[Calcium inhibitors and cardioprotection].

The main goal in treating hypertensive patients is to reduce the incidence of complications, especially on the heart. The lowering of blood pressure do not seem enough. Some properties, not shared by all antihypertensive drugs, are likely to allow some protection against heart and coronary diseases.

Captopril test in the detection of renovascular hypertension in a population with low prevalence of the disease. A prospective study.

The value of the captopril test as a screening test for identifying renovascular hypertension has been outlined by several studies performed in populations with a high prevalence of renovascular disease (20% to 50%). We prospectively assessed the value of the test in 103 hypertensive patients referred to our center for evaluation of their hypertension. They had taken no diuretics and no converting-enzyme inhibitors for more than four days.

Left ventricular mass in normotensive subjects. Importance of blood pressure response to activity.

Recent works have shown the importance of blood pressure (BP) response to exercise or to daily activity as determinants of hypertensive cardiac hypertrophy. We have tested the relationship between BP and left ventricular (LV) mass in 23 normotensive young adults (mean age 25 +/- 5) with normotensive parents. Blood pressure was measured at rest, at the end of maximal exercise test, and during 24-hour ambulatory monitoring during daily routine.

[Persistent arterial hypertension].

Antihypertensive therapy has markedly improved, in the last few years, but, in some patients, the blood pressure remains high despite an association of several medications. We are proposing to consider as persistent or refractory, any essential hypertension remaining higher than or equal to 165/95 despite a well administered triple therapy, initiated since at least one month. With such patients, the first step consists in verifying the various terms of the definition: measurement of the blood pressure under standard condition and, at best, over a long period of time, in ambulatory conditions; re-evaluation of the drug combination (synergistic action); observance of the treatment by the patient; re-investigation of the etiology; determination of the resistance factors to the treatment.

[Beta blocking drugs in chronic obstructive bronchopneumopathies].

Unlabelled: The respiratory tolerance can limit the use of beta-blocker medication (beta-) currently indicated in numerous clinical situations, both cardiovascular and also neurological and ophthalmological. Blockade of beta adrenergic receptors is without risk in subjects free of bronchial pathology, but may destabilize underlying airflow obstruction; either presenting as or sustaining bronchospasm in an asthmatic, and increasing bronchial obstruction, in patients suffering from chronic airflow obstruction (BPCO). Now BPCO, and in particular asthma, are easily associated with diseases for which beta- are indicated.

[Association of sacciform aneurysm of the renal artery and hypertension. Cause or coincidence? Apropos of a case].

Aneurysms of the renal artery are seldom encountered. They present as different aetiopathological types. We report the case of a female patient who had both severe arterial hypertension and an apparently dysplastic aneurysm of the right prepyelic artery.

[Doppler echocardiography of ventricular diastole].

Non-invasive studies of left ventricular relaxation and filling by means of doppler-echocardiography are of considerable interest owing to easy recording and good reproducibility. However, such physiological parameters as site of measurement, heart rate and, chiefly, age may interfere with the curves obtained. The interpretation of tracings must also take into account the presence of mitral valve pathology (stenosis or regurgitation), aortic stenosis, disorders of atrioventricular (prolonged PR complex) or intraventricular (left bundle branch block) conduction and medication (e.

Accuracy of M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection: an experience with 128 cases.

The accuracy of combined M-mode and two-dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six-year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%).

High night blood pressure in treated hypertensive patients: not harmless.

Unlabelled: The left ventricular mass index (LVMI) is better related to activity than resting systolic blood pressure (BP) in treated hypertensive patients. Many recommend ambulatory BP monitoring only during the day. However, 24-hour BP monitoring may be useful in treated patients to check adequate control of BP during the entire 24-hour period.

[Circadian rhythm of blood pressure. Importance of the severity and not the cause of arterial hypertension].

Recent work have raised the possibility of a lack of circadian blood pressure variability in secondary hypertension. To test this hypothesis, we compared 11 patients with renovascular hypertension (RVH) and 11 essential hypertensive patients (EH) matched for sex, age, body weight, height and the average level of SBP from 7 a.m.

[Cardiac Doppler ultrasonography in the diagnosis and surveillance of chronic aortic insufficiency].

Chronic aortic insufficiency is, since a few years, a topic of renewed interest because of the development of non-invasive monitoring methods: sonocardiography, cardiac Doppler. The problem raised is that of deciding the most opportune time for surgery in asymptomatic chronic AI, the course of which may quietly evolve towards irreversible myocardial lesions. The severity of AI may be determined by numerous sonocardiographic and Doppler criteria.

[Treatment of renovascular arterial hypertension: angioplasty versus surgery].

Percutaneous transluminal angioplasty is being more and more performed as the first choice treatment of renovascular hypertension. However, very few studies are devoted to the comparison of angioplasty versus surgery in treating renovascular hypertension and no one is prospective. A group of 25 patients with renovascular hypertension who underwent surgical treatment in the years 78-82 was compared to a group of 32 patients who underwent transluminal angioplasty in the years 82-86.

[Acute aortic insufficiency. Diagnostic and prognostic value of cardiac ultrasonic Doppler].

Although infrequent, acute aortic insufficiency must be identified at an early stage. The clinical picture is often deceptive. Ultrasonic cardiography and cardiac Doppler represent, today, a diagnostic technique of choice which specify the mechanism of the acute valve leakage, the condition of the ascending aorta and the repercussions on the left ventricle.

[Evaluation of aortic to pulmonary blood flow ratio by Doppler echocardiography in septal defects].

Pulsed Doppler-echocardiography was used to measure systemic and pulmonary blood flows in 22 patients aged from 3 months to 62 years presenting with interatrial (n = 13) or interventricular (n = 9) septal defect. Calculations were based on echographic measurements of aortic and pulmonary orifice areas and on the integral of maximal aortic and pulmonary Doppler velocity curves. Section areas or the arteries, taken as being circular, were deduced from arterial diameter measurements effected above Valsalva's sinus.

[Echocardiographic diagnosis of aortic dissection: contribution of pulsed Doppler. Apropos of 29 cases].

Echocardiography is universally recognized as a first-line examination easy to perform at all times in patients with thoracic pain suggestive of aortic dissection. But like all diagnostic methods, it has its limitations and pitfalls. The present study, based on 29 consecutive cases, demonstrates the value of pulsed Doppler echocardiography in the diagnosis and monitoring of aortic dissection.

[Echocardiographic diagnosis of aortic dissection. Limits, pitfalls and difficulties].

In patients with suspected dissection of the aorta two-dimensional echocardiography has become a fundamental complementary examination which can easily be used in emergencies. In the light of our experience and of published data, a floating dissected intima is the pathognomonic sign. However, false-negative results have been recorded in about 30% of the cases, as against 10% with angiography, computerized tomography and nuclear magnetic resonance imaging.

Rapid growth of a left atrial myxoma shown by echocardiography.

Rapid growth of a left atrial myxoma was demonstrated in a patient who showed no echocardiographic evidence of the tumour when he was admitted for coronary artery bypass grafting. Eight months later he complained of dyspnoea and fatigue, and cross sectional echocardiography showed a 6 x 4 cm left atrial myxoma. This was removed and the diagnosis was confirmed by histological examination.

[The echocardiogram in arterial hypertension].

Echocardiography seems to be the best non-invasive method for the detection of hypertensive heart disease: it shows early abnormalities of left ventricular compliance, frequently left ventricular hypertrophy and late abnormalities of myocardial contractility. These results are of paramount importance since recent epidemiological data have shown that left ventricular hypertrophy is a factor of severity and should be treated.

[Should nocturnal arterial pressure be monitored in treated hypertensive patients?].

Ambulatory blood pressure monitorings for diagnosis purpose in non treated hypertensive patients are often performed only during day time for two reasons. First, target organ responses to hypertension, and mainly left ventricular hypertrophy, are more closely related to activity than to rest BP. Second, these automatic devices are frequently not well tolerated during sleep because of their noise during inflation of the cuff.

[Effects of perindopril on left ventricular hypertrophy, coronary reserve and mechanical properties of the papillary muscle of the rat with renovascular arterial hypertension].

We investigate the effect of a new angiotensin-converting enzyme inhibitor: Perindopril (IRIS) on regression of left ventricular hypertrophy (LVH), coronary blood flow and mechanical performance of isolated papillary muscle in renovascular hypertensive (Goldblatt 2 kidneys-1 clip) Sprague-Dawley male rats. Sham operated rats (G1) and half of hypertensive rats (G2) were studied after 8 weeks. The other half of 8 weeks long hypertensive rats (G3) were treated during 8 weeks with Perindopril in drinking water at a dosage adjusted to maintain blood pressure (BP) measured with tail cuff method under 140 mmHg.

An unusual complication of the Le Veen shunt: a right atrial ventricular chamber pseudotumor.

We report the case of a right atrial-ventricular chamber thrombus discovered four years after insertion of a Le Veen shunt for treatment of refractory ascites. A two-dimensional echocardiogram, performed after the discovery of an isolated systolic murmur, demonstrated a "tumorlike" mass seated in both the right atrium and the right ventricle. The mass was surgically removed and histologic examination confirmed that it was a thrombus developed at the tip of the catheter.

[Left ventricular hypertrophy of the hypertensive patient. Approach to its pathogenesis and consequences].

The knowledge of the characteristics and consequences of left ventricular hypertrophy (LVH) in the hypertensive patient has greatly progressed in the past few years, owing to echocardiography. This examination provides a reliable and reproducible measurement, and therefore the left ventricular mass is used more and more as a severity index of hypertension and a mean of evaluation of the efficacy of the treatment. This attitude is justified in part by the poor prognosis of LVH.

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases].

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases.