[Cardiac erethism]. / L'éréthisme cardiaque.

Cardiac erethism is a state of hyperexcitability of the heart. It results in hyperpulsatility, which is characterized by an ample pulse, an accentuation of heart sounds on auscultation, and an exaggeration of heart movements on echocardiography. While it can be very troublesome, cardiac erethism has no pathological significance. However, care must be taken to exclude any underlying cardiac or extracardiac pathology before confirming the diagnosis. No treatment is usually considered except to reassure the patient and avoid contributing factors. Beta-blockers are effective and should be prescribed on a case-by-case basis.

L'éréthisme cardiaque est un état d'hyperexcitabilité du cœur. Il en résulte une hyperpulsatilité qui se caractérise par un pouls ample, une accentuation des bruits cardiaques à l'auscultation et une exagération des mouvements cardiaques à l'échocardiographie. Bien qu'il puisse être gênant, l'éréthisme cardiaque n'a aucune signification pathologique. Cependant, il faut veiller à exclure toute pathologie cardiaque ou extracardiaque sous-jacente avant de confirmer le diagnostic. Aucun traitement n'est habituellement prescrit sauf pour rassurer le patient et éviter les facteurs contributifs. Les bêtabloquants sont efficaces et doivent être prescrits au cas par cas.

Identification of cardiac repercussions after intense and prolonged concentric isokinetic exercise in young sedentary people.

INTRODUCTION: Cardiopathies are the world's leading cause of mortality and morbidity. Although rare, cardiovascular accidents can occur during intense and infrequent sporting activity, particularly among those who are unaware of their heart condition. The development of cardiospecific biochemical markers has led to a reconsideration of the role of biology in the diagnosis of cardiovascular illnesses. The aim of this study therefore was, through the use of cardiac biomarker assays, to highlight the impact of sustained physical effort in the form of intense and prolonged concentric isokinetic exercise and to research potential cardiovascular risks. MATERIALS AND METHODS: Eighteen subjects participated in a maximal concentric isokinetic exercise involving 30 knee flexion-extensions for each leg. Five blood tests were taken to study the kinetics of the cardiac biomarkers. Haemodynamic parameters were measured continuously using a Portapres, and respiratory parameters were measured using a Sensormedics Vmax 29C. RESULTS: The results showed significant increases in the creatine kinase, myoglobin, homocysteine and haemoglobin cardiac markers. Evolutionary trends were also observed for the following biomarkers: NT-proBNP, myeloperoxydase and C-reactive protein. All the physiological parameters measured presented statistically significant changes. CONCLUSION: Isokinetic effort leads to the release of cardiac markers in the blood, but these do not exceed the reference values in healthy subjects. Maximal concentric isokinetic exercise does not, therefore, lead to an increased risk of cardiovascular pathologies.

Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy.

AIMS: Lack of response to cardiac resynchronization therapy (CRT) may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on left ventricular (LV) reverse remodelling (decrease in LV end-systolic volume > or =15% after 6 months of CRT). METHODS AND RESULTS: Fifty-one consecutive patients with heart failure underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve and local contractile reserve (assessed by two-dimensional speckle tracking) in the region of the LV pacing lead. Responders (30 patients) showed a greater exercise-induced increase in left ventricular ejection fraction (LVEF) compared with non-responders (P < 0.001). Contractile reserve was directly related to the improvement in LVEF and to LV reverse remodelling after 6 months of CRT (P < 0.001). A 6.5% exercise-induced increase in LVEF yielded a sensitivity of 90% and a specificity of 85.7% to predict the response after 6 months of CRT. Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders than in non-responders (P < 0.0001). CONCLUSION: Myocardial contractile reserve (global and regional) is a strong predictive factor of LV reverse remodelling after CRT.

Impact of contractile reserve on acute response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation. METHODS: Fifty-one consecutive patients with heart failure (LV ejection fraction 27% +/- 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume > or = 15% after CRT. RESULTS: Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p < 0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p < 0.0001). CONCLUSION: The present study showed that response to CRT largely depends not only on the extent of LV dyssynchrony and the severity of mitral regurgitation but also on the presence of contractile reserve.

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure.

Cardiac resynchronization therapy (CRT) reduces functional mitral regurgitation (MR) at rest. This study assessed exercise-induced changes in MR in patients with heart failure who were helped by CRT. The determinants of these exercise-induced changes in MR were analyzed in asynchronous and resynchronized left ventricles.