The impact of an ultra-trail on the dynamic of cardiac, inflammatory, renal and oxidative stress biological markers correlated with electrocardiogram and echocardiogram.

The aim of this study was to describe the effects of a 64.2 km ultra-trail on the biomarkers of muscle damage, inflammation and oxidative stress, and compare the results observed with an ECG and an echocardiogram, both performed before and after the race.Thirty-three ultra-trail volunteers (45.8 ± 8.7 years old) were enrolled in our study. Three blood tests were drawn from each runner, one just before (TPRE), one just after (TPOST) and the last 3 h after the end of the race (TPOST3h).All the markers increased. The maximum concentrations observed were at TPOST3h and were significant (p < 0.001) for creatine kinase, creatine kinase isoform MB, high-sensitivity C-reactive protein, uric acid and for the ratio of reduced glutathione to oxidised glutathione. However, in the case of myoglobin, high-sensitive troponin T, N-terminal pro-brain natriuretic peptide, oxidised glutathione, myeloperoxidase, cystatin C and creatinine, the most significant increases were at TPOST (p < 0.001). Modifications were observed in the medical imaging using echocardiography such as reduction of left ventricule end-sytolic and diastolic volumes and left ventricular global longitudinal strain. ECG showed electrical criteria for left ventricular hypertrophy and incomplete right bundle branch block after the race.Endurance races cause significant physiological stress to the body that can be measured by the increase of different biomarkers. From a laboratory perspective, it is important to take into account the possible exercise performed previous to the testing to avoid a misinterpretation of the results. From a training perspective, due to these increases in biomarkers, it is recommended that runners wait at least 72 h after an ultra-trail before subsequent training. In addition a transient impairment of ventricular function due to dehydration were observed.

[Sudden cardiac death prevention in athletes. Electrocardiogram interpretation: the Seattle criteria]. / Prevention de la mort subite chez le sportif. Apport de l'électrocardiogramme: les critères de Seattle.

Sudden cardiac death is the leading cause of death in athletes. Pre-competition screening including 12-lead electrocardiogram is recommended by the European Society of Cardiology. This attitude contributes to significantly decrease the risk of sudden cardiac death. We review the electrocardiographic criteria of Seattle that increase the specificity of screening in athletes.

[Cardiac amyloidosis, about an atypical case]. / Le cas clinique du mois. Amyloïdose cardiaque, a propos d'un cas atypique.

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease.

[Structured differential diagnosis of a transient impairment of consciousness]. / La vignette diagnostique de l'étudiant. Diagnostic différentiel structuré d'une perte brève de conscience.

Transient impairment of consciousness frequently prompts the patient to consult a neurologist or a cardiologist. Detailed medical history and physical examination allow to distinguish fainting from epileptic seizure, metabolic or psychogenic events. We report the history of an 83-year-old woman who presented a transient loss of consciousness.The vascular, investigation demonstrated a subocclusive stenosis of one of the internal carotid arteries. We shall consider the differential diagnosis of transient impairment of consciousness and discuss the relationship between fainting and carotid artery disease.

[Inadvertent implantation of a defibrillation lead in the left ventricle through a patent foramen ovale]. / Le cas clinique du mois: Implantation fortuite d'une sonde de défibrillation dans le ventricule gauche au travers d'un foramen ovale perméable.

Inadvertent insertion of a defibrillation lead in the left ventricle is a rare complication generally underdiagnosed after device implantation. Management is not strictly codified due to the small number of observed cases. We report the case of a 78 year-old man in whom the diagnosis has been performed lately during an echocardiography.

[Clinical case of the month. Purulent pericarditis in a patient with pulmonary sarcoidosis]. / Péricardite purulente chez un patient atteint de sarcoïdose pulmonaire.

We report the case of a patient, suffering from pulmonary sarcoidosis, who developed a purulent pericarditis complicated with a cardiac tamponade. The widespread use of antibiotics has progressively reduced the number of purulent pericarditis. However, it remains a serious disease that has to be rapidly diagnosed to be treated timely. We will review the required tests for the diagnosis and the treatment of this pathology that leads to death otherwise. The link with pulmonary sardoidosis is uncertain.

[The student diagnostic vignette. Electrocardiographical criteria for the diagnosis of ventricular tachycardia]. / La vignette diagnostique de l'étudiant. Critères électrocardiographiques d'une tachycardie ventriculaire.

Recording of a regular wide QRS tachycardia is often source of panic and anxiety for the young clinician who has to make the differential diagnosis between ventricular tachycardia and supraventricular tachycardia with aberration associated with fundamentally different vital prognosis. Most of the time, a rigorous approach and a systematic analysis of the electrocardiogram associated with clinical examination allow to obtain the correct diagnosis.

[Perspectives and recommendations for the anti-arrhythmic treatment of atrial fibrillation: focus on dronedarone]. / Perspectives et recommandations pour le traitement anti-arythmique de la fibrillation auriculaire: le point sur la dronédarone.

The European Society of Cardiology has recently published an update on the antiarrhythmic treatment of atrial fibrillation. The recommendations emphasize the safety aspect of the treatment. The first line antiarrhythmic medication should be chosen on the basis on a safer although possibly less efficacious profile while more potent but possibly more toxic agents should be reserved in case of treatment failure. Therefore, the use of amiodarone is reserved for cases who have failed treatment with class I agents or sotalol or have contraindications for their use. The recommendations put dronedarone, a new antiarrhythmic drug, as a first line treatment in the new therapeutic algorithm based on its safety profile and positive impact on morbi-mortality. This article presents the main properties of dronedarone based on the published results of randomized trials.

[How I explore: ventricular arrhythmias in athletes]. / Une arythmie ventriculaire chez le sportif.

Documented ventricular tachyarrhythmias or related symptoms need meticulous cardiac investigations. The mechanism of ventricular arrhythmia must be defined. The prognosis is related to underlying cardiac electrical or structural disorders. In the absence of cardiovascular abnormalities, the prognosis is good. No disqualification to competitive activity is required in most cases. Assessment of the risk of sudden death remains a continuing challenge in athletes. This article reviews the diagnostic and therapeutic approaches of ventricular arrhythmias encountered in trained athletes.

[The long QT syndrome]. / Le syndrome du QT long congénital.

The congenital long QT syndrome (LQTS) is a hereditary cardiac disease characterized by a prolongation of the QT interval > 440 ms at rest ECG associated with a high risk of ventricular arrhythmias (torsade de pointe). Clinical manifestations are syncope and sudden cardiac death. The implicated genes encode cardiac ion channel subunits or proteins involved in modulating ionic currents. The diagnosis of LQTS can be complex in borderline cases. Etiology, pathogenesis, diagnosis and treatment are discussed.

[2010 European guidelines for antithrombotic therapy in patients with atrial fibrillation and new risk score for the assessment of the risk of bleeding]. / Recommandations Européennes 2010 pour le traitement anti-thrombotique de la fibrillation auriculaire: Nouveaux scores pour l'évaluation des risques d'accident vasculaire cérébral et de saignement.

2010 European guidelines for the treatment of atrial fibrillation have introduced modified criteria for the instauration of oral anticoagulation. Guidelines also include a new score for the assessment of the risk of bleeding. We report the new risk scores CHA2DS2-VASc and HAS-BLED introduced for the assessment of thrombotic and bleeding risks, respectively.

[How I treat...paroxysmal narrow complex QRS tachycardia]. / Comment je traite...une tachycardie paroxystique à QRS fins par réentrée.

Paroxysmal narrow complex QRS tachycardias are a clinical entity characterized by abrupt onset and termination of palpitations, dyspnea, dizziness. They depend on mechanisms of reentry within the atrio-ventricular node or with the participation of an accessory pathway (reciprocating orthodromic tachycardia). We review the clinical and electrocardiographical diagnosis as well as the acute and long term treatment of these tachycardias.

[Adherence to the rules for antithrombotic treatment in atrial fibrillation]. / Adhésion aux règles du traitement anti-thrombotique dans la fibrillation auriculaire.

Adherence to the rules for antithrombotic ment in atrial fibrillation patients significantly reduces the risk of stroke. We review the criteria for the use of anti-vitamin K as well as its daily management in patients with atrial fibrillation.

[First episode of atrial fibrillation]. / La vignette thérapeutique de l'étudiant. Premier épisode de fibrillation auriculaire.

We report the case of a patient seen at the outpatient clinic for a first episode of atrial fibrillation. We discussed the steps of the treatment including anticoagulation, rate and rhythm control.

[Arrhythmogenic right ventricular dysplasia]. / Dysplasie arythmogène du ventricule droit.

Arrhythmogenic right ventricular dysplasia is an unfrequent disease that associates ventricular tachycardia with left bundle branch block morphology and right ventricular fibro-fatty degeneration. The etiology, pathogenesis, criteria for diagnosis and treatment are discussed.

[Recommended approach towards a fortuitously diagnosed cardiac arrhythmia]. / Attitude a adopter devant la découverte fortuite d'une arythmie cardiaque.

In the present article, we elaborate a rational approach for the initial management of arrhythmias by the general practitioner. We briefly review the electrocardiographic aspects of arrhythmias.

[The Brugada syndrome]. / Le syndrome de Brugada.

The Brugada syndrome, a genetically transmitted disease according to an autosomal mode with a variable penetrance, is responsible for sudden death secondary to polymorphic ventricular tachycardia. The diagnosis is based on a typical electrocardiographical paturn that combines a right bundle branch block with ST elevation in the right precordial leads. In high risk patients, the automatic implantable defibrillator has the unique capability to protect against the occurrence of ventricular arrhythmias.

[Paroxysmal atrial fibrillation]. / La fibrillation auriculaire paroxystique.

Paroxysmal atrial fibrillation is one of the most common disorders of cardiac rhythm. It is often a step toward permanent arhythmia, specially if associated with cardiac disease. The management objectives of intermittent arhythmia may be different, as maintenance of sinus rhythm. However, risks of stroke and thrombo-embolism are similar to those for sustained atrial fibrillation and must be carefully assessed. In this article we review the epidemiology, pathophysiology, clinical aspects and current guidelines for treatment and management of paroxysmal atrial fibrillation.

[Paroxysmal supraventricular tachycardia]. / Les tachycardies supraventriculaires paroxystiques.

Paroxysmal supraventricular tachycardias are often encountered in young and otherwise healthy patients. They are rarely life threatening even though they may alter the quality of life. In this article, we review the acute treatment of an episod of tachycardia and the prevention of recurrences.

[Syncope]. / La syncope.

Syncope remains a clinical challenge. Accurate history taking, physical examination and EKG are mainstays of the diagnosis work up. The most important parameter for prognosis and requiring aggressive management is a structural heart disease. Patient without cardiopathy presenting multiple episodes may be candidate for tilt testing and loop EKG recorder.