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We describe a case of Torsade de Pointes as first manifestation of adrenal insufficiency. A 56-year-old female without remarkable medical history was admitted in our hospital because syncopes in last 24 hours. Repetitive polymorphic ventricular tachycardia were documented in the setting of QT interval prolongation. Indeed, spontaneous hypothermia, severe hypoglycemia and hyponatremia (125 mEq/ml) were appearing progressively. Due to high clinical suspicion of adrenal insufficiency and patient status of vital emergency an empirical treatment with high doses of glucocorticoids was started. Under this treatment, metabolic and electrocardiographic abnormalities were progressive corrected. The complete endocrine study detected systemic low level of cortisol with normal values of ACTH suggesting diagnosis of secondary adrenal insufficiency due to an empty sellar documented in a craneal magnetic resonance. Our case illustrates that adrenal insufficiency should be considered in patients with QT prolongation and Torsade de Pointes since an urgent correction of cortisol levels is crucial to improve the prognosis of these patients.

Introduction

Chronic venous insufficiency is a disease that affects 20-30% of the adult population, reaching 50% in the population over 50 years. The lifestyle, hours in standing, diet and genetic factors improve the development of symptoms such as heaviness, pain or swelling of the lower limbs, as well as varicose veins.

Objective

To demonstrate the beneficial effects of the escine + procyanidine association in patients with chronic venous insufficiency assessing the changes in the patients treated by quality of life questionnaires and determining the safety.

Methodology

Prospective and longitudinal study in patients diagnosed with chronic venous insufficiency. Patients were randomly in 2 groups, usual care and the escine + procyanidine complex.

To measure results, the questionnaires SF-36v2 and VEINES-QOL/SYM were used, comparing the beginning with the end of the study. In order to measure the clinical relevance, the index denominated “d” of Cohen was calculated and used. The analysis was made by intention to treat.

Results and conclusions

In the escine + procyanidine complex patients the VEINES-SYM questionnaire indicated a significant improvement in the parameters “swollen legs”, “night cramps”, “heat/burning” and “restless legs” with respect to the Usual Care group.

Results

showed that the escine + procyanidine complex is safe, no significant differences were detected compared to the usual care group.

Prosthetic valve endocarditis is still a serious complication of replacement valve surgery. It involves a high mortality rate. Therefore, an early diagnosis and an aggressive treatment are required in order to improve the prognosis of these patients. Transthoracic echocardiography is still the gold standard for the diagnosis of endocarditis. However, this may be not conclusive or negative in the early stages of this disease.

We present the case of a 79-year-old male who underwent aortic valve replacement surgery by biological valve mitroflow number 21 in October 2014. He suffered from fever and syncope after having a colonoscopy and polipectomy without endocarditis prophylaxis the previous month.

Supraventricular tachycardias in pregnant affect the mother and the fetus too, being the pregnancy itself the principal conditioner for pharmacological treatment. In recurrent cases, ablation is an alternative, even more if are performed without fluoroscopy.

We report the case of a 31-week pregnant woman who undergoing to electrophysiological study assisted by a non-fluoroscopic navigation system, with recurrent tachycardias despite treatment. During the study, the presence of a left concealed accessory pathway is verified, and it's mapping and ablationed by retroaortic acces successfully, with only 6 seconds of fluoroscopy to avoid injury in the aortic arch. This case highlights the use of 3D navigation system to perform procedures zero or minimal fluoroscopy.

Mediastinal radiotherapy for the treatment of certain cancers can cause devastating effects on the cardiovascular system. We present the case of a 47-year-old male with a history of Hodgkin's lymphoma at 30 years of age, who was treated with radiotherapy and chemotherapy. Three years before he underwent surgery for severe aortic stenosis. He is admitted to our hospital for acute pulmonary edema caused by severe mitral valve disease. During pre-surgery workout, severe calcification of the entire and thoracic abdominal aorta was detected, as well as the presence of an aortic pseudoaneurysm related to prior surgery. It is a complex and infrequent case that encompasses almost the entire spectrum of radiotherapy damage in the same patient.

We present the case of a patient who came to the Emergency Room with a heart failure clinic with a casual finding of a left atrial space-occupying mass in chest CT Angiography, in the context of de onset atrial fibrillation with rapid ventricular response and mitral stenosis moderate-severe rheumatism not known. An echocardiogram was performed with diagnostic doubts about the etiology of the mass (myxoma Vs atrial thrombus). Oral anticoagulation is initiated with systemic embolization and secondary multi-organ failure, with disappearance of the mass in the left atrium. The peculiarity of this clinical case lies in the difficulty involved in the differential diagnosis of atrial mass and the devastating consequences that may arise after initiating anticoagulation in these cases, despite being indicated by current clinical practice guidelines.