyroid ultrasound showed some cystic lesion without any nodule. Thyroid scintigraphy was normal. Antithyroid medications were started and one month later complete normalization of thyroid hormones occurred. The patient was event–free after correction of the hyperthyroidism.

Discussion
“Happy heart syndrome” (HHS) is a TTS triggered by deep happiness and positive emotions. TTS is an usual form of acute cardiomyopathy characterized by reversible left ventricle apical ballooning which occurs in the absence of significant coronary artery disease. Although the exact cause of TTC remains unknown, several pathogenetic mechanisms have been suggested. Catecholamines seem to play a central role and we know that thyroid hormones interact with sympathetic nervous system so that hyperthyroidism is associated with hypersensitivity to catecholamines. Tako–Tsubo syndrome is usually triggered by negative stressors such as fright, grief, rage, other diseases. The role of positive emotions is not well known neither described. We assume that the mechanisms are similar but triggered by different emotions. HHS seems to be caused by pleasant emotional life events such as birthday party, son’s wedding and so many others. Both positive and negative life events could trigger TTS, nevertheless negative life events trigger TTS in almost 95% of the cases, so “broken hearts” are more frequent than “happy hearts”.
P322 A MISLEADING SAM
Authors: Armillotta M , Sansonetti A , Amicone S , Stefanizzi A , Impellizzeri A , Bergamaschi L , Paolisso P , Foà A , Rinaldi A , Casella G , Galiè N , Pizzi C 
Published: May 2022

Abstract
A 66–year–old woman with a history of anxious–depressive syndrome and osteoporosis, without significant cardiological history, reported onset of cardiopalmus and dyspnoea for a few days due to moderate efforts, in conjunction with a period of strong emotional stress. Due to the persistence of these symptoms and the onset of epigastric pain, she underwent a cardiological examination which found low blood pressure values associated with the presence of a systolic murmur. The ECG showed diffuse changes in repolarization compatible with ischemia. Access to the emergency room (ER) was recommended. In ER, the first high–sensitivity troponin value was significantly high (1542 ng/L). Therefore, in the suspect of ACS, the patient was transferred to the cardiological intensive care unit. Echocardiogram showed akinesia of the mid–apical segments, hypercontractility of the bases (EF 35%) and a SAM (systolic anterior motion) with a dynamic outflow tract pressure gradient of 80 mmHg which resulted in severe mitral regurgitation. During the first days of hospitalization, persistent hypotension was observed requiring intravenous infusion of fluids to maintain systolic blood pressure values between 90–100 mmHg. Coronary angiography showed only severe ostial stenosis of a branch of the first diagonal branch. At the same time, ventriculography was performed which showed basal hypercontractility with muscle salience at the base and systolic obliteration of the outflow tract with a small apical aneurysm. 5 days after admission, another echocardiogram showed the almost complete normalization of the global systolic function (EF 68%) with apical hypokinesia and hypercontractility of the basal segments. However, the SAM persisted with a dynamic outflow tract pressure gradient of 140 mmHg with the presence of multiple and dislocated papillaries, accessory tendon cords and insertion of muscle tendon at the level of the septum. To complete the diagnosis, cardiac MRI was performed which documented a diffuse increase in T2 relaxation times more evident in the apical area, absence of LGE areas and normalization of contractility of the left ventricle with disappearance of the SAM. These findings, together with the absence of significant hypertrophy and the complete regression of the ECGgraphic changes, allowed us to exclude the presence of an unrecognized hypertrophic cardiomyopathy and to diagnose Takotsubo syndrome.
P324 A CASE OF ATRIAL MYXOMA WITH UNUSUAL CLINICAL PRESENTATION
Authors: Rossini D , Amati R 
Published: May 2022

Abstract
Myxoma (mx) is the most frequent adult cardiac tumour, that often poses a difficult diagnostic challenge due to the variety and aspecifity of presenting clinical signs. Alongside the more typical clinical onset caused by intracardiac obstruction and systemic embolization, mainly at cerebral level, a mx may initially manifest itself with nonspecific systemic symptoms such as fever, weight loss, fatigue, skin rash, myalgia and arthralgia. We present the case of a 58–year–old woman diagnosed in December 2018 with idiopathic, serum–negative arthritis of the metacarpophalangeal joint of the first finger of the right hand, treated with methotrexate (Reumaflex 10 mg/week s.c.), hydroxychloroquine sulphate (Paquenil 200 mg/day per os) and corticosteroids cycles; in January 2021, this therapy was suspended by the patient (pt) as ineffective. In April 2021, pt was admitted for bilateral SARS–CoV–2 pneumonia. As dyspnoea and fatigue persisted during moderate physical activity (NYHA class II), the pt underwent a cardiological examination on 13 August, when echocardiographic diagnosis of a left atrial mass with the appearance of a mx was made. Interleukin–6 (IL–6) was assayed for a suspected relationship between the cardiac tumour and rheumatic symptoms and was found to be elevated (490 pg/m)l. On 23 August, cardiac surgery was performed to remove the left atrial mass by right minithoracotomy. Histopathological examination confirmed that the 3.5 x 2.5 x 1.5 cm neoformation was a mx. On 1 September, strong attenuation of joint pain and IL–6 reduction to 107 pg/ml was detected. On 9 October, resolution of rheumatic symptoms and normalisation of IL–6 to 3.7 pg/ml (N.V &lt; 7) occurred. This clinical case is emblematic of the long time that sometimes can elapse between the first clinical manifestation and the diagnosis of mx. Also the widespread use of echocardiography did not significantly reduce the diagnostic delay when cardiac symptoms are absent. In a large number of cases, onset symptoms mimicking autoimmune connective tissue disease are reported for 5% (“Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases” Medicine (Baltimore) 2001 May;80(3):159–729). The monoarticular localisation we describe is however unusual. Finally, our observation confirms that the association between mx and systemic symptoms is most likely due to IL–6 synthesis by tumour cells.