[Myocardial infarction following rapid perfusion of corticoids].

The authors report the case of myocardial infarction occurring immediately after rapid intravenous infusion of a high dose of corticosteroids prescribed for a relapse of multiple sclerosis. Ventriculography confirmed the myocardial damage but the coronary arteries were normal. An aetiological investigation was negative.

[Left main coronary artery disease].

There are many causes of left main coronary artery disease, the first of which is atherosclerosis. Other rarer causes may be observed, such as acute and chronic occlusions, spasm and primary and secondary dissection. The prevalence of stenosis of the left main coronary artery at coronary angiography is about 5%.

[Anesthesia and general surgery in cardiac patients].

Close cooperation is necessary between the cardiologist and anesthesiologist preoperatively in order to identify the risks associated with a surgical procedure. This article reviews the various types of anesthesia and their effects on the cardiovascular system, in particular in relation to the category of cardiovascular disease. Accurate definition of the operative risk involves thorough evaluation of three essential parameters: cardiovascular status, the type of surgery and the type of anesthesia.

Myocardial infarction and nicotine patch: a contributing or causative factor?

A case of angina pectoris revealed by nicotine patch treatment is described in a patient who continued to smoke and subsequently suffered a myocardial infarction. The various side effects of nicotine and its derivatives are recalled. The action of nicotine on coronary vasomotricity and its mediators is discussed.

[Painless infarction in antiphospholipid syndrome].

The authors report a rare case of myocardial infarction secondary to coronary thromboses caused by the antiphospholipid syndrome. The relations between the cardiac pathology, especially the coronary disease, and antiphospholipid antibodies are recalled. The importance and methods of monitoring the anticoagulant therapy are emphasised.

[A rare cause of loss of consciousness: mastocytosis. Apropos of 3 cases].

The authors report three cases of syncope due to systemic mastocytosis. This is a rare cause of syncope but should be recalled in certain circumstances. In the light of these cases, the authors review the literature with respect to this unusual presentation.

[Left bundle-branch block and chest pain of simultaneous occurrence during exercise].

The authors report a new case of left bundle branch block with pain during exercise, with arteriographically normal coronary arteries. Clinical findings and the course of the condition are reviewed. Pathophysiological mechanisms are discussed, with attribution of first place to an ischemic theory.

[Markers of hemostasis and myocardial infarction in persons under 40 years of age].

Coronary disease before the age of 40 has special clinical and pathogenic features. The authors sought evidence of the existence of abnormalities of hemostasis markers in 39 patients aged under 40, several weeks after a myocardial infarction (MI). Blood samples were drawn a mean of 8 months after the MI.

[Localized type 2 dissection unrecognized by transesophageal echography. Apropos of a case].

The authors report a case of type 2 dissection, strictly confined to the terminal portion of the ascending aorta, not seen by transesophageal echocardiography because of the existence of a blind spot and responsible for a false negative. The role of TEE in the diagnostic approach to dissections is reviewed, as are its limitations, of which it is important to be aware because of the poor prognosis of pathology of this type.

[Cerebral abscess disclosing congenital heart disease].

Cerebrovascular accidents and brain abscesses are the most worrisome complications of cyanogenic cardiac lesions in infants and young children, but remain rare in the adult. The authors report the case of a brain abscess which led to the subsequent discovery of a congenital cardiac malformation consisting of a ventricular septal defect and moderate pulmonary valve stenosis. Complete correction of the cardiac lesions was carried out three months after neurosurgical treatment (needle biopsy/drainage).

[Spontaneous angina caused by spasm of the left coronary artery].

A 42 year old woman presented with a one year history of retrosternal chest pain and back pain on effort and at rest sometimes accompanied by minor syncopal attacks. Transient atrioventricular block was documented during one such episode associated with hypotension. Coronary angiography showed spontaneous spasm of the left main coronary artery with clinical symptoms but no electrocardiographic changes.

[Spontaneous calcified coronary embolism and myocardial infarction. Apropos of a case].

The authors report a rare case of myocardial infarction due to calcific coronary embolisation in a patient with previously asymptomatic calcific aortic stenosis. The diagnosis was suggested by the finding of a lacunar image in the distal segment of the left anterior descending artery exactly corresponding to a punctiform mobile calcification visible before opacification of the coronary arteries. The clinical features of coronary embolism and in particular of calcific embolism are reviewed.

[Pheochromocytoma disclosed by isolated inflammatory syndrome].

Among the atypical forms of phaeochromocytoma the isolated inflammatory form is rare and difficult to diagnose clinically. The authors report such a case, where computerized tomography and magnetic resonance imaging contributed enormously to the diagnosis.

[Torsades de pointes and prolongation of the duration of QT interval after injection of droperidol].

Following a case of torsades de pointe (TDP) after the injection of droperidol (D), the authors studied the electrocardiographic variations caused by the drug. Fifty five unselected patients under the same conditions (general anesthesia) were given D (0.25 mg/kg IV).

[Echography and scintigraphy using technetium 99m pyrophosphate in the diagnosis of cardiac amyloidosis].

The diagnosis of amyloid cardiomyopathy was only based, until the last few years, on the results of invasive techniques. It seems presently that the combined contribution of cardiac sonography and scintigraphy using technetium 99m pyrophosphate, makes, most of the time, this diagnosis possible without need for additional examinations. This notion is illustrated by a typical case-report and data from the literature.