[Role of low-molecular-weight heparin in acute coronary syndromes]. / Place des héparines de bas poids moléculaire dans les syndromes coronariens aigus.

Looking to their efficiency in the treatment of venous thrombosis and the problems caused by non fractioned heparins (NFH) in the treatment of acute coronary syndromes, several studies were realised to prove the interests of fractioned heparins (FH) as good alternative therapeutics in acute coronary syndromes. A fist attempt, FRISC study, showed that dalteparin was superior to the placebo given in patients receiving aspirin (75 mg daily). In the FRIC study the pursuit of dalteparin between the sixth and the fortieth day, at a low dose, don't give benefits compared to aspirin given simply. Enoxaparin seems to be superior to the NFH in ESSENCE and TIMI IIB studies:--In ESSENCE study witch was included 3171 patients with unstable angina or non Q wave myocardial infarction and all patients received aspirin, enoxaparin compared to NFH reduced significantly the combined risk of death, myocardial infarction, recurrent ischemia and the need of revascularisation. These benefits persisted after a year of the study:--TIMI IIB study realised in 3910 patients confirmed the results of ESSENCE study. Furthermore, their proved efficiency in unstable angina and the non Q wave myocardial infarction, a recent study published this year (2002) concluded that the use of FH, in patients with myocardial infarction and receiving fibrinolytic treatment (streptokinase), was associated of a less frequent major adverse cardiac evenment (MACE) than in patients receiving NFH.

[Sinus node dysfunction in a "healthy heart" in an infant. A case report]. / Dysfonction sinusale à "coeur sain"chez l'enfant. A propos d'un cas.

Sinus node dysfunction (SND) is a rare cause of bradycardia in children without structural heart disease. However the association between (SND) and abnormality of atrio-ventricular conduction, is more uncommon. We report a case of a child 23 months old, admitted in the cardiology department for a symptomatic bradycardia. Routine ECG and 24-h-Holter monitoring showed atrioventricular junctional rhythms with minimal rates of 24 bpm and episodes of asystole with a maximal duration of 3.7 seconds. The children was implanted with a permanent VVIR mode pacemaker to relieve his symptoms. During a follow-up period of four years, the child developed syncope, the epicardial pacing lead was broken and atrioventricular block was observed. A second pacemaker was inserted by a subclavicular vein, and was programmed in VVIR mode.