[Torsade de pointe resulting from a drug interaction between sotalol and ciprofloxacin]. / Torsade de pointe sur interaction médicamenteuse entre sotalol et ciprofloxacine.

Sotalol is a bêta-blocker and class 3 anti-arrhythmic. Ciprofloxacin is a fluoroquinolone antibiotic used against Gram - germs. Both drugs have a common adverse effect : they increase QT interval with a risk of torsade de pointe. The risk increases even more if other risk factors are present such as old age, female gender, renal failure, high blood pressure and ionic disturbances. Because a long QT interval is not associated with symptoms, only an electrocardiogram can establish the diagnosis. However, it's not rare that a torsade de pointe will reveal it. We report a clinical case of a long QT interval due to the association of sotalol and ciprofloxacin, which led to a torsade de pointe. Intravenous magnesium sulphate is the recommended treatment if haemodynamic parameters are good. If not, an external electric shock may be needed.

Le sotalol est un bêta-bloquant utilisé principalement comme anti-arythmique de classe 3. La ciprofloxacine est un antibiotique de la classe des fluoroquinolones, actif sur les germes Gram négatif. Ces deux médicaments présentent, comme effet secondaire commun, le fait d'augmenter l'espace QT avec un risque de torsade de pointe. Si on y ajoute les autres facteurs de risque d'un allongement de QT que sont notamment l'âge, le sexe féminin, l'insuffisance rénale, l'hypertension artérielle et les troubles ioniques, le risque de torsade de pointe est encore majoré. Comme un QT long ne s'accompagne pas de symptômes, seul l'électrocardiogramme permet d'établir le diagnostic. Il n'est néanmoins pas rare qu'une torsade de pointe le révèle. Nous rapportons ici un cas dont le QT long engendré par une association sotalol-ciprofloxacine s'est manifesté par une torsade de pointe chez une patiente âgée avec insuffisance rénale. Le traitement est le sulfate de magnésium par voie intraveineuse si les paramètres hémodynamiques restent bons. S'ils viennent à se dégrader, un choc électrique externe peut s'avérer nécessaire.

[Hypertensive crisis]. / Les crises hypertensives.

Hypertensive crisis has fortunately become rarer due to a better diagnosis and management of arterial hypertension. However, its development needs urgent management with adapted therapy according to the severity of the blood pressure levels and the associated clinical signs. After confirmation of severe hypertension (blood pressure above or equal to 180/120 mmHg), target organ lesions have to be looked for and according to their pre-sence, an urgent hospitalization has to be immediately organized. Starting active drug therapy often occurs in intensive units with the intravenous route of administration.

La crise hypertensive est devenue moins fréquente qu'auparavant, grâce au dépistage de l'hypertension et à sa prise en charge thérapeutique. Cependant, sa survenue expose le patient à un risque vital considérable. Il faut donc ne pas rater le diagnostic et la mise au point pour démarrer rapidement un traitement adapté selon le niveau de pression artérielle et les signes cliniques associés. Après avoir confirmé l'existence d'une hypertension sévère (pression supérieure ou égale à 180/120 mmHg), il faut rechercher la présence d'une défaillance viscérale. Si celle-ci est observée, une hospitalisation urgente s'impose avec un traitement sans attendre, souvent réalisé aux soins intensifs et par voie intraveineuse.

[Bipressil® : first single-pill combination of bisoprolol and perindopril arginine]. / Le médicament du mois BIPRESSIL® : Première association fixe bisoprolol et perindopril arginine.

In patients suffering from systemic arterial hypertension, coronary artery disease, or heart failure, beta-blockers and angiotensin-convertase enzyme inhibitors play a major therapeutic and preventive role. Coronary artery disease remains the leading cause of mortality in industrialized countries. Unless adapted preventive strategy, notably pharmacological interventions, cardiovascular events in these patients remain high. One reason for this relative failure is represented by non-adherence to treatment. A treatment consisting in an association in one pill of several different molecules should confer a higher treatment compliance and thus efficacy. This article describes the characteristics of the first available dual association between a cardioselective beta-blocker agent, bisoprolol, and an angiotensin-convertase enzyme inhibitor, perindopril arginine.

Chez les patients souffrant d'hypertension artérielle, de maladie coronaire, ou d'insuffisance cardiaque, les bêtabloquants et les inhibiteurs de l'enzyme de conversion de l'angiotensine jouent un rôle thérapeutique et préventif majeur. La maladie coronaire demeure actuellement la première cause de mortalité dans les pays industrialisés. Malgré des mesures préventives adaptées, notamment pharmacologiques, le taux d'événements cardiovasculaires reste élevé chez ces patients. Une des raisons de cet échec relatif réside dans le manque d'observance au traitement. Un traitement antihypertenseur consistant en une association en un seul comprimé de plusieurs molécules distinctes devrait permettre une plus grande adhérence au traitement et donc, efficacité. Cet article décrit les caractéristiques de la première double association fixe entre un bêtabloquant cardio-sélectif, le bisoprolol, et un inhibiteur de l'enzyme de conversion, le perindopril arginine.

[Increased heart rate as a risk factor and treatment target in patients with heart failure]. / Place du traitement médical bradycardisant dans l'insuffisance cardiaque.

Numerous epidemiological studies have shown that a high resting heart rate is associated with an increased cardiovascular morbidity and mortality, particularly in heart failure. The resting heart rate is not only a risk marker in heart failure, but it is also a risk factor, i.e., modifying heart rate also modifies the risk. Chronotropic drugs have shown benefits in terms of morbidity and mortality. Nevertheless, there is a major difference between the recommended heart rate and the patients’ everyday life heart rate. Indeed, even if the proportion of heart failure patients on beta-blockers is satisfactory, the number of patients with an optimal heart rate remains insufficient. The aim of this article is to examine the deleterious effect of an elevated resting heart rate in heart failure with systolic dysfunction, in order to overcome the therapeutic inertia and to improve the outcome in this patient group.

De nombreuses études épidémiologiques ont révélé qu'une fréquence cardiaque de repos supérieure à 75 battements par minute est associée à une morbi-mortalité cardiovasculaire augmentée, notamment chez les patients insuffisants cardiaques. La fréquence cardiaque de repos n'est pas seulement un marqueur de risque accru; elle est aussi un facteur de risque «modifiable¼. Plusieurs classes thérapeutiques chronotropes négatives ont démontré des bénéfices en termes de morbidité et mortalité. Néanmoins, il existe une différence majeure entre la fréquence cardiaque recommandée et celle de la vie de tous les jours. En effet, même si la proportion de patients insuffisants cardiaques sous bêta-bloquants est satisfaisante, le contrôle de la fréquence cardiaque demeure souvent insuffisant. L'objectif de cet article est de mettre en lumière le rôle délétère d'une fréquence cardiaque élevée au repos chez les insuffisants cardiaques souffrant de dysfonction systolique, afin de surmonter l'inertie thérapeutique et d'améliorer le devenir de ces patients.

[Old phenotype and new genotypes. Pituitary adenomas]. / VIEUX PHÉNOTYPE ET NOUVEAUX GÉNOTYPES. Actualités dans le domaine des adénomes hypophysaires.

Gigantism and acromegaly, usually caused by a pituitary adenoma linked inappropriate secretion of growth hormone (GH), are generally considered as very rare diseases, even if, according to some authors, their cumulative prevalence is about 1/5000. Starting from the historical case of a giant from Liège we shall describe the different types of GH pituitary adenomas and their pathophysiology. We shall particularly discuss rare forms of inherited GH secreting pituitary adenomas like the FIPA (familial inherited isolated pituitary adenomas) and the X-LAG (X linked acrogigantism), both described for the first time in Liège, in 2000 and 2014, respectively.

[A wing clipping beverage]. / Une boisson qui coupe les ailes.

Chronic consumption of soda energizing caffeine has known a growing success. Its deleterious effects, however, are often ignored. We report a case of tetraparesis associated with chronic excessive consumption of cola. The development of muscle weakness is variable, resulting from a hyperpolarization of excitable membranes. The outcome is most often favorable after potassium supplementation and interruption of the offending beverage consumption. The mechanisms involved are multiple and involve both a leakage of fecal and urinary potassium and a potassium entry into the intracellular compartment. Other mechanisms related to caffeine are also involved. It therefore appears mandatory to assess the consumption of such beverages in the presence of hypokalemia and muscle weakness.

[Importance of a bad adherence to the antihypertensive treatment in the hypertensive population. How to improve it?]. / Importance de la mauvaise adhésion au traitement antihypertenseur dans la population hypertendue: comment l'améliorer ?

Overwhelming evidence indicates that the treatment of arterial hypertension is beneficial, but, in practice, less than 50% of treated hypertensive patients have well-controlled blood pressure. The success of treatment relies upon adherence (for both non pharmacologic and drug treatment) by the patient. This problem of observance is multifactorial. Several factors play a role: the patient, his/her illness, his/her treatment and the therapeutic environment where the relationship between the medical doctor and the patient is crucial. To improve observance, but also treatment persistence we need to think about it. Observance must be discussed with the patient at each visit. An excellent relationship between doctor and patient, education about hypertension, its risks, and the ways to avoid complications, the choice of a well tolerated and simple treatment progressively introduced, the intervention in this management of the family and the pharmacist, the development of home self blood pressure measurement by the patient are all important ways to improve adherence. This could reduce the cardiovascular complications related to high blood pressure and thus decrease the general costs for the society.

[Why and how should the patient perform a correct home blood pressure measurement?]. / Pourquoi et comment faire mesurer correctement la pression artérielle par le patient.

Home blood pressure (BP) measurement is a medical prescription. The interpretation of the results must be left to the physician. This method is complementary to the classical office BP measurement and the 24 hour ambulatory blood pressure measurement. It must be proposed to some selected patients on the basis of their capacity of learning and understanding the place of the technique for the diagnosis and the treatment compliance. It allows a more active contribution of the patient to the management of her chronic disease and, this, may improve the prevention of cardiovascular complication. A normal blood pressure during self BP measurement is equal or lower to 135/85 mmHg or even lower in high cardiovascular risk patients. This new technique, already largely used by patients, needs adequate education and good advice for buying a validated device.