RESUMO
Age is the most important determinant of outcome for patients with acute coronary syndromes [ACS] and ischemic heart disease is the leading cause of death among elderly patients. To determine the epidemiologic particularities, the clinical presentation, and the treatment of Acute Myocardial Infarction [AMI] in patients over 65 years. One hundred patients >65 years of age with myocardial infarction were hospitalized in intensive care of cardiologic unit of Military Hospital of Tunis between 2000 and 2008. Clinical characteristics, reperfusion therapy and outcomes of in-hospital period and for one year follow-up were seen for every patient. The mean age of our population was 77 years. Sex-ratio was 3/1.Our population was divided into tow groups; patients aged between 65 and 75 years [48 patients] and those aged more than 75 years [52 patients]. Only 44% of our patients had arrived at the hospital within the first 12 hours. STEMI was found in 65% of our patients. At admission, 40% had congestive heart failure [[3] Killip II], 10% were in cardiogenic shock. Urgent reperfusion therapy was given to 58% of our patients; 33% received a thrombolytic therapy and 25% were allocated to primary PCI. During in-hospital period, 40% have developed congestive heart failure, 20% have had a cardiogenic shock and 12% were died. All these events were more frequent in patients aged over 75 years and reperfusion therapy was associated with best outcome. In our study invasive treatment such as fibrinolysis and PCI was associated to better outcome in acute period and at 12 months of follow up in elderly patients treated for AMI
RESUMO
Angioplasty of coronary arteries with a small diameter [commonly defined as diameter inferior than 2.75 mm] is associated with a high rate of restenosis and revascularization. Since the use of Drug Eluting Stents [DES] and considering their good results on simple lesions compared to other techniques [balloon dilation and bare metal stents], many studies have also demonstrated the superiority of DES in reducing restenosis and revascularization of complex lesions in particular lesions on coronary arteries with small diameter. Assessement of this revascularization procedure. Our study is a prospective one carried on between june 2002 and august 2006, involving a cohort of 299 patients. Patients are divided into 2 groups: group I: 175 patients with 220 lesions on coronary arteries with small diameter treated by 233 sirolimus DES [Cypher] and group II: 124 patients treated by 136 angioplasty of coronary arteries with diameter superior than 2.75 mm using 179 DES. During hospitalisation, there was no significant difference in MACE between the 2 groups. Nevertheless: 2 patients among the first group had no angioplasty because of unsuccessful progression of the balloon through the lesion and the absence of atherectomy in our center. All patients having acute thrombosis during hospitalization and presenting with ST elevated acute coronary syndrom had successful urgent revascularization with TIMI 3 flow. The mid-term follow-up [12 months] concerned 157/174 patients in group land 113/123 patients in group II. We observed a higher mortality and non fatal myocardial infarction in group I without statistically significant difference. despite the complexity of the lesions on coronary arteries with small diameter and despite the association with several risk factors in particular diabetes, the use of DES reduces the MACE specially secondary revascularisations thus improving early and midterm prognosis
Assuntos
Humanos , Masculino , Feminino , Reestenose Coronária/prevenção & controle , Stents Farmacológicos , Sirolimo , Estudos ProspectivosRESUMO
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
Assuntos
Humanos , Endocardite Bacteriana , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Marca-Passo Artificial/efeitos adversos , Staphylococcus aureus , Ecocardiografia , Contaminação de Equipamentos , Infecções Estafilocócicas/etiologiaRESUMO
Prerequis: 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 was 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 syncoe" "pathophysiology" "diagnosis" "tilt-table testing", "imlantableloop recorder", "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 treatemtn are largely empirical and this is due to our lack of understanding of the pathopysiology. 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 a isometric muscle tensing should be considered. Tilt training can also be considered first-line therapy in motivated patients. Nevertheless, if patients still experience sudden reccurrent and unpredictable episodes of syncoep, 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