Giornale italiano di cardiologia最新文献

The enormous progress made in recent decades in the diagnosis and treatment of oncological and hematological diseases has resulted in a significant increase in patient survival and a substantial growth in the population of cancer survivors. These include both living patients with active disease and those who are free of cancer after treatment. There is strong evidence that cancer survivors are at an increased risk of developing cardiovascular diseases and that this risk may outweigh the prognostic impact that is imposed by the disease itself for certain types of cancer. The pathophysiological bases of the interaction between cardiovascular disease and cancer are complex and involve the sharing of both modifiable and non-modifiable risk factors, the effects on the cardiovascular system of certain treatments, as well as the pathogenic changes imposed by cancer, in which inflammation appears to play a key role. In this context, it is therefore essential to increase the attention of the cardiology community to this issue and to enhance cardiological follow-up programs for this high cardiovascular risk population.

Waiting lists in cardiology are one of the most significant problems of the Italian Health Service (SSN). This phenomenon is perceived with significant delays in accessing specialist visits, diagnostic tests and surgical interventions, negatively affecting the health of patients and the overall quality of the SSN. Structural, organizational and demographic factors can be identified among the main causes of waiting lists in cardiology. On the one hand, the number of cardiologists and specialized healthcare workers is often insufficient compared to the growing demand for care. In fact, the distribution of medical personnel is uneven across the country and there are also real problems regarding the number of doctors and nurses within the SSN, workloads and salary aspects. Furthermore, the Italian population is rapidly aging, with a significant increase in age-related cardiovascular diseases, such as heart failure, arrhythmias and coronary heart disease. These factors lead to an ever-increasing demand for cardiology services, putting pressure on the SSN. The aim of this document is to provide an updated overview of the problem of waiting lists in cardiology, to analyze the causes and to provide possible solutions.

The athlete's heart is a complex physiological adaptation to sustained physical training, necessitating a specialized approach to diagnosis and management. Advanced cardiac imaging plays a pivotal role in differentiating physiological remodeling from pathological conditions such as cardiomyopathies. In particular, cardiac magnetic resonance is essential for detecting subclinical myocardial fibrosis and other structural abnormalities that may indicate underlying disease. Serial imaging during follow-up is valuable for monitoring the progression or regression of cardiac remodeling, especially during periods of detraining, and is key to confirming the physiological nature of observed changes. Early identification of high-risk features, including complex arrhythmias or structural abnormalities, is critical for preventing adverse outcomes such as sudden cardiac death.

Electrical storm represents a significant challenge in the management of cardiological emergencies, with a high mortality rate. The therapeutic armamentarium is limited, and the efficacy of available drugs is not always consistent. Furthermore, non-pharmacological strategies are restricted in their application and not universally accessible in medical facilities. There is a close link between the autonomic nervous system and ventricular arrhythmias, as the activation of the sympathetic nervous system can modify the electrophysiological characteristics of the substrate and increase triggered activity and automaticity. This combination is crucial for the initiation and maintenance of ventricular arrhythmias. In recent years, percutaneous stellate ganglion block has emerged as an option in the management of electrical storm, a development largely informed by the findings of multicenter studies that have substantiated its efficacy and safety, along with its expeditious learning curve, thereby paving the way for its widespread adoption. Nevertheless, the role of stellate ganglion block within clinical guidelines remains circumscribed, primarily due to the paucity of data from randomized studies. Its indication is reserved for when alternative therapeutic strategies, both pharmacological and non-pharmacological, have failed to yield the desired outcomes. In the future, it may well be used earlier in the treatment of arrhythmic storm, helping to avoid arrhythmia refractoriness and an unfavorable outcome.

In recent years, there has been a constant reduction in mortality and morbidity in numerous cardiovascular diseases. The advent of hospital networks has allowed for a reduction in the timing of reperfusion treatment in patients with acute coronary syndromes (ACS). However, to date, only the network for ST-elevation myocardial infarction, according to the latest Cardiological Census, is widely spread in Italy. Instead, there are several other acute heart diseases for which there is no equally widespread network, and there is still great heterogeneity among regions. The data from the National Outcome Plan of AGENAS confirms these gaps, particularly for non-ST-elevation ACS and for cardiogenic shock. This observation is further complemented by the profound transformation that the intensive cardiac care units (ICCUs) have undergone in recent years. Today's ICCUs are no longer just places for treating ACS, but should also care for and monitor other acute heart diseases, in particular heart failure, cardiogenic shock, intermediate-to-high-risk pulmonary embolism, and multiple cardiac complication of non-cardiac organ damage as well. This evolution requires significant developments in clinical skills, technological resources, and healthcare organization. The purpose of this work is therefore to describe this clinical and organizational evolution and identify the necessary pathways, interactions with the territory and system indicators to implement them with the aim to improve the prognosis of patients with acute heart diseases as well.