Aspiration of barium sulfate is possible during radiographic contrast procedures and is potentially life‐threatening in severe cases. In patients with dysphagia or suspected tracheoesophageal fistula, barium compounds may be used, considering lateral projection fluoroscopy of the pharyngeal phase of swallowing, but iso‐osmotic agents should also be considered.

Aortic dissection is a life-threatening clinical emergency and a challenging diagnosis. Depending on its initial location, it may present with several symptoms with the most common being chest pain. We describe the case of a 62-year-old man admitted to the Emergency Department with acute neurological deficits and triaged for the stroke protocol. After unexpected findings on physical examination, other diagnostic hypotheses were evaluated, culminating in the diagnosis of aortic dissection with haemothorax mimicking a stroke.

In patients with previous cardiovascular (CV) event it is not clear whether Ambulatory Blood Pressure Monitoring 24 H (ABPM) has prognostic value for recurrence. The objective was to compare ABPM values after a first CV event between patients with (2EV) and without (1EV) a second CV event and to evaluate if ABPM has a role in secondary prediction. We studied 187 hypertensive patients with ABPM after a first CV event. ABPM data in 2EV vs 1EV were compared. Of the 187 patients (74.3 % male) ageing 66,6 ± 10.7 years, followed for 2.3 ± 1.9 years, 158 were 1EV and 29 were 2EV. In the 2EV, mean age was 67.2 ± 9.5 and 72.4% were male. Comparison of the ABPM parameters between the 2EV vs 1EV showed: 24H systolic blood pressure (SBP) (134 ± 15 vs 125 ± 13 mmHg, p 0.002), day SBP (138 ± 15 vs 129 ± 13 mmHg, p 0.002), night SBP (128 ± 18 vs 118 ± 16 mmHg, p 0.003), 24H pulse pressure (PP) (62 ± 13 vs 55 ± 13 mmHg, p 0.004), day PP (63 ± 13 vs 55 ± 14 mmHg, p 0.005) and night PP (62 ± 14 vs 53 ± 14 mmHg, p = 0.003). The Cox model, adjusted for gender and age, showed correlation with recurrent events for: 24H SBP (HR = 1.032, 95CI 1.005–1.060, p 0.021), day SBP (HR = 1.026, 95CI 1.001–1.052, p 0.043), night SBP (HR = 1.031, 95CI 1.007–1.055, p 0.011) and 24H PP (HR = 1.046, 95CI 1.013–1.081, p 0.007). In the survival analysis, the 24H SBP ROC curve showed an AUC of 0.627 (p 0.003). The value of 124 mmHg was the best cutoff of SBP (sensitivity 82.7, specificity 51.2) for prediction of secondary CV events. The survival Kaplan Meyer curve showed a worse prognosis for the 2EV with 24H SBP > 124 mmHg (log rank 6.032, p 0.014) (not observed in the 135 mmHg 24H SBP Kaplan Meyer, p 0.224). In patients with previous cardiovascular events, higher values of 24H, daytime and night-time SBP are more predictive of cardiovascular events. In our 2EV population, a 24H SBP higher than 124 mmHg is more predictive of secondary events.

Background. Hypertension is an important risk factor of cardiovascular (CV) disease. An early diagnosis of target organ damage could prevent major CV events. Electrocardiography (ECG) is a valuable clinical technique, with wide availability and high specificity, used in evaluation of hypertensive patients. However, the use of ECG as a predictor tool is controversial given its low sensitivity. This study aims to characterise ECG features in a hypertensive population and identify ECG abnormalities that could predict CV events. Methods. We studied 175 hypertensive patients without previous CV events during a follow-up mean of 4.0 ± 2.20 years. ECGs and pulse wave velocity were performed in all patients. Clinical characteristics and ECG abnormalities were evaluated and compared between the patients as they presented CV events. Results. Considering the 175 patients (53.14% male), the median age was 62 years. Median systolic blood pressure was 140 mmHg and diastolic blood pressure was 78 mmHg. Median PWV was 9.8 m/s. Of the patients, 39.4% were diabetic, 78.3% had hyperlipidaemia, and 16.0% had smoking habits. ECG identified left ventricular (LV) hypertrophy in 29.71% of the patients, and a LV strain pattern was present in 9.7% of the patients. Twenty-nine patients (16.57%) had a CV event. Comparative analyses showed statistical significance for the presence of a LV strain pattern in patients with CV events ( ). Univariate and multivariate analysis confirmed that a LV strain pattern was an independent predictor of CV event (HR 2.66, 95% IC 1.01–7.00). In the survival analysis, the Kaplan–Meier curve showed a worse prognosis for CV events in patients with a LV strain pattern ( ). Conclusion. ECG is a useful daily method to identify end-organ damage in hypertensive patients. In our study, we also observed that it may be a valuable tool for the prediction of CV events.