We report the case of a 40-year-old man, transferred from another hospital to our ICU because of acute coronary syndrome. Coronarography did not show coronary stenosis. Twenty-four hours monitoring EKG allowed diagnosis of Prinzmetal angina and appropriate therapy was administered. Six months after discharge due recurrence of symptoms, ranolazine was added to therapy. After one year the patient is symptoms free.

Ranolazine derives from piperazine and has been approved as a drug for the therapy of chronic stable angina. It acts by selectively inhibiting the late sodium inward current. Moreover, ranolazine has other metabolic features which makes it effective in other diseases as well as coronary artery ones. In this paper I make an updated review of all possible therapeutic roles of ranolazine: through cardiology and beyond.

Background/Objectives: Heart failure (HF) is associated with substantial morbidity, impaired quality of life (QOL), and reduced functional capacity. In selected patients with symptomatic HF despite Optimal Medical Therapy (OMT), Cardiac Contractility Modulation (CCM) may be a therapeutic option. Identifying patients most likely to benefit from CCM remains an unmet need. The Predict-CCM study aims to evaluate long-term clinical and objective outcomes after CCM therapy and to assess the predictive value of pre-implant low-dose dobutamine stress echocardiography (LDDSE). Methods and Results: Predict-CCM is an independent, non-profit, multicenter, observational cohort study conducted in Italy, with both retrospective and prospective enrollment. The primary endpoint is the proportion of subjects with a clinical response to CCM at 12 months, defined as a ≥1-class reduction in NYHA class. Secondary clinical endpoints include reductions in HF-related hospitalizations, changes in QOL assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and changes in NT-proBNP levels from baseline to follow-up. Outcomes will be evaluated in the overall cohort and in two subcohorts stratified by pre-implant LDDSE response: (1) reduction in left ventricular end systolic volume (LVESV) ≥ 15% (DeltaLVESV ≥ 15%); and (2) reduction in LVESV < 15% (DeltaLVESV < 15%). Assuming a 70% clinical response rate at 12 months, the estimated sample size is 120 patients. The study was approved by the Ethics Committee in March 2025. Enrollment will continue for 2 years, with a 12-month follow-up period after implant for each subject. Conclusions: This study may provide new criteria for patient selection and outcome assessment in CCM therapy. Left ventricular contractile reserve assessed by stress echocardiography may be a promising predictor of response.

Aortic diseases cover a large spectrum of conditions, such as aortic aneurysm and acute aortic syndromes (i.e., dissections, intramural hematoma, penetrating atherosclerotic ulcer, traumatic aortic injuries, and pseudoaneurysms), genetic diseases (e.g., Marfan syndrome) and congenital abnormalities, such as coarctation of the aorta. These conditions may have an acute presentation; thus, if the acute aortic syndrome is the first sign of the disease, the prognosis is extremely poor. Prompt diagnosis and timely therapy are therefore mandatory. In this paper, we discuss a deceptive symptom of painless aortic dissection and its physiopathology. Furthermore, we briefly review the literature and discuss the management of diagnostic tools.

Background: Reel syndrome, rotation of the generator on its transverse axis with coiling of the lead, is a rare cause of cardiac implantable electronic device failure. While described for transvenous systems, it is exceptionally rare in subcutaneous ICDs (S-ICD). Case presentation: A 63-year-old woman with dilated cardiomyopathy and S-ICD implanted in 2022 for secondary prevention in a standard subcutaneous pocket presented with a shock during exertion. Remote monitoring (LATITUDE) had not been activated. Device interrogation showed an inappropriate 80J shock due to myopotential oversensing after caudal retraction of the lead. Chest X-ray documented Reel syndrome with proximal coiling around the can and distal tip retracted to the subcostal region, >10 cm from the manubrio-sternal junction, with horizontalization of the shock coil, incompatible with effective defibrillation. Management: The system was explanted and a new S-ICD re-implanted using the intermuscular two-incision technique in the virtual space between serratus anterior and latissimus dorsi. The procedure was performed under ultrasound-guided serratus anterior plane block combined with parasternal block. The generator was anchored to the fascia with non-absorbable sutures. Defibrillation test was effective at 40J. Remote monitoring was activated. Conclusion: To our knowledge, this is one of the few documented cases of Reel syndrome in S-ICD with both radiographic and stored electrogram evidence of inappropriate 80J shock, rescued with intermuscular two-incision technique under ultrasound-guided serratus anterior plane block. Intermuscular fixation with non-absorbable sutures, combined with regional anesthesia and systematic remote monitoring, ensures device stability and maintains continuous defibrillation protection.