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Over the last decade, pharmacological therapies for primary and secondary prevention of chronic coronary syndromes enriched with new agents have been demonstrated to be effective in reducing cardiovascular adverse events. However, currently available evidence on treatment for anginal symptom control is weaker. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) aims to briefly report evidence that supports the use of anti-ischemic drugs for chronic coronary syndromes. Furthermore, we propose a therapeutic algorithm for the choice of the most appropriate drug on the basis of the clinical characteristics of the individual patient.

Background: Cardiac rehabilitation (CR) is a model of care proven to reduce recurrent cardiovascular events, new hospitalizations and mortality in patients with coronary artery disease. The aim of this study was to describe ambulatory CR in Gualdo-Tadino, ASL1 of Perugia (Italy), analyzing the outcomes of this population at 1 year and in the medium-long term., Methods: The clinical instrumental characteristics and the outcome of patients referred to CR after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), angina, coronary artery bypass graft (CABG), ischemic heart disease have been analyzed. Follow-up interval: 2005-2018. Average follow-up 4.9 ± 4.4 years/patient. Comorbidity, new events, and mortality have been analyzed., Results: From a population of 1552, 1384 were selected with a history of coronary artery disease: age 64.6 ± 9.8 years; 17% female (mean age 67.6 ± 8.8 years); 13.2% elderly >75 years; 57.2% were referred for CR after STEMI, 17.1% after non-STEMI, 19.9% after angina or ischemic heart disease. Patients with CABG were 79 (5.7%), but treatment by CABG was used in 287 patients (20.7%) referred for STEMI, non-STEMI or angina. CR lasted on average about 3 weeks, followed by scheduled periodic visits every 6 months and every 1-2 years thereafter. At the last check, 82.4% of patients were on antiplatelets, 71.1% on beta-blockers, 75.8% on angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, 90.5% on statins or cholesterol-lowering agents, with the following secondary prevention targets: LDL cholesterol 87.5 ± 31.9 mg/dl (target <70 mg/dl in 30.4% of patients) and 78.9 ± 28.7 mg/dl (target <70 mg/dl in 37.2% of patients) in the whole population and in those enrolled since 2010, respectively; heart rate was 63.4 ± 10.8 bpm, systolic and diastolic blood pressure 128.3 ± 15.6/73.6 ± 8.6 mmHg, triglyceridemia 135.6 ± 73.6 mg/dl. Events during the overall follow-up were 156 reinfarctions in 136 patients, 341 coronary angioplasty procedures in 258 patients, angina in 99 patients, CABG in 60 patients, re-CABG in 7 patients, heart failure in 21 patients, stroke in 44 patients. At 1-year follow-up, 10.3% of patients had a new hospitalization for cardiovascular events (1.6%) or coronary angioplasty (8.7%). Peripheral vascular disease, diabetes mellitus and chronic renal failure, analyzed in 627 patients in an average period of 6.5 years, increased by 11.0%, 5.3% and 4.8%, respectively. All-cause mortality over the entire period and at 1 year was 10.5% and 0.7%, respectively. Multivariate analysis shows that the probability of death increases in males, with age, left ventricular dysfunction, peripheral vascular disease, dyslipidemia and diabetes, while it decreases as the number of controls increases. The probability of reinfarction is higher in smoking patients, with renal insufficiency, vascular disease, neoplasms., Conclusions: The study highlights the efficacy of ambulatory CR programs and subsequent follow-up in the treatment of a population with coronary heart disease, risk factors and comorbidities. The increase of comorbidities, particularly peripheral vascular disease, diabetes mellitus and chronic renal failure - along with the non-reduction of smoking - have significantly affected the outcome, despite the effective control of the other coronary risk factors.

We report a case of a 48-year-old man who complained episodes of angina at rest. Instrumental investigation demonstrated a mass involving the ventricular side of the aortic valve suggestive for papillary fibroelastoma; an anomalous origin of the right coronary artery from the left sinus of Valsalva and no significant coronary artery disease were shown as well. The patient underwent open heart surgery, the tumor was excised and the aortic valve was spared. Pathological examination confirmed the diagnostic hypothesis of papillary fibroelastoma. The resolution of anginal symptoms after surgery suggests the possibility of papillary fibroelastoma causing these symptoms.

More often to day odontologist must face emergency situations especially of cardiovascular kind. The article reviews the principal clinical aspects: syncope, cardiac arrest, arrhythmias, acute hypertension, acute myocardial infarction. The authors besides describe cardiopulmonary-resuscitation (CPR) techniques. The article ends with some recommendations to prevent cardiovascular emergency and to incite medical and paramedical staff to learn perfectly CPR techniques.

The authors report fifty-nine cases of non-transmural myocardial infarction. The diagnosis was made on the basis of clinical electrocardiographic data and enzyme changes. The clinical course was characterized by several chest pain attacks; a transmural myocardial infarction occurred in four patients a few days after admission. Out of fifty-five patients, followed for a nineteen - months period, six died, thirty-one were asymptomatic and fourteen complained of angina. In the last group, chest pain was generally present before the non-transumural myocardial infarction. The ECG were within normal limits in thirty-seven patients. The coronarographic patterns found in fifteen patients are also described and discussed.