An atrial septal defect (ASD) is the most common congenital heart defect (CHD) diagnosed in adulthood. It is characterized by significant anatomical heterogeneity and complications that evolve over time. While often asymptomatic in children, the signs of adverse effects of ASD increase with age, including a greater risk of heart failure, stroke, atrial fibrillation (AF), and reduced life expectancy. ASD is traditionally considered a right-heart lesion due to long-term complications such as arrhythmias, right-sided heart failure, thromboembolism, and, in a subset of patients, pulmonary arterial hypertension (PAH). The pathophysiology of atrial shunts also affects the left heart due to volume overload and adverse ventriculo-ventricular interaction. Early diagnosis of interatrial septal anomalies is essential to prevent hemodynamic consequences and/or thromboembolic events. Electrocardiographic (ECG) findings play a crucial role in this early diagnosis. This narrative review aims to update clinicians on the latest evidence regarding the pathophysiological link between ASD and cardiac rhythm disorders, the nuances of optimal diagnostics, treatment options (surgical, interventional, pharmacological), and the need for long-term follow-up for patients with ASD. The review will determine the risk of conduction disorders compared to a healthy population and to compare the prevalences of conduction disorders, mortality, and pacemaker use in patients with closed ASDs versus those with open ASDs.

Takotsubo syndrome (TTS) is an acute, reversible cardiomyopathy that clinically mimics acute coronary syndrome in the absence of obstructive coronary artery disease. In oncology, TTS may be precipitated by the cancer milieu itself (stress, inflammation, neuroendocrine activation) and by antineoplastic therapies, notably fluoropyrimidines, vascular endothelial growth factor (VEGF) pathway inhibitors, tyrosine kinase inhibitors, and immune checkpoint inhibitors. Cancer currently stands as the second leading cause of morbidity and mortality worldwide. Cancer can directly induce TTS through an increase in catecholamines or indirectly via surgical and chemotherapeutic treatments. Several antineoplastic drugs are associated with an increased risk of TTS. We conducted a narrative, clinically oriented review. This narrative review aims to analyze the pathophysiological link between TTS and cancer and to explore potential preventive and therapeutic strategies in cancer patients.

Background/Objectives: The diagnosis and risk stratification of valvular heart disease have traditionally relied on resting echocardiography. However, in a significant portion of patients, resting findings do not fully reflect the hemodynamic severity of the condition, particularly in asymptomatic individuals with severe valvular disease or those with nonspecific symptoms. In this context, stress echocardiography emerges as a vital imaging modality, providing a dynamic assessment of valvular, ventricular, and pulmonary function under hemodynamic load (from physical exercise or pharmacological agents). Methods: We conducted a comprehensive synthesis and critical evaluation of the current landscape, recent advancements, and future directions regarding the application of stress echocardiography in valvular heart disease. Results: This comprehensive review explores the incremental role of stress echocardiography in valvular heart disease, analyzing the evolution of its clinical applications, from low-flow, low-gradient aortic stenosis to the evaluation of contractile reserve and exercise-induced pulmonary hypertension in mitral stenosis and regurgitation. We discuss standardized protocols, key parameters to monitor, and the diagnostic and prognostic outcomes from major clinical trials and current guidelines. Attention is given to stress echocardiography’s ability to unmask the true severity of the disease and to identify patients at high risk for adverse events, thereby guiding crucial clinical decisions, such as the optimal timing for surgical or transcatheter intervention. Conclusions: The review evaluates the limitations of modality and outlines future research directions, including its integration with new technologies like 3D echocardiography and speckle tracking techniques, to further optimize the role of stress echocardiography as a decision-making tool in the multidisciplinary management of valvular heart disease.

Acute myocarditis encompasses a broad clinical spectrum, ranging from mild chest pain with preserved ventricular function to fulminant heart failure, malignant ventricular arrhythmias, cardiogenic shock and sudden cardiac death. Recent advances have shifted its definition from a primarily histopathological entity toward an integrated clinical syndrome in which multimodality imaging, biomarkers and endomyocardial biopsy contribute to diagnosis and risk assessment. Cardiac magnetic resonance has become central to non-invasive tissue characterization while endomyocardial biopsy remains a relevant approach in high-risk or treatment-refractory patients, allowing identification of histological subtypes that may require specific therapy. Management is largely determined by clinical severity and aetiology, ranging from supportive care and guideline-directed heart failure therapy to immunosuppression, targeted antimicrobial treatment and temporary mechanical circulatory support in fulminant cases. Increasing evidence also highlights the relationship between myocarditis-like episodes and inherited cardiomyopathies, particularly desmosomal disease, in which recurrent “hot phases” may represent an early manifestation of a genetic substrate. Based on a structured literature search, this narrative review summarizes current concepts in the classification, diagnosis, complications and management of acute myocarditis with particular emphasis on heart failure and fulminant presentations, risk stratification and genetic susceptibility. Throughout the text, established treatments are kept separate from emerging mechanism-based strategies, which are still supported by limited evidence.