[Cardiovascular complications of alpha interferon].

Interferon-alpha is a biological response modifier with antiviral and tumoral effect that is used in the treatment of chronic viral hepatitis. Cardiovascular complications occurred in clinical trials of interferon. The most common presentations of cardio toxicity were cardiac arrhythmia, dilated cardiomyopathy, atrial extrasystole and symptoms of ischemic heart disease, including myocardial infarction and other effects less common and dangerous: low-level conduction impairment or reversible hypertension.

[Management of sudden death in a semi-rural district, Seine-et-Marne: the DEFI 77 study].

Sudden death is a major problem in public health, affecting around 50 000 people a year in France. The prognosis for cardiac arrest is abysmal because for every minute lost the chances of survival diminish by 10%. The aim of this work was to prospectively evaluate the characteristics of cardiac arrest victims across an entire 6000 km? area, the Seine-et-Marne district, distinguished by the paradox of lying just outside the capital whilst actually being semi-rural, and to determine the current methods of dealing with this emergency.

[A familial form of conduction defects associated with a PRKAG2 gene mutation].

Conduction defects are usually secondary to elective aging of the conduction pathways. However, some familial and genetic forms are now being described. Here we report a particular electrocardiographic pattern in four members of the same family over three generations, naturally leading to the suspicion of a hereditary origin.

A familial form of conduction defect related to a mutation in the PRKAG2 gene.

We describe four members of the same family with a very similar ECG pattern characterized by conduction defects (right bundle branch block, frequent left anterior hemiblock, atrial hypertrophy, and sometimes severe nodal dysfunction) contrasting with a short PR interval. Significant clinical events were reported only after 60 years of age. A mutation in the gamma2 subunit of the AMP activated protein kinase gene (PRKAG2) was identified in the four members of the family, with an autosomal dominant inheritance.

[Diagnostic and therapeutic progress. Venous thromboembolism, cardiac insufficiency and radio contrast agents].

MODALITIES FOR THE DIAGNOSIS OF VENOUS THROMBOEMBOLISM: Currently rely on the confrontation of the initial clinical data and the results of D-dimer measurements, a venous Doppler, although reliable, is not a first-line exploration. REGARDING TREATMENT: Indications for thrombolysis are currently limited to massive pulmonary oedema with shock. Alteplase added to heparin improves the progression of severe embolism; it spares the patients from heavy interventions of resuscitation but the mortality remains the same.

[Acute coronary syndromes with ST-segment elevation].

UNBLOCK THE CORONARY ARTERIES: For the treatment of acute coronary syndromes with ST-segment elevation, emergency repermeabilisation is of the artery is crucial, generally by primary angioplasty than by fibrinolysis. The other treatments have little beneficial effects on mortality. Primary angioplasty is the technique of choice when it can be performed in the intensive care units with staff with sufficient experience and within the 90 minutes following the preliminary medical management, and benefiting from the supply of PG IIb-IIIa.

[Acute coronary syndromes without ST segment elevation].

NEW DENOMINATIONS: With the arrival of new therapeutic strategies requiring rapid intervention, acute coronary syndromes required classification on earlier data than the Q-wave or MB creatinine kinase. In a patient with anginal pain and depending on the electrocardiogram, we now distinguish syndromes with or without ST segment elevation. REGARDING ANTIPLATELET DRUGS: Aspirin is used in all cases, as well as clopidogrel.

[Changes in the management of cardiac arrest].

NEW RECOMMENDATIONS: for cardio-pulmonary resuscitation Methods such as mouth to mouth or the search for a pulse, until now the fundamental preliminaries, have now become second line. Everything must be organised to allow for defibrillation as rapidly as possible. NEW MODALITIES FOR CARDIAC MASSAGE: The frequency of compressions recommended is currently 100 per minute in the adult with a rhythm of compression-ventilation reaching 15/2 before intubation.

Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial.

Background: beta-Blockade-induced benefit in heart failure (HF) could be related to baseline heart rate and treatment-induced heart rate reduction, but no such relationships have been demonstrated.

Methods And Results: In CIBIS II, we studied the relationships between baseline heart rate (BHR), heart rate changes at 2 months (HRC), nature of cardiac rhythm (sinus rhythm or atrial fibrillation), and outcomes (mortality and hospitalization for HF). Multivariate analysis of CIBIS II showed that in addition to beta-blocker treatment, BHR and HRC were both significantly related to survival and hospitalization for worsening HF, the lowest BHR and the greatest HRC being associated with best survival and reduction of hospital admissions.

[Septic false aneurysm of the ascending thoracic aorta. Value of covering omentum repair].

The incidence of post-sternotomy mediastinitis is 1 to 5% but the mortality is about 40%. The formation of a pseudo-aneurysm is a rare complication and an infectious origin is exceptionally rare. Diagnosis must be early because of the risk of rupture.

[Late potentials in chronic alcoholics].

Objective: Cardiac arrest is the most frequent cause of death in chronic alcoholics. Detection of late potentials in this population could be helpful in screening from early signs of myocardial disorders and identifying patients at risk of severe ventricular dysrythmia.

Patients And Methods: A prospective study of late potentials was conducted in 53 subjects (mean age 49 +/- 10 years) with a history of long-standing alcohol abuse (mean 13.

[Signal averaging electrocardiography in chronic alcoholism].

Cardiovascular death is the main cause of mortality in chronic alcoholics, perhaps due to a pro-arrhythmogenic effect of alcohol associated with infraclinical myocardial lesions. The authors investigated prospectively 41 patients (average age: 49.7 years) who were chronic alcoholics but had no acute alcoholic episodes for cardiac disease (ECG, signal averaging for late ventricular potentials, echocardiography and Holter ECG monitoring) and hepatic disease (liver biopsy).

Late ventricular potentials and heavy drinking.

Objectives: To assess the effects of chronic drinking on detection of low amplitude signals, and to determine the relation between late ventricular potentials (LVP) and liver biopsy findings.

Design: Prospective study.

Setting: General hospital.

[Do arrhythmias after infarction deter patients from smoking?].

Although the short-term outcome of patients treated by thrombolysis during the acute phase of myocardial infarction is now well known, data concerning the repercussions of the coronary accident on smoking are less clearly established. This aspect is particularly important, as cessation of smoking is one of the most effective measures in the context of secondary prevention, with an excellent cost-benefit ratio. Between 1985 and 1991, 218 consecutive patients underwent thrombolysis for myocardial infarction.

[Practical value of the detection of silent myocardial ischemia in patients with coronary disease using Holters].

The prognosis of painless myocardial ischemia is similar to that of symptomatic ischemia. The Holter technique (and solid memory Holter in particular) is a simple method of detection which, taken together with exercise testing, enables the identification among coronary disease patients of a high risk group in whom effort ischemia is accompanied by episodes of ischemia under everyday conditions and in whom additional investigations (exercise thallium scan then coronary arteriography) and appropriate treatment, including transluminal angioplasty and aorto-coronary bypass if necessary, may be required. The role of drug treatment in silent ischemia has not yet been clearly defined.

[Diffuse cholesterol embolism after fibrinolysis for myocardial infarction].

The authors report the case of a 57 year old man admitted to hospital 3 hours after the onset of an infero-latero-basal infarct who underwent thrombolytic therapy with intravenous streptokinase, in whom the immediate outcome was complicated by multiple cholesterol embolisation which cause renal failure, mesenteric ischemia, medullary ischemia and livedo reticulosis of the lower half of the body complicated by gangrene of the toes, despite the fact that cardiac catheterisation had not been performed. This case (fifth reported case) of multiple cholesterol embolisation from the abdominal aorta caused by thrombolysis is the earliest presentation of this complication in the literature.

[Hemodynamic study of intravenous milrinone in 26 patients with NYHA class III or IV cardiac failure].

The hemodynamic effects of milrinone (WIN 47203) were studied in 26 NYHA Class III or IV patients. The compound was administered intravenously using a protocol including an initial push dose of 50 micrograms/kg in 10 min, followed by a 24 hour infusion at the dose of 0.5 microgram/kg/min.

[Can solid state Holter monitoring replace endomyocardial biopsy in patients with heart transplantation?].

Acute cardiac graft rejection after transplantation, the diagnosis of which is based on the findings of endomyocardial biopsy, is associated with a reduction in coronary reserve due to abnormalities of the microcirculation. But this reduction in coronary reserve cause silent myocardial ischaemia (SMI)? In order to assess the frequency of SMI and ventricular arrhythmias during rejection, 53 consecutive Holter recordings were performed in 32 patients (28 men, 4 women, average age 47 +/- 11 years) 11 months after transplantation and within 24 hours of endomyocardial biopsy. The recorder which was used (Monitor One TC) analysed the ST segment in 2 leads in real time: ST segment depression of more than 1 mm lasting over 40 ms, 0.

[Primary isolated dissection of the left anterior descending coronary artery].

The authors report the case of a 30 year old Senegalese man admitted with an acute antero-septo-apical myocardial infarction which was fibrinolysed at the 5th hour. Coronary angiography showed dissection of the left anterior descending artery. This young patient with no previous medical history or cardiovascular risk factors had an abnormal skin biopsy showing proliferation of the elastic tissues.

[Silent myocardial ischemia during hemodialysis in patients with chronic renal insufficiency].

A prospective search for episodes of silent myocardial ischaemia (SMI) was carried out during sessions of haemodialysis in 62 patients with chronic renal failure and was positive in 37.1% of the cases. The occurrence of SMI is correlated with the number of cardiovascular risk factors (p = 0.

[Frequency of painless myocardial ischemia during hemodialysis in 50 patients with chronic kidney failure].

The authors carried out a prospective study to determine the frequency of silent ischemia (SI) in 50 consecutive patients with end stage renal failure during dialysis by Holter monitoring. Twenty patients had SI (40%). This event was related to the number of cardiovascular risk factors (p = 0.