No abstract

The endothelium is a dynamic organ with many properties that takes part in the regulation of the principal mechanisms of vascular physiology. Its principal functions include the control of blood-tissue exchange and permeability, the vascular tonus, and the modulation of inflammatory or coagulatory mechanisms. Many vasoactive molecules, produced by the endothelium, are involved in the control of these functions. The most important is nitric oxide (NO), a gaseous molecule electrically neutral with an odd number of electrons that gives the molecule chemically reactive radical properties. Already known in the twentieth century, NO, sometimes considered as a dangerous molecule, recently valued as an important endogenous vasodilator factor. Recently, it was discovered that it is involved in several physiological mechanisms of endothelial protection (Tab. I). In 1992, Science elected it as “molecule of the year”; 6 yrs later three American researchers (Louis Ignarro, Robert Furchgott and Fried Murad) obtained a Nobel Prize for Medicine and Physiology “for their discoveries about NO as signal in the cardiovascular system”

Psoriasis is a chronic immune-mediated disorder that affects about 2% to 3% of the adult population. Several reports have demonstrated an association between psoriasis and cardiovascular diseases such as myocardial infarction, hypertension, valvular disease and arrhythmia. In this review we analysed the link between psoriasis and cardiovascular disease and the possible physiopathologic mechanism of this correlation.

The endothelium is a dynamic organ with many properties that takes part in the regulation of the principal mechanisms of vascular physiology. Its principal functions include the control of blood-tissue exchange and permeability, the vascular tonus, and the modulation of inflammatory or coagulatory mechanisms. Many vasoactive molecules, produced by the endothelium, are involved in the control of these functions. The most important is nitric oxide (NO), a gaseous molecule electrically neutral with an odd number of electrons that gives the molecule chemically reactive radical properties. Already known in the twentieth century, NO, sometimes considered as a dangerous molecule, recently valued as an important endogenous vasodilator factor. Recently, it was discovered that it is involved in several physiological mechanisms of endothelial protection (Tab. I). In 1992, Science elected it as “molecule of the year”; 6 yrs later three American researchers (Louis Ignarro, Robert Furchgott and Fried Murad) obtained a Nobel Prize for Medicine and Physiology “for their discoveries about NO as signal in the cardiovascular system”

Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. It is a relatively rare phenomenon, representing about 2% of all cases of arterial embolism. We report a case of a 79-years-old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale.

Erythropoietin is a hormone produced by the kidney, which regulates proliferation, differentiation and maturation of red cells. Recombinant human EPO (rH-EPO) is well known to correct anaemia in patients with chronic renal failure in terminal stage. However, recent studies showed the existence of several not haematopoietic effects of erythropoietin. EPO receptors have been found to be expressed in several tissues, included the cardiovascular system. An increase in cardiac systolic function has been observed in patients with chronic heart failure treated with EPO. Other beneficial effects appear to be related to the pro-angiogenic properties on endothelial cells and could be useful for treatment of ischemic heart disease. These findings suggest that EPO could provide potential therapeutic benefits in the management of cardiovascular diseases beyond anaemia correction. This review focuses its attention on the pleiotropic effects of EPO and its future promising applications in cardiovascular pathology.

These data suggest that 2MN is able to induce a lower cGMP increase and less tolerance induction; since these observations seem to be correlated, the vasodilator effect of 2MN probably also involves mechanisms other than stimulation of guanylate cyclase.

Monaldi Arch Chest Dis 2008; 70: 15-23 RASSEGNA IntroduzioneI primi autori che stabilirono una relazione tra scompenso cardiaco e puerperium furono Virchow [1], Ritchie [2] e Porak [3], alla fine del diciannovesimo secolo; tuttavia soltanto nel 1937, dopo che Gouley et al. [4] ebbero osservato gli aspetti clinici e patologici di sette pazienti gravide affette da scompenso cardiaco severo e spesso fatale, tale associazione iniziò ad essere descritta come entità clinica distinta. Le donne presentarono sia negli ultimi mesi di gravidanza sia durante il postpartum una cardiomiopatia dilatativa non ischemica; quattro delle sette pazienti decedettero; l'autopsia mostrò la dilatazione miocardica associata alla presenza di diverse aree necrotiche e fibrotiche molto estese, reperti comunque atipici se paragonati a quelli di altri pazienti con diagnosi di scompenso cardiaco. Per tale motivo gli autori proposero l'esistenza di una relazione, diretta o indiretta, tra scompenso cardiaco, gravidanza e/o puerperium. Analoga associazione fu poi descritta nel 1938 da Hull et al. in 80 pazienti di New Orleans [5], e negli anni successivi diversi autori coniarono i termini di scompenso cardiaco tossico post-partum, malattia cardiaca post-partum, miocardite post-partum, sindrome di Meadow, degenerazione miocardica idiopatica associata a gravidanza, sindrome Zaria e cardiomiopatia post-partum [6][7][8][9][10]. Nel 1971 Demakis et al. [11], in uno studio retrospettivo, descrissero la storia naturale di 27 pazienti con cardiomiopatia associata a gravidanza nel periodo 1947-1967 e definirono tale condizione Cardiomiopatia Peripartum (CMPP), stabilendone i criteri diagnostici, confermati poi durante la Workshop del National Heart, Lung, and Blood Institute (NHLBI) e dell'Office of Rare Diseases of the National Institutes of Health (NIH) nel 2000 [12]: a) scompenso cardiaco insorto nell'ultimo mese di gravidanza o nei 5 mesi dal parto; b) non disfunzione cardiaca preesistente; c) assenza di cause determinanti cardiomiopatia; più recentemente d) disfunzione sistolica ventricolare sinistra dimostrata ecocardiograficamente con frazione di eiezione (FE) < 45% e/o fractional shortening in M-mode < 30% con dimensione telediastolica > 2.7 cm/m 2 [13][14][15]. Nonostante i classici criteri per la definizione della CMPP di Demakis et al. limitassero la diagnosi all'ultimo mese gestazionale e ai primi 5 mesi dal parto, diversi articoli pubblicati successivamente descrissero donne con cardiomiopatia più precoce nel corso della gravidanza [16][17][18][19][20][21]. Infine Elkayam et al., presentando un'ampia casistica di pazienti affette da CMPP, suggerirono il cambiamento dei criteri "classici" dopo aver osservato che sia la presentazione clinica che l'outcome delle pazienti con cardiomiopatia associata alla gravidanza diagnosticata più precocemente rispetto all'ultimo mese di gestazione erano simili a quelle della CMPP "classica", concludendo quindi che entrambe le condizioni potessero rappresentare un continuum della stessa patologia [22]. C...