[Cardio-vascular assessment before starting to exercise after the age of 70]. / Bilan cardio-vasculaire pour débuter une activité sportive après 70 ans.

Taking care of an elderly patient involves encouraging them to do some exercise. Ageing is responsible for a gradual loss of our capacity to adapt. Taking up a sport after the age of 70 must be done gradually and be preceded by a certain number of medical examinations, in particular an assessment of cardiac function.

Point-of-Care Capillary Blood Creatinine: A Prospective study in Cardiology and Nephrology Outpatients.

BACKGROUND: The radiological or interventional use of contrast medium exposes patients to a risk of contrast-induced nephropathy. Pre-existing kidney failure is a major risk factor. Point-of-Care Capillary blood creatinine tests are promising; their speed might help to optimize treatment decisions and patient care in these situations. METHODS: The objective of the present study was to assess the ability of a new point of care capillary blood creatinine test (Stat Sensor X-press, Nova Biomedical Cooperation, Waltham, MA, USA) to diagnose kidney failure, relative to a standard lab-based plasma creatinine assay. A total of 113 patients 33 women (29.2%) were included. The capillary blood creatinine concentration was significantly correlated with the plasma creatinine concentration in both men (Pearson's r [95% Confidence Interval (CI)] = 0.84 [0.75 - 0.89]; p<0.001) and women (Pearson's r [95%CI] = 0.95 [0.89 - 0.97]; p<0.001). The test's diagnostic performance was satisfactory, its sensitivity was 70% [35 - 93] in women and 78% [52 - 94] in men, and its specificity was 91% [72 - 99] in woman and 93% [84 - 98] in men. CONCLUSION: Rapid Point-of Care Capillary creatinine test is an easy-to-use, accurate tool for detecting kidney failure before a patient is exposed to procedures involving contrast medium. The POC test performed less well in patients over the age of 75 and in patients with high plasma creatinine level.

Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report.

BACKGROUND: Noninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive end-expiratory pressure can induce or worsen a right-to-left shunt through a patent foramen ovale associated with systemic hypoxemia. Thus, in obese patients treated with noninvasive positive pressure ventilation, a paradoxical worsening of hypoxemia may reveal the existence of a patent foramen ovale. CASE PRESENTATION: A 50-year-old African woman was referred to our sleep center for severe obstructive sleep apnea syndrome and obesity hypoventilation syndrome. Because she had alveolar hypoventilation and had failed previous obstructive sleep apnea syndrome therapy, noninvasive positive pressure ventilation was started. In May 2015, she had a normal residual apnea/hypopnea index calculated by the ventilator software with no hypoventilation. Six months later, severe hypoxemia without hypercapnia was noted. Contrast transthoracic echocardiography showed right-to-left shunt through a patent foramen ovale. This finding prompted a decrease in expiratory and inspiratory positive airway pressures, after which the ventilator software recorded a normal residual apnea/hypopnea index and the blood gas values improved. CONCLUSION: Noninvasive positive pressure ventilation therapy for combined obstructive sleep apnea syndrome and obesity hypoventilation syndrome must be monitored by arterial blood gas measurements, both to reassess the hypercapnia and to look for worsening hypoxemia due to a patent foramen ovale.

Incidence, Characteristics, Risk Factors, and Outcomes of Takotsubo Cardiomyopathy With and Without Ventricular Arrhythmia.

Takotsubo cardiomyopathy (TC) is a medical entity mimicking an acute coronary syndrome (ACS). Ventricular arrhythmia (VA) in TC has been reported in small studies, leading to uncertain knowledge of its incidence. We sought to describe the characteristics, incidence, predictive factors, and outcomes of VA in patients presenting with TC. Over a 12-year period, we reviewed all patients (n = 5,484) referred to our coronary care unit for a suspicion of ACS. TC was diagnosed in 90 patients according to the Mayo Clinic criteria. Incidence of VA among TC was 10%. In multivariate analysis, the factors significantly associated with an increased risk of VA were syncope (p = 0.007), age <55 years (p = 0.008), atypical TC (p = 0.04), a troponin I peak >7 µg/L (p = 0.04), and dobutamine use during hospitalization (p = 0.04). During follow-up, there was no significant difference in mortality rate between patients with or without VA. In conclusion, VA occurred in 10% of patients at the acute phase of TC and independent predictive factors of VA were syncope, atypical pattern of TC, high troponin peak, dobutamine use, and a relatively young age in a female and menopausal population. During the acute phase, identification of high-risk patients with VA allows better management, with electrocardiographic monitoring and therapeutic intervention in the coronary care unit.