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Il Caso Antonio Cassano: Quali Strumenti ha a Disposizione la Cardiologia per una Diagnosi Efficace

Pubblicato da Dr.Guidalberto Guidi in News · 30/10/2011 09:13:00
Tags: malorecassanojuventus
Dramma sfiorato per l’attaccante del Milan, il calciatore è stato colpito da un malessere improvviso qualche ora dopo la partita.

La sintomatologia era complessa, vertigini, turbe visive, incapacità nel parlare (disartria), difficoltà motorie ecc.

Sono poche le patologie che possono scatenare questi sintomi, tra queste l’ischemia cerebrale, cioè la mancanza di flusso sanguigno nel tessuto cerebrale, è la principale e più temibile.
Le cause di ischemia cerebrale sono dovute alla riduzione del flusso a causa di ostruzioni totali o parziali delle carotidi o dei vasi cerebrali, solitamente causate da lesioni aterosclerotiche, per questo motivo si manifestano in soggetti adulti o anziani e raramente nei giovani dove invece più frequentemente è uno spasmo arterioso la causa del ridotto flusso sanguigno.
Le conseguenze possono essere transitorie, allora si parla di TIA (transient ischemic attack) oppure permanenti, la cui gravità dipende dalla localizzazione e dall’estensione della zona ischemica.

L’altra causa è quella embolica, dovuta a coaguli o microcoaguli che vengono trasportati dalla corrente sanguigna fino al cervello.

Patologie cardiache associate ad aritmie come la fibrillazione atriale possono favorire la formazione di trombi all’interno del cuore, questi possono migrare ed ostruire il flusso nei vasi cerebrali causando ischemia.

Ma esiste un’altra causa, subdola, spesso misconosciuta e quindi imprevedibile che dipende da un piccolo difetto anatomico congenito del cuore: si tratta di un difetto del setto che divide i due atri, solitamente a livello della “fossa ovale”, questo difetto consente al sangue di passare da un atrio all’altro senza passare dal “filtro” fisiologico costituito dai polmoni.

Normalmente è presente alla nascita ma nei primi giorni di vita tende spontaneamente a chiudersi, impedendo al sangue di mescolarsi. Se ciò non avviene, nella vita adulta può succedere che microtrombi, magari formatisi in seguito ad ematomi da trauma, possano passare indisturbati dal sangue venoso al sangue arterioso e andare ad embolizzare e ostruire il flusso in qualche arteria, se avviene nel cervello si manifesta l’ischemia cerebrale.

Per diagnosticare questa anomalia è necessario eseguire l’Ecocardiogramma colordoppler, l’Ecocardiogramma Tridimensionale o in alcuni casi l’Ecocardiogramma Trans Esofageo, in quanto non esiste alcun segno clinico rilevabile con la sola visita medica, né con l’elettrocardiogramma.

Lo studio morfologico e funzionale eseguito con l’Ecocardiogramma colordoppler infatti evidenzia il difetto anatomico e con opportune manovre anche il passaggio anomalo di sangue tra i due atri (shunt).

Come Cardiologo della Juventus F.C. sottopongo tutti gli atleti ad esame Ecocardiografico mono, bidimensionale e tridimensionale per visualizzare l’anatomia del cuore, completandolo con il colordoppler lo studio dei flussi valvolari ed eventuali shunts anomali.

Ritengo che sia un esame essenziale ed estremamente utile per la prevenzione di complicanze, anche perché in caso di positività è possibile rimediare al difetto senza necessità di intervento chirurgico, assumendo basse dosi di aspirina per prevenire i trombi e con semplice posizionamento di un “ombrellino” tra gli atri, per via vascolare percutanea tramite un sottile catetere in anestesia locale.

È doveroso ricordare che circa il 5% dei giovani affetti da cefalea ricorrente sono portatori di questa piccola, ma subdola patologia cardiaca.

Concludo raccomandando le regole fondamentali per la prevenzione dell’ictus:
consultare sempre il medico in caso di cefalea ricorrente o persistente, eseguire l’Ecodoppler delle Carotidi dopo i 50 anni, anche più precocemente in caso di concomitanti patologie metaboliche come diabete o dislipidemia, eseguire l’Ecocardiogramma Colordoppler se si svolge attività fisico-sportiva intensa o agonistica.

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Nuvole
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