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Ebstein's anomaly is a rare congenital cardiac disease initially described by Wilhelm Ebstein in 1866. It is defined as the significant apical displacement of the part of the tricuspid valve causing significant tricuspid regurgitation and reduction of the functional right ventricle, right atrial and right ventricular dilatation and atrial and ventricular arrhythmias. Ebstein's anomaly occurs approximately once in 20,000 live births and only 5% of patients survive beyond the fifth decade. We present a case of Ebstein's anomaly in a 69-year-old Italian woman. Also this case is illustrative of Ebstein's anomaly in adult.

Left bundle branch block with changing axis deviation also during acute myocardial infarction has been rarely reported. Changing axis deviation with changing bundle branch block during acute myocardial infarction has also been rarely reported. Prostate-specific antigen (PSA) is an established tool in detecting prostate cancer. Immediately after 15 min of exercise on a bicycle ergometer, serum PSA concentrations increased by as much as threefold. Apparently spurious result has been reported in a work about mean serum PSA concentration during acute myocardial infarction with mean serum PSA concentration significantly lower on day 2 than either day 1 or day 3 and it has been reported that these preliminary results could reflect several factors, such as antiinfarctual treatment, reduced physical activity or an acute-phase response. We present a case of changing axis deviation and elevation of serum PSA concentration in a 92-year-old Italian man with acute myocardial infarction. Our report confirms previous findings and extends the evaluation of PSA during acute myocardial infarction.

Interatrial defects, ventricular septal defects, and patent ductus arteriosus can occur as part of more congenital cardiac malformations or as an isolate finding. We present a case of interatrial defect associated with ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant.

Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. We present a case of acute myocardial infarction associated with an allergic reaction in a 73-year-old Italian woman with recent implantation of stents.

The discovery of a large left atrial mass obliges the clinician to perform a differential diagnosis including tumour versus thrombus, but because of morphology and mobility of the mass, always it is difficult to differentiate one from the other. We present the case of a large left atrial thrombus mimicking a large tumour in an 83-year-old Italian woman.

Pulmonary stenosis comprises variable pathologic features from the right ventricular outflow tract to the peripheral pulmonary arteries. Most frequently, the obstruction occurs at the level of the pulmonary valve; however, it occurs less frequently at the infindibular level. It can occur as part of more congenital cardiac malformations such as tetralogy of Fallot, complete transposition of great arteries, or atrial septal defect. Proximal pulmonary artery stenosis has also been reported as an acquired lesion in infants treated for congenital heart disease. Primary isolated supravalvular pulmonary stenosis is less common. We present a case of primary isolated pulmonary artery stenosis in an asymptomatic 25-day-old newborn infant.

Many patients with ventriculoarterial discordance have survived to adulthood. Those with complete transposition of the great arteries have often had an atrial switch procedure (Mustard or Senning operation) performed, which leaves the morphological right ventricle supporting the systemic circulation. It has been also reported previously undiagnosed congenitally corrected transposition of the great arteries. We present the complete transposition of the great arteries in an 8-year-old Romanian child with a septal defect of the ventricle (functionally single ventricle).

Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ecg shows an LBBB with changing QRS morphology and changing axis deviation. We describe a case of atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block in an 84-year-old Italian woman in the Cardiology Unit.

Rarely the ECG shows an LBBB with changing QRS morphology and changing axis deviation. The intermittent positive aspect of the neglected lead aVR indicates an intermittent right axis deviation in the presence of complete LBBB. An additional left posterior fascicular block accompanying predivisional LBBB is the possible explanation. We describe the case of a 78-year-old Italian woman admitted to the Cardiology Unit with acute myocardial infarction and permanent atrial fibrillation. Electrocardiographic changes were observed. The ECG showed atrial fibrillation and LBBB with intermittent left axis deviation or atrial fibrillation and LBBB with intermittent right axis deviation.

a Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me), Azienda Sanitaria Provinciale di Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy b Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy c Pronto Soccorso Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me), Azienda Sanitaria Provinciale di Messina, Italy

We greatly appreciated the letter to the Editor by Prof. Mehtap Cakir "Hashitoxicosis (or Graves' disease?) with pericardial effusion" regarding "Hashitoxicosis with pericardial effusion". The definitive diagnosis was made in the follow-up period, in which transient thyrotoxicosis followed by hypothyroidism strongly suggested Hashitoxicosis.