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Background: Kounis syndrome is a hypersensitivity coronary disorder induced by exposure to several triggers; the most common are antibiotics, followed by insect bites., Methods: We reviewed the literature and identified 66 patients who experienced acute coronary syndrome after insect bites., Results: The median age was 51 years, and 19.0% were women and only 12% had a history of allergy. The most involved insects were bee and wasp (86%) and the most frequent clinical manifestations were chest pain and anaphylaxis (36% and 29%, respectively). ST-segment elevation was the most common electrocardiographic finding (>70%). There was a not negligible rate of complications (15%), with a possible increased arrhythmic burden in patients without significant coronary atherosclerosis., Conclusions: Acute coronary syndrome after insect bites is not so rare and it could have serious complications, with a possible increased arrhythmic burden in patients without significant coronary atherosclerosis.

Myocardial revascularization in patients with stable ischemic heart disease aims at eliminating myocardial ischemia, in order to (i) relieve anginal symptoms; (ii) improve functional capacity; and, possibly, (iii) improve prognosis. Given that ischemic recurrences are relatively common in patients undergoing myocardial revascularization, an appropriate follow-up is needed as part of a secondary prevention program. Stress testing can be here useful to: (i) detect residual or recurrent ischemia/angina; (ii) define functional capacity in order to establish physical aerobic training individualized programs; (iii) stratify prognosis. These goals can in large part be achieved by the ECG stress test, by far the cheapest, the easiest to perform and the most accessible test among those proposed so far, particularly compared with other imaging stress test modalities. There is, however, considerable discrepancy among scientific society recommendations on the use, timing and methods of ECG stress testing and of stress testing in general after revascularization. In addition to the diversity of recommendations, the use of stress tests in general is extremely variable in current clinical practice.This review aims therefore at revisiting principles, advantages and limitations of the ECG stress test and of stress tests in general in revascularized patients, highlighting recent developments of the ECG stress technique. This should also aim at issuing new recommendations to avoid the inappropriate prescription of expensive and more cumbersome techniques, to be reserved only to a second-tier diagnostic level and in a minority of cases.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic problem in Italy. Costs and resources required are increasing in close correlation to both the improved quality of care and to the population ageing. There is an overwhelming evidence of the efficacy of cardiac rehabilitation (CR) in terms of reduction in morbidity and mortality after acute cardiac events. CR services are by definition multi-factorial and comprehensive. Furthermore, systematic analysis and monitoring of the process of delivery and outcomes is of paramount importance. The aim of this position paper promoted by the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is to provide specific recommendations to assist CR staff in the design, evaluation and development of their care delivery organization. The position paper should also assist health care providers, insurers, policy makers and consumers in the recognition of the quality of care requirements, standards and outcome measure, quality and performance indicators, and professional competence involved in such organization and programs. The position paper i) include comprehensive CR definition and indications, ii) describes priority criteria based on the clinical risk for admission to both inpatient or outpatient CR, and iii) defines components and technological, structural and organizing requirements for inpatient or outpatient CR services, with specific indicators and standards, performance measures and required professional skills. A specific chapter is dedicated to the requirements for highly specialized CR services for patients with more advanced cardiovascular diseases.

A workshop endorsed by the Italian Association of Cardiovascular Prevention and Rehabilitation--Emilia Romagna Section--held in Piacenza in May 2011, gave the opportunity to discuss the emerging role of Preventive Cardiology in the modern era. From the new documents recently published by the European and Italian Scientific Associations, the barriers in their implementation, and the contribution of the health care providers, physicians, nurses, both in primary and secondary prevention were discussed. The local initiatives of cardiac prevention in different areas were presented and compared. A new project of secondary prevention in the follow-up and management of patients with dilated cardiomyopathy and heart failure promoted by the Emilia Romagna Region Health Authority was presented.

Exercise Capacity is the expression of the cardiovascular and of metabolic organic efficiency and represents a important prognostic marker. The Six Minute Walking Test is adopted in the practice for exercise capacity evaluation in the normal subject as in pneumologic or cardiac rehabilitation programs, and in both pediatric and elderly ages. The aim of the work is to present a practical summary of the application of the six minutes walking test, according to the American Thoracic Society statement. We reviewed the various experiences of its application, and reported the indications, clinical interpretation parameters, relationship and correlation between functional and clinical parameters (hospitalization, quality of life, therapy and exercise control response and compliance), the basic and advanced protocol, the application modality, the reporting models, and the educational checklist.