Obstructive sleep apnea (OSA) is an important sleep disorder and is associated with increased cardiovascular morbidity and mortality. Several recent studies have demonstrated an association OSA and atrial fibrillation (AF). Therefore, it is of great importance understanding the pathophysiological substrate and the interaction between OSA and AF. Moreover, it is well accepted that interatrial block (IAB), evaluated not only by the P-wave duration but also by the P-wave morphology, has the potential to give information about the anatomical substrate predisposing to AF. OSA and AF share many risk factors and comorbidities, including older age, male gender, obesity, hypertension, heart failure, and coronary artery diseases. IAB is defined when the P-wave is ≥120 ms which signifies excessive time for sinus impulses to conduct from the right atrium to the left atrium and may predict future AF events. Accordingly, recent studies have suggested that OSA is associated with atrial functional and structural remodeling which indeed are associated with increased risk of AF. We speculate that IAB, a known factor to predict future AF episodes, may associate with OSA and contribute to the development of arrhythmic events. In the present case, the report presents a woman with OSA and IAB on the surface electrocardiogram (ECG) automatic P-wave analysis and some short episodes of AF in the external event recorder monitoring.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting both upper and lower motor neurons. Cardiovascular consequences related to ALS are relatively under appreciated. Autonomic dysfunction in ALS is common. In fact, patients with ALS often exhibit bulbar dysfunction impacting centrally mediated vagal and sympathetic nerves with resultant greater autonomic dysfunction. The consequences of disruptions in the autonomic reflex loop on the cardiovascular system include chronotropic incompetence and vasomotor instability

Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods. Prediction of early cardio-embolic stroke remain a permanent challenge in everyday practice. The early identification of an increased risk for atrial fibrillation episodes (which are frequently asymptomatic) is essential for the prevention of cardioembolic events. One of the noninvasive modalities of atrial fibrillation prediction is represented by the electrocardiographic P-wave analysis. This includes study and diagnosis of interatrial conduction block. Our short case report presents a case with ischemic cortico-sottocortical stroke involving capsulo and caudo regions in a woman patient with interatrial block as realized by electrocardiographic P analysis.

Atrial arrhythmias and especially atrial fibrillation in the early phase (first 12 hours) of acute myocardial infarction (AMI) are rare. They are more common in the later stages of AMI and the most of the times as a sign of heart failure. The pathogenesis seems to be an underlined coronary ischemia. Among the causes an ischemia of sinus node artery (SNA) is previously described. SNA arise the most of the times from the initial part of right coronary artery while the remaining from the LCx or in a small proportion of them have double origin from RCA and LCx one. In this case we describe a case of atrial fibrillation in the early phase of AMI promptly resolved in the next one hour after successful percutaneous coronary angioplasty (PTCA) treatment of the culprit lesion in the LCx at site of the origin of SNA.

In the era of new coronavirus infection pulmonary embolism (PE) is a corollary manifestation that may aggravate the patient`s clinical status. In this setting of patients various coagulation abnormalities such as raised D-dimers and prolonged APTT have been reported previously in up to 65% and 45% of adults SARS patients respectively and multiple previously necropsy series of SARS patients showed that vascular thromboses were not uncommonly seen in lung specimens. During this period emergency rooms work is note of worthy in differentiation COVID from non-COVID patients due to separate admission procedure in the hospital. Accordingly, among the non-COVID population there exist a high percentage of patients with a typical radiologic pattern of COVID-19 but without a positive reverse transcription polymerase chain reaction (RT-PCR) resulting in naso-faringeal swamp. The above findings raise the suspicion of an occulted COVID-19 or a like-COVID-19 clinical presentation. In the last istance there is a need to pay more attention just to avoid further contamination. In this report we describe a case with high risk PE, as a first manifestation of a like- COVID-19 pneumonia. In the above case the patient in question, after careful CT angiography evaluation, has a clear COVID-19 pneumonia radiological findings in spite of three RT-PCR swamp negative for true COVID-19.

5-fluorouracil (5-FU) cardiotoxicity is not a common, but with potentially deleterious effects on the patient condition. In this paper we present the case of an 53-year-old woman undergone local resection for localized anal cancer and then she was treated with NIGRO protocol. 48 hours after the end of 5-FU i.v. administration an acute coronary syndrome was developed. The electrocardiogram showed hyperacute T waves in all leads except for V1 and aVL that showed negative T waves in combination with chest pain and diaphoresis promptly resolved after sublingual isosorbide dinitrate. A subsequent coronary angiography was performed and normal coronary arteries were shown. The potential causes and the treatment are being discussing.

We present the case of a 43-year-old woman with a history of Ebstein's anomaly, who was referred for a myocardial perfusion single-photon emission computed tomography (SPECT) study due to angina-like symptoms. Dilatation of the right ventricle and right atrium, apical displacement of the septal tricuspid leaflet, small left ventricle with good left ventricular and a moderate degree of tricuspid regurgitation with mild pulmonary hypertension were found on echocardiography. Myocardial SPECT perfusion imaging with [99m Tc]tetrofosmin demonstrated a large defect in the inferior septal wall in the stress study with mild partial reversibility at rest. Coronary angiography revealed normal coronary arteries. Histological studies have shown that these patients develop increased fibrosis in the left ventricular wall and ventricular septum, especially in the basal and middle region of the septum, which adjoins with the atrialized component of the right ventricle. This is in concordance with the findings of the myocardial perfusion scan in the case described.

Apical ballooning syndrome (ABS) is a unique acute cardiac syndrome characterized by symptoms and electrocardiographic changes that mimic acute myocardial infarction. It occurs in patients without evidence of significant obstructive coronary artery disease and is associated with transient extensive wall motion abnormalities of the apical and mid portions of the left ventricle. The onset of ABS is preceded by a stressful event, either emotional or physical in around 65% of cases. The underlying pathophysiology for ABS remains unclear; however, several mechanisms have been proposed including multivessel epicardial spasm, microvascular spasm, catecholamine induced myocardial stunning and myocarditis. The treatment of ABS remains entirely empirical and should be individualized according to the patient's clinical picture at the time of presentation. It should be initially managed according to the guidelines for acute coronary syndrome. Once the diagnosis of ABS is made, supportive care usually leads to spontaneous recovery. The prognosis of patients with Takotsubo cardiomyopathy is generally favourable. The left ventricular systolic dysfunction usually resolves within a few weeks. In-hospital mortality is low, less than 2%, and recurrence rate is no more than 10%. The aim of this article is to clarify, for the clinicians dealing with acute cardiac care, when they should suspect ABS and how they should confirm the diagnosis and subsequently manage it.

Type 2 diabetes markedly increases cardiovascular risk, and patients often present with advanced and asymptomatic disease. The fact that diabetes is associated with an increased risk of acute coronary events and poor long-term survival makes a strong case for detecting coronary artery disease early, perhaps before clinical manifestation in this patient population. This article examines the role of myocardial perfusion scintigraphy in the diagnostic and prognostic evaluation of diabetic patients with suspected coronary artery disease and in screening high-risk asymptomatic diabetic patients.

AIMS:This is a case report of an athlete whose professional football career was transiently terminated because of the presumed diagnosis of hypertrophic cardiomyopathy.METHODS AND RESULTS:The diagnosis was based on electrocardiographic repolarisation changes. The ECGs, treadmill exercise tests (Bruce protocol) and echo examinations at the time of his active training and several years after termination of his professional career are discussed. No hypertrophic cardiomyopathy was documented by ultrasound examination.CONCLUSIONS:The distinction between physiological athlete's heart and pathological conditions has critical implications for professional athletes. Criteria and guidelines for screening of athletes in competitive sports are recommended.

Reverse redistribution is a well-known pattern found when performing thallium myocardial scintigraphy, and it has been implicated as an indicator of myocardial ischemia. Much more rarely, when using technetium compounds, which do not redistribute, a similar pattern is noted after the second injection of the radiotracer. This pattern has been termed "reverse perfusion pattern," and its full implications are not yet clear and are still being investigated.

ver the last 20 years, it has been proven that left ventricular dysfunction after myocardial infarction in patients with acute or chronic coronary artery disease (CAD) is not necessarily an irreversible process. It appears that if there are areas within the dysfunctional segments of the myocardium which display some viability, both the regional and the global performance of the left ventricle (LV) can be restored either partially or totally, automatically or following revascularization 1-5 . Consequently, in patients with ischaemic cardiomyopathy, and particularly in those who display LV dysfunction, the identification of viability is of great clinical importance and this is due to the significant prognostic value and the therapeutic benefits in patients with viable myocardium. In this review, an attempt is made to analyze the pathophysiology of reversible systolic dysfunction, to determine the most reliable method of identifying viable myocardium and to evaluate the prognostic significance of viability, with respect to clinical endpoints. All of these issues comprise the main aim of both current clinical and experimental research.

Background: Although blood pressure is a major determinant of myocardial oxygen-demand, little information is currently available regarding the changes in blood pressure (BP) during myocardial ischemia. Since BP elevation may cause left ventricular (LV) wall stress and an increase in oxygen demand, infusion of an α-adrenergic agonist, such as phenylephrine (PH), may provoke changes in myocardial perfusion in coronary artery disease (CAD) patients. As the effects of BP changes alone on myocardial perfusion have never been assessed by thallium-201 (Tl) scintigraphy, we investigated the effects of BP elevation after PH infusion, in order to study the hypothesis that pressure loading alone without increases in heart rate, may provoke transient impairment of regional myocardial perfusion, in CAD patients. Patients and methods: Forty-one (41) patients with angiographically documented CAD, aged 54±8 years, were included in our study. Each patient was given, without any complications, a PH (0.1 mg/ml) dose infused at a rate of 0.8 ml/mm, determined by a standardisation procedure and producing a mean blood pressure elevation of approximately 30% above baseline levels and a heart rate response to levels of no less than 50 bpm. One minute after the desired blood pressure and heart rate responses were reached, 2 mCi of Tl were injected and the PH infusion continued until the termination of the test. Tl scintigraphy was performed both 2 min after Tl injection and 4 h later, while the results were correlated to coronary angiography findings. Results: PH scintigraphy produced 152 total defects. The mean perfusion defect size (%) was 14±12 and was directly related to the number of diseased vessels, i.e., 2% for one-vessel disease, 15% for two-vessel disease and 25% for three-vessel disease (P<0.05). The lowest percentage Tl activity values were 56±14 and were inversely related to the number of diseased vessels (P<0.01). The mean Tl lung counts/pixel values were 25±8 while it increased as the number of diseased vessels increased (P<0.01). The mean lung/heart ratio values were 0.31±0.08 while it increased as the number of diseased vessels increased (P<0.01). Conclusion: BP elevation after PH loading, produces a significant impairment of myocardial perfusion, that correlates well with the extend of angiographic findings.

Discrete subaortic stenosis (DSS) accounts for 8 to 20% of all cases of congenital left ventricular outflow tract obstruction. There have been few scattered reports of left ventricular obstructive lesions occurring in immediate family members of patients with DSS. This is a report of four cases of DSS in one family: one brother with a fibrous ring, and two sisters and the son of one of the sisters with a fibrous membrane. The occurrence of multiple cases of DSS in this family suggests an autosomal dominant mode of inheritance.