[Cardiac conduction disorders in athletes: diagnosis and management]. / Troubles de la conduction cardiaque chez le sportif : diagnostic et prise en charge.

BACKGROUND: The sino-atrial or atrio-ventricular conduction disturbances are commonly seen in athletes. They are due to predominant effect of the parasympathetic tone. AIM: To describe the physiological cardiac adaptation to physical exercises and to specify the limits of this activity in front of persons with conduction abnormalities. METHODS: Review of literature and lecture of recommendations. RESULTS: conduction disturbances in athletes disappear during physical activities. Their frequency is variously reported in literature. These disorders should be well considered particularly when they are priors to sport practice and need definitive implantable devices. Such decision must be taken after a detailed evaluation of the nature of the physical activity wished and the conduction disturbance type. CONCLUSION: The decision to allow competition should be take after a careful evaluation of the conduction disorder and the type of sport.

[Infective endocarditis on probe of pacemaker]. / L'endocardite infectieuse sur sonde de stimulateur cardiaque.

Infective endocarditis is an uncommon but potentially lethal complication of permanent cardiac pacing. Infection is mainly caused by local contamination during the implantation procedure. The most frequently detected causative microorganisms were staphylococci. The clinical presentation is often atypical causing prolonged diagnostic delay. Bacteriological data and visualisation of neostructures consistent with vegetations on transoesophageal echocardiography, strongly suggest pacemaker lead infection. Management is based on a combined approach using both prolonged antibiotic treatment and early complete device explantation. Percutaneous techniques are currently the method of choice for lead extraction but it is not without possible complications. Antibiotic prophylaxis in order to reduce infection risk related to pacemaker implantation is widely recommended.

[Overview on the management of vasovagal syncope]. / Mise au point sur la prise en charge de la syncope vasovagale.

BACKGROUND: Vasovagal syncope (VVS) is the most common type of syncope. Despite its benignity, quality of life may be severely affected in a significant proportion of highly symptomatic patients. AIM: To review achral knowledgement concerning vasovagal syncope, to assess the utility of diagnostic investigation and report the updat therapeutic management. METHODS: An electronic search of the relevant literature was carried out using medline. Key words used for the final search were "Vasovagal syncope" "pathophysiology" "diagnosis" "tilt-table testing", "imlantableloop recoder", "treatment", "tilt training", isometric muscle tensing", "cardic pacing". RESULTS: A typical history of VVS is usually sufficient to make the diagnosis without any additional testing. Further testing is required when the diagnosis remains uncertain. Approaches to treatment are largely empirical and this is due to our lack of understanding of the pathophysiology. The management of VVS is often limited to reassuring and advising how to avoid predisposing factors with behaviour modification. For patients with recurrent episodes of syncope and premonitory symptoms, a conservative nondrug approach such as isometric muscle tensing should be considered. Tilt training can also be considered first-line therapy in motivated patients. Nevertheless, if patients still experience sudden recurrent and unpredictable episodes of syncope, a more aggressive treatment strategy is required with need of a prophylactic pharmacologic therapy. Various forms of medical treatment have been proposed but there are limited data from randomized controlled trials to support their effectiveness. The role of cardiac pacing is controversial and its indication should be restricted to patients over the age of 40 with severe recurrent syncope that is refractory to other therapies and in whom episodes include a substantial bradycardic component.

[Chronic heart failure: role of Doppler echocardiography in the evaluation of mortality risk]. / Insuffisance cardiaque chronique: place de l'échocardiographie-doppler dans l'évaluation du risque de mortalité.

BACKGROUND: Chronic heart failure (CHF) is a major cause of morbidity and mortality. Despite recent improvements in the management of this condition, the overall prognosis remains poor. Echocardiography is the most useful test in the evaluation of systolic and diastolic function and has also a prognostic value. AIM: The aim of this study is to determine echocardiographic predictors of mortality in patients with CHF. METHODS: We followed 100 patients with a diagnosis of CHF over an average period of 44+/-40.5 months. We compared echocardiographic parameters in survivors and non survivors. RESULTS: Four variables predicted death: LVEF <35% (p=0.001), TDE <150ms (p=0.001), E/A ratio >2 (p=0.05) and E/Ea ratio >10 (p=0.008). CONCLUSION: Doppler echocardiography has a central role in the evaluation of patients with CHF. It provides valuable prognostic information by combination of several parameters.

[Influence of sex on immediate and late results of percutaneous coronary angioplasty]. / Influence du sexe sur les resultats immediats et tardifs de l'angioplastie coronaire percutanee.

Prior studies have reported worse results after percutaneous transluminal coronary angioplasty (PTCA) in women than in men. However, recent data suggest that this difference is less marked. The aim of our study is to evaluate whether the procedural outcome is equal in the two genders. Six hundred and eighty-eight PTCA were studied in 96 consecutive women and 509 men who underwent the procedure in our catheterization laboratory between 1998 and 2004. Women undergoing PTCA were older than men and had a higher incidence of diabetes, hypercholesterolemia and hypertension. Multivessel disease and severe coronary lesions were more frequent in women. The stenting rates, the use of drug eluting stents and of glycoprotein IIbIIIa inhibitors were similar in the two sexes. Procedural success rate was similar in the two groups. No significant differences were found in in-hospital mortality and in the resort to emergency coronary artery bypass grafting (CABG). 14 month after the procedure there were similar rates of death, repeated revascularisation and restenosis have been shown in the two sexes. Even if the baseline characteristics remain worse in women, increased experience of the operators, introduction of new stents and use of glycoprotein IIIbIIa inhibitors have improved the results in patients undergoing PTCA. This improvement has been higher in women than in men leading to the equalization of the outcome in the two sexes.

[Asymptomatic cor triatriatum sinister in adulthood]. / Le coeur triatrial gauche asymptomatique de l'adulte.

Cor triatrium sinister is a rare congenital disease (0,1% of cases of congenital heart disease). Cor triatrium is recognized by the finding of an abnormal fibromuscular membrane that subdivise the left atrium into posterosuperior and anteroinferor chambers. This anomaly creates an obstacle to the venous pulmonary flow. Depending on the severity of obstruction, cor triatrium may be symptomatic in childhood but it can be symtom free even in adulthood. Diagnosis of this abnormality has been easy supported by transthoracic and transoesophageal echocardiography.Treatment is easy to perform and consists in surgical defenitive correction in symptomatic patients. We report a case of a 31-year-old man in whom a non obstructive cor triatrium was discovered while evaluation for an atrial fibrillation secondary to a hyperthyroidism. According to this rare case we try to evaluate the severity and the outcome of this disease relating the literature data.

[Diagnostic and prognostic values of troponins in acute coronary syndromes]. / Valeurs diagnostique et pronostique des troponines au cours des syndromes coronariens aigus.

Coronary disease is a frequent clinical entity which, in some cases, makes a difficult diagnostic problem. However, the very big revolution realised these last decades in both diagnostics and therapeutics, improved management of these patients. Troponins which are specific and sensitive biomarkers of myocardial damage were evaluated in several domains, especially in acute coronary diseases. We purpose to clarify diagnostic and prognostic place of these markers in acute coronary disease in order to optimize their clinical use.

[Short coupled variant of torsade de pointes: our experience and review of the literature]. / La torsade de pointes a couplage court: notre expérience et revue de la littérature.

We present three cases of short-coupled variant of torsade de pointes with review of the literature. These women presented with syncope or presyncope due to torsade de pointes initiated by a short-coupled premature ventricular beat and without evidence of prolonged QT. There were no electrolyte disturbances in all cases, no apparent structural heart disease in two cases and a mild interventricular septum hypertrophy in the other case. One patient took spiramycin and metronidazole and another was taking pheniramin and lincomycin without any evidence of cause to effect relationship. One patient responded to verapamil but died suddendly after 44 months of follow-up. The two others recieved implantable cardioverter-defibrillators and verapamil per os. They still alive 46 and 54 months later. Short-coupled variant of torsade de pointes have a high incidence of sudden death, so it is very important for physicians to identify and treat it promptly. Long-term verapamil treatement is effective but still insufficient and patients should be considered for implantable cardioverter-defibrillator therapy.

[GPIIB/IIIA blockade after high-risk angioplasty: new perspectives]. / Les anti-GPIIB/IIIA, de l'angioplastie a haut risque vers de nouvelles perspectives.

The treatment of acute coronary syndromes knows today revolution, with the clinical use of platelet glycoprotein IIb/IIIa inhibitors. The benefit of these agents as adjunctive treatment for percutaneous coronary intervention has been substantial and consistently proved among trials; however patients undergoing revascularization after drug discontinuation demonstrated a moderate event reduction. In this analysis, including the entire large-scale trial experience of intravenous glycoprotein IIb/IIIa inhibitors, we try to evaluate this therapeutic class in the high risk coronary intervention, in patients with acute coronary syndromes primarily medically managed, and in combination therapy with thrombolytics in the acute myocardial infarction. The purpose was to demonstrate the reduction of cardiac events after administration of this drug in the different indications and to precise their different adverse effects.

[Role of fibrin D-dimer in acute coronary syndrome. Prospective study of 22 cases]. / Intérêt des D-dimères dans les syndromes coronariens aigus. Etude prospective à propos de 22 cas.

Fibrin D-dimer are the consequence of an excess of fibrinolysis. The raise of their level in coronary heart disease seems to be helpful to enhance the diagnosis of coronary ischemia. Prospective study over 4 months, including 22 patients (16 male, 6 female) divided in 2 subgroups: Group I: 10 patients investigated for stable angina Group II: 12 patients investigated for ACS without ST elevation. All patients underwent fibrin D-dimer dosage and coronarography. Fibrin D-dimer levels were higher in group II (924.5 ng/ml vs 703.9 ng/ml; p < 0.0001). In group II, 6 patients had ST depression with a level of fibrin D-dimer 879.5 ng/ml vs 969.6 ng/ml in the other 6 patients. We found a positive correlation between level of fibrin D-dimer and complexity of coronary lesions (1007 ng/ml in type C vs 675 ng/ml in type A lesions; p < 0.0001). Fibrin D-dimer seems highly implicated in coronary disease and if these results are confirmed by larger studies their routine dosage will be helpful in ACS.