Cardiological Syndrome Research Articles

Cognitive and Speech Rehabilitation in a Patient Affected by Takotsubo Cardiomyophathy: A Case Report

Background and Objectives: Takotsubo Syndrome (TS) constitutes one of the most recent clinical realities in modern cardiology. It is clinically similar to the acute coronary syndrome, in the absence of obstructive coronary artery disease. Case Presentation: We described a case of a female patient affected by TS and left ventricular apical thrombus. Several studies described the cardiological syndrome, overlooking the neuropsychological and psychological outcomes. We aimed to assess the advantages of an integrated, multidisciplinary and multifunctional rehabilitation. Conclusions: This specific training contributed to reducing the tolerance to frustration given by her communication’s difficulty. It has favored a good therapeutic alliance and a good success of the psychotherapeutic path, guaranteeing the reduction of her anxious symptoms and an improvement in the emotive and relational status.

When to say “no” to a patient with an ovarian tumour and in poor general condition?

Neuroendocrine tumours (NET) originating from the ovary are very rare, constituting about 0.52–1.7% of all NETs. Primary carcinoids constitute about 0.1% of ovarian tumours and 0.3% of all carcinoids. They rarely show hormonal activity. They are most often diagnosed post-operatively, based on pathomorphological examination using immunohistochemical methods. Due to the small number of cases, most information on the management of patients with this diagnosis comes from retrospective studies and case reports. This paper presents a case report of a 63-year-old woman who was admitted to the department of surgical gynaecology with the diagnosis of a 15-cm right ovary tumour. Her general condition was poor due to severe respiratory failure and severe tricuspid valve insufficiency. The clinical picture and the performed echocardiographic examination aroused the suspicion of carcinoid heart disease (Hedinger syndrome — a cardiological syndrome of carcinoids). Due to the determination and cooperation of a multidisciplinary medical team, despite a very bad prognosis, the patient underwent surgery. Immediately after the operation, the patient’s condition was critical, but it gradually improved. In the postoperative pathomorphological examination, a highly differentiated neuroendocrine tumour (grade 1 – G1) was diagnosed at stage IA according to the FIGO classification. The patient was referred to the endocrinology department, where receptor scintigraphy was performed without revealing other tumour changes. The patient did not require adjuvant therapy. Making a decision about surgical treatment of a patient in poor physical condition with a possibly reversible cause of heart failure was the right thing to do, and it allowed her to return to normal physical activity.

Chagas Disease: Where to now?

<p class="normal">This special issue includes expert reviews on the neglected cardiological syndrome – Chagas Disease<ins cite="mailto:Andrew%20Coats" datetime="2016-07-11T15:49"> (CD)</ins>, also known as American trypanosomiasis. First described in 1909 this syndrome is endemic in several Latin American countries. This specially commissioned themed issue of the International Cardiovascular Forum Journal brings together notable experts who discuss a wide range of emerging topics in CD. These include the changing, and challenging, epidemiology of CD in migrants and visitors to the Europe and the USA. We also review what treatments exist for the primary infective aetiology, and how to manage Chagas cardiomyopathy when it has reached its end-stage heart failure form. We have expert reviews on advanced imaging techniques and their role in the assessment and care of Chagas’ patients and the opportunity to protect against sudden death in this enigmatic condition. </p>

Cardiological Syndrome X: Diagnosis and Intensive Care

Objective: to study the efficacy of the atypical neuroleptic sulpiride in the complex intensive therapy for cardialgic syndrome X (CSX). Subjects and methods. Sixty-six patients with CSX were randomly divided into 2 groups comparable by clinical and history data. Group 1 including 33 patients received traditional intensive antianginal therapy. Group 2 patients were additionally given the atypical neuroleptic sulpiride. The duration of therapy was 4 weeks; thereafter the impact of the therapy performed was evaluated by the time course of changes in anginal symptoms, the frequency of attacks a day, the adaptive capacities of the cardiovascular system, and psychoneurological status. Results. In Group 2 patients taking sulpiri-de in complex therapy, there were more reductions in the number of anginal attacks, their severity and duration. Pain syndrome relief was achieved in the earlier periods. Sulpiride exerted a positive effect on the patients’ psychoneurological status, which made itself evident in the abolishment of the anxious and depressive manifestations of the disease. Conclusion. Reduced symptoms and improved adaptive capacities of the cardiovascular system in CSX patients treated with sulfide leads to the conclusion that the drug used in complex and intensive therapy for CSX is a current effective psychocorrect-ing agent that is well tolerated and safe, which promotes the improvement of final treatment Results.

Disfunción endotelial y desequilibrio hemostásico en el síndrome X cardiológico

Introduction The possible presence of endothelial dysfunction and hemostatic imbalance in cardiological syndrome X, frequent in the postmenopause, remains controversial. Objective To compare the biomarkers von Willebrand factor (vWF), fibrinogen (Fb), total tissue factor pathway inhibitor (TFPI-t) and plasminogen activator inhibitor (PAI-1) between patients without coronary artery disease (cardiological syndrome X, mixed angina and vasospastic angina) and patients with coronary artery disease. Material and methods These biomarkers were determined in 10 patients with cardiological syndrome X, 13 patients with mixed angina, 15 patients with vasospastic angina, 10 patients with coronary arterial disease and 20 healthy controls. Results Compared with healthy controls, all patients had elevated levels of Fb [3.1 (2.7-3.6) vs 2.8 (2.2-3.2) g/l; P=.003], vWF [211.9 (165-266) vs 116.5 (91-155)%, TFPI-t [122.3 (101-136) vs 86 (72-100) ng/ml; P<.001] and PAI-1 [45.9 (32-61) vs 21 (11-26) ng/ml; P<.001]. However, patients without coronary artery disease had lower levels of vWF [200.5 (151-249) vs 255.2 (221-277) %; P=.01)] and TFPI-t [110.5 (100-127) vs 136.7 (121-148) ng/ml; P=.02)] than those with coronary artery disease. Conclusion The presence of endothelial dysfunction and hemostatic imbalance is similar in patients with cardiological syndrome X and those with mixed or vasospastic angina, although these disorders are less severe than in patients with coronary artery disease.

782 Towards enhanced, personal, intelligent and mobile systems for early detection and interpretation of cardiological syndromes. The EPI-MEDICS project

782 Towards enhanced, personal, intelligent and mobile systems for early detection and interpretation of cardiological syndromes. The EPI-MEDICS project

Biochemical parameters of endothelial dysfunction in cardiological syndrome X

The endothelial dysfunction in cardiological syndrome X has been studied mainly by invasive methods and by measuring vasoactive mediator (nitric oxide (NO), endothelin-1) levels. Other parameters evaluating this dysfunction (defined as an imbalance between vascular relaxing and contracting factors, between procoagulant and anticoagulant or growth-inhibiting and growth-promoting substances) have not been used. Methods : Twenty-five non-diabetic patients (16 men, 9 women) with cardiological syndrome X and 10 healthy volunteers (5 men, 5 women) were examined. Biochemical parameters : ET-1, the end products of nitric oxide metabolism (NO x ), VEGF, vWF, g TG, tPA, PAI-1 were measured before and during an ECG exercise tolerance test. The blood concentrations of testosterone and estradiol in men and LH, FSH and estradiol in women were tested. Results : A significantly lower basal concentration of NO x (p = 0.01), lower basal NO x /ET-1 ratio (p < 0.05) and higher levels of VEGF (p < 0.05) were observed in patients with cardiological syndrome X. The male patients also had higher concentrations of estradiol (p < 0.05). A significant decrease in tPA concentration and increase in g TG was noticed during exercise, but with no differences between the study groups. Conclusions : Endothelial dysfunction in cardiological syndrome X manifests mainly in the regulation of vessel wall tonus, which was revealed by the decrease of NO x level and NO x /ET-1 ratio. VEGF elevation in syndrome X may result from chronic tissue ischaemia due to endothelial dysfunction. Exercise augments the prothrombotic activity of the blood, since a significant elevation in g TG and decrease in tPA were observed after exercise.

Microvascular angina (cardiological syndrome X) per se is not associated with hyperinsulinaemia or insulin resistance.

Microvascular angina has been found to be associated with insulin resistance. However, many factors known to affect insulin sensitivity were not excluded in patient selection. We aimed to evaluate whether microvascular angina is per se associated with insulin resistance. We performed a Frequently Sampled Intravenous Glucose Tolerance Test (0.33 g kg(-1) b.w.) in 10 normal weight and normotensive patients with microvascular angina, with normal glucose tolerance and normal plasma lipids. Ten healthy subjects, comparable for age, sex, body mass index, blood pressure and plasma lipids, were used as control group. Fasting serum glucose (4.49+/-0.2 SEM vs. 4.52+/-0.13 mmol L(-1), P = 0.9), insulin (39.46 +/-3.68 SEM vs. 47.12+/-4.6 pmol L(-1), P = 0.21) and C-peptide (0.56 +/-0.05 SEM vs. 0.53+/-0.05 nmol L(-1), P = 0. 68) values, as well as estimated parameters of insulin secretion and hepatic insulin extraction were similar in the two groups. Insulin sensitivity values (median, range) were also similar in the patients and control subjects (5.76 (3.39-12.30) vs. 7.54 (3.68-13.89. 10(-4) x min(-1)/(microU/mL), P = 0.97). Microvascular angina per se is not associated with hyperinsulinaemia or insulin resistance when other confounding factors are excluded in patient selection.

P-80. Estratest Improves Emotional Well Being in Postmenopausal Women with Cardiological Syndrome X

P-80. Estratest Improves Emotional Well Being in Postmenopausal Women with Cardiological Syndrome X

Insulin resistance syndrome in postmenopausal women with cardiological syndrome X.

To determine whether postmenopausal women with cardiological syndrome X (chest pain and abnormal exercise electrocardiogram despite normal coronary angiography) exhibit disturbances in the full range of proposed components of the putative "insulin resistance syndrome". 20 postmenopausal women with syndrome X and 20 healthy controls each underwent measurement of insulin resistance (by minimal model analysis of the intravenous glucose tolerance test), lipid, lipoprotein, and apolipoprotein concentrations, a range of haemostatic variables, serum uric acid concentration, and centrality of body fat distribution (by dual energy x ray absorptiometry). Women with syndrome X had higher fasting triglyceride concentrations than controls (median: 1.60 v 1.02 mmol/l, P < 0.05). Concentrations of high density lipoprotein cholesterol were lower (1.33 v 1.61 mmol/l, P < 0.05) as were those of the high density lipoprotein apolipoproteins AI and AII. Insulin and C peptide responses to the intravenous glucose tolerance test were higher (27.6 v 19.8 microU/ml/min, P < 0.01; 101 v 72 pmol/ml/min, P < 0.05, respectively), and insulin sensitivity was lower (1.89 v 3.09 min/microU/ml, P < 0.05). There were, however, no significant differences between other proposed components of the insulin resistance syndrome (blood pressure, glucose tolerance, proportion of central body fat, serum uric acid concentration, and plasminogen activator inhibitor-1 activity). Antithrombin III activity was higher in women with syndrome X (121 v 113%, P < 0.01). Women with syndrome X tend to be insulin resistant and have lipid and lipoprotein abnormalities, but do not exhibit all characteristics of the insulin resistance syndrome. Such variation in correlated risk factors is consistent with underlying heterogeneity in the insulin resistance syndrome and cardiological syndrome X.

Serum angiotensin-I-converting enzyme activity in women with cardiological syndrome X: relation to blood pressure and lipid and carbohydrate metabolic risk markers for coronary heart disease.

Polymorphism of the angiotensin-I-converting enzyme (ACE) gene is associated with variations in serum ACE activity and the incidence of cardiovascular disease. Whether a similar association exists with cardiological syndrome X (chest pain, positive ECG exercise test, and normal angiography) is unclear. As ACE activity affects vascular tone, it could be involved in the pathogenesis of this syndrome. We measured serum ACE activity in 18 postmenopausal women with syndrome X and in 18 healthy controls matched for age, adiposity, and menopausal status. The relationship of ACE activity to coronary heart disease risk factors was also examined within these groups. Serum ACE activity did not differ significantly between women with syndrome X and controls. Neither blood pressure, serum total cholesterol, triglyceride, nor high density lipoprotein subfraction 2 cholesterol was associated with ACE activity in either patient group. However, serum high density lipoprotein cholesterol, high density lipoprotein subfraction 3 cholesterol, and apolipoprotein-A-I and -A-II were inversely associated with ACE activity in women with syndrome X, but not in controls. Insulin sensitivity, fasting plasma glucose, insulin, and C-peptide as well as their postglucose challenge concentration profiles were not significantly associated with ACE activity in either group. We conclude that serum ACE activity and, consequently, ACE polymorphism are not associated with syndrome X and are largely independent of metabolic risk factors in these women.

Serum angiotensin-I-converting enzyme activity in women with cardiological syndrome X: relation to blood pressure and lipid and carbohydrate metabolic risk markers for coronary heart disease

Serum angiotensin-I-converting enzyme activity in women with cardiological syndrome X: relation to blood pressure and lipid and carbohydrate metabolic risk markers for coronary heart disease

Insulin resistance syndrome as a feature of cardiological syndrome X in non-obese men.

To assess the features of the insulin resistance syndrome in patients presenting with cardiological syndrome X, who experience angina despite angiographically normal coronary arteries. 14 Non-obese male patients with syndrome X and 38 symptom free, apparently healthy, male volunteers were studied. Insulin sensitivity (inversely related to insulin resistance) was measured by minimal modelling analysis of glucose and insulin concentrations during an intravenous glucose tolerance test. Serum lipids, lipoproteins, and apolipoproteins were also measured. Insulin sensitivity was 31% lower in the men with syndrome X (p < 0.05) and fasting insulin concentration was 30% higher (p < 0.05). The patient group also had 64% higher mean triglycerides (p < 0.001) and 20% lower mean high density lipoprotein cholesterol concentration (p < 0.01). Systolic blood pressure was also 10% higher in the syndrome X group (p < 0.01). There were no differences in total cholesterol, low density lipoprotein cholesterol or lipoprotein (a). These findings show that non-obese male patients with anginal chest pain but normal coronary arteries (syndrome X) are insulin resistant, hyperinsulinaemic, and have higher concentrations of triglycerides and lower high density lipoprotein cholesterol than healthy men. The insulin resistance syndrome may predispose to a spectrum of arterial disease capable of causing myocardial ischaemia.

Lyme disease and its neurologic complications.

Lyme disease is recognized as a cause of illness involving multiple organ systems. The transmission of the Borrelia burgdorferi spirochete depends on a complicated vector life cycle, involving multiple mammalian and avian hosts. Although the illness is reported worldwide, variable clinical presentations on different continents raise questions about disease mechanisms. Multiple neurologic syndromes can occur alone or in combination, producing peripheral neuropathies, radiculopathies, myelopathies, encephalitides, meningitides, and pain syndromes. These may be noted with dermatological, rheumatological, and cardiological syndromes. Several pathophysiologic mechanisms are reviewed. Antibiotic therapy for different clinical presentations is discussed.