[Chronic hiccups: diagnosis and treatment]. / Hoquet chronique : diagnostic et traitement.

Chronic hiccups, lasting more than 48 hours, are a medical condition that remains challenging in both diagnosis and treatment. They can be the sole symptom of a serious underlying disorder, and should therefore not be overlooked, although gastroesophageal reflux disease (GERD) constitutes their most prevalent cause. Chronic hiccups mandate a comprehensive etiological assessment. Treatment strategy may include physical, pharmacological and interventional approaches, as described in literature, particularly when direct causal treatment is unattainable.

Le hoquet chronique, de plus de 48 heures, est une entité dont la prise en charge est souvent méconnue. Il ne doit pas être négligé parce qu'il peut être le seul symptôme d'une maladie sous-jacente grave, même si le reflux gastro-œsophagien (RGO) en est la cause la plus fréquente. Face à un hoquet chronique, un bilan étiologique doit donc être effectué. Dans les cas où un traitement causal n'est pas envisageable, plusieurs possibilités de traitements physiques, médicamenteux et interventionnels sont décrites dans la littérature.

Masked hypertension and cardiac remodeling in middle-aged endurance athletes.

OBJECTIVES: Extensive endurance training and arterial hypertension are established risk factors for atrial fibrillation. We aimed to assess the proportion of masked hypertension in endurance athletes and the impact on cardiac remodeling, mechanics, and supraventricular tachycardias (SVT). METHODS: Male participants of a 10-mile race were recruited and included if office blood pressure was normal (<140/90 mmHg). Athletes were stratified into a masked hypertension and normotension group by ambulatory blood pressure. Primary endpoint was diastolic function, expressed as peak early diastolic mitral annulus velocity (E'). Left ventricular global strain, left ventricular mass/volume ratio, left atrial volume index, signal-averaged P-wave duration (SAPWD), and SVT during 24-h Holter monitoring were recorded. RESULTS: From 108 runners recruited, 87 were included in the final analysis. Thirty-three (38%) had masked hypertension. The mean age was 42 ±â€Š8 years. Groups did not differ with respect to age, body composition, cumulative training hours, and 10-mile race time. Athletes with masked hypertension had a lower E' and a higher left ventricular mass/volume ratio. Left ventricular global strain, left atrial volume index, SAPWD, and SVT showed no significant differences between the groups. In multiple linear regression analysis, masked hypertension was independently associated with E' (beta = -0.270, P = 0.004) and left ventricular mass/volume ratio (beta = 0.206, P = 0.049). Cumulative training hours was the only independent predictor for left atrial volume index (beta = 0.474, P < 0.001) and SAPWD (beta = 0.481, P < 0.001). CONCLUSION: In our study, a relevant proportion of middle-aged athletes had masked hypertension, associated with a lower diastolic function and a higher left ventricular mass/volume ratio, but unrelated to left ventricular systolic function, atrial remodeling, or SVT.

Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation.

BACKGROUND: Left atrium (LA) dilation and P-wave duration are linked to the amount of endurance training and are risk factors for atrial fibrillation (AF). The aim of this study was to evaluate the impact of LA anatomical and electrical remodeling on its conduit and pump function measured by two-dimensional speckle tracking echocardiography (STE). METHOD: Amateur male runners >30 years were recruited. Study participants (n=95) were stratified in 3 groups according to lifetime training hours: low (<1500 h, n=33), intermediate (1500 to 4500 h, n=32) and high training group (>4500 h, n=30). RESULTS: No differences were found, between the groups, in terms of age, blood pressure, and diastolic function. LA maximal volume (30±5, 33±5 vs. 37±6 ml/m(2), p<0.001), and conduit volume index (9±3, 11±3 vs. 12±3 ml/m(2), p<0.001) increased significantly from the low to the high training group, unlike the STE parameters: pump strain -15.0±2.8, -14.7±2.7 vs. -14.9±2.6%, p=0.927; conduit strain 23.3±3.9, 22.1±5.3 vs. 23.7±5.7%, p=0.455. Independent predictors of LA strain conduit function were age, maximal early diastolic velocity of the mitral annulus, heart rate and peak early diastolic filling velocity. The signal-averaged P-wave (135±11, 139±10 vs. 148±14 ms, p<0.001) increased from the low to the high training group. Four episodes of non-sustained AF were recorded in one runner of the high training group. CONCLUSION: The LA anatomical and electrical remodeling does not have a negative impact on atrial mechanical function. Hence, a possible link between these risk factors for AF and its actual, rare occurrence in this athlete population, could not be uncovered in the present study.

Right ventricular adaptations and arrhythmias in amateur ultra-endurance athletes.

OBJECTIVE: Ultra-endurance sports are becoming increasingly popular in middle-aged amateur athletes. Right ventricular (RV) arrhythmogenic remodelling has been described in high-level endurance athletes, like professional cyclists. The clinical relevance for amateurs is unknown. DESIGN: We investigated male amateur runners of the 2011 Grand Prix of Bern, a popular 10-mile race in Switzerland. Participants were stratified according to their former participations in long-distance competitions: active controls (leisure-time runners), marathon runners and ultra-endurance athletes (78 and 100 km runners, long-distance triathletes). RV function and morphology were assessed by echocardiography, including two-dimensional speckle tracking. Primary endpoint was RV global strain. Ventricular ectopy was assessed by 24 h ambulatory Holter monitoring. Results were adjusted for lifetime training hours. RESULTS: 97 normotensive athletes were included in the final analysis. The mean age was 42±8 years. Compared with active controls and marathon runners, ultra-endurance athletes had significantly more lifetime training hours and participated more often in competitions. Groups showed no differences with regard to RV global strain (-21.8±2.9 vs -23.3±2.8 vs -21.7±2.3%; p=0.973) and RV end-diastolic area (22.1±2.9 vs 22.9±4.2 vs 23.2±3.5 cm(2); p=0.694). The number of premature ventricular contractions (PVCs) was weakly associated with the RV size (r=0.208; p=0.042). Overall ventricular ectopy was low (0-486 PVCs/24 h) and equally distributed between the groups. CONCLUSIONS: In our small sample of amateur athletes, long-term ultra-endurance sport practice was not associated with RV dysfunction or complex ventricular arrhythmias.