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Objective of our study was to evaluate the prevalence of arrhythmias as well as their correlation with the reported anamnestic symptomatology in the elderly population. With 24 hour ambulatory electrocardiography (Holter ECG) 913 patients, (440 males and 473 females, range 60-89 years, mean age 71) were consecutively studied and subdivided according to the following criteria: (1) age (3 classes: 60-69 [I], 70-79 [II],or = 80 [III]; (2) presence/absence of "guide" symptoms (syncope/faintness, chest pain, palpitation), and (3) Holter electrocardiography results. We have demonstrated a high prevalence of arrhythmias: 72% (657), which was significantly higher in age classes II (80.5%) and III (79.1%) in comparison to class I (60.6%). A notably higher prevalence of tachyarrhythmias is documented compared to bradyarrhythmias (5:1). With a higher age the prevalence of supraventricular tachyarrhythmias increases significantly, while bradyarrhythmias do not have the same trend. We have a similar prevalence of arrhythmias between symptomatic (77.4%) and asymptomatic patients (63.6%) and no significant correlation between anamnestic symptoms and presence of arrhythmias are observed. Considering the high prevalence of arrhythmias during Holter ECG we think that the clinical importance and prognosis should be evaluated with caution.

The goal of this study was the evaluation of cardiac arrhythmias in an unselected population of elderly patients by 24-hour Holter electrocardiography. An elevated incidence of hyperkinetic (62%) and hypokinetic arrhythmias (22.7%) were detected. Following a critical review of the literature, the Authors conclude that even in hyperkinetic arrhythmias a conservative approach is advisable without indiscriminate therapeutic treatment. This review also confirmed the clinical utility of ambulatory monitoring in the detection of arrhythmias, otherwise underestimated, mainly in asymptomatic patients.

The general aspects and newer applications of two-dimensional, contrast, and doppler echocardiography in the assessment of congenital heart diseases are reviewed. The M-mode techniques are presently of limited value as diagnostic tool and are confined to few detailed findings which are often missed at standard examination: particularly the M-mode is useful in the visualization of pulmonic valve which shows characteristic abnormalities in pulmonary hypertension. Two-dimensional echocardiography has opened a new era of investigation in the evaluation of congenital heart diseases. It has enhanced the ultrasonic resolution in the delineation and connection of intracardiac structures, providing a systematic approach to the diagnosis of complex cardiac abnormalities. The left and right ventricular chambers can be identified through the position and morphology of their atrioventricular valves and papillary muscles, and by evaluation of the mitral-semilunar valve continuity. The newest utilization of standard echocardiography involves the prenatal diagnosis of congenital heart diseases by way of intrauterine echocardiography: the fetal heart can be visualized in several planes by transabdominal approach in the mother. With careful attention, a complete examination including four and five chambers view of the ventricle and short axis view of the great arteries, can be accomplished in almost all cases, allowing an accurate determination of many congenital defects. The contrast technique was originally used for identifying right cardiac chambers on M-mode echocardiograms: it provides excellent times resolutions and an accurate analysis of flow related events across the cardiac structures.(ABSTRACT TRUNCATED AT 250 WORDS)

The introduction of computer technology has overcome many of the technical difficulties in performing and interpreting echocardiograms obtained from exercising individuals and has made stress echocardiography a potentially practical examination. Additional data, however, are necessary to establish the accuracy of exercise echocardiography. The purpose of this study is to compare exercise echocardiography and planar thallium studies for accuracy in detecting coronary artery disease. The study was performed on 50 patients, 41 of whom underwent coronary angiography. For the remaining 9 patients accuracy was defined as concordance of clinical information, treadmill ECG results, thallium data and the exercise echocardiogram. If there was any discrepancy among these tests, the patient was not included in the analysis. The sensitivity of exercise 2D digital echocardiography was comparable to stress thallium (0.86 vs 0.85) and was better than treadmill test alone (0.66). There were no false positive tests with echocardiographic study, while 1 false positive thallium examination was detected. The diagnostic accuracy of stress echocardiography was 0.90, stress thallium 0.85 and treadmill test only 0.75. In conclusion, exercise echocardiography appears to give results comparable to stress planar thallium studies. In addition, the ultrasonic procedure has several advantages: it is totally non-invasive, does not require a reperfusion study 4 hours later, avoids radiation and is less expensive.