Mitral insufficiency with congenital double-orifice mitral valve in an elderly patient.

We describe the case of a 79-year-old woman with mitral insufficiency and a double-orifice mitral valve (DOMV), discovered by echocardiography. Transthoracic echocardiography showed two insufficiency jets. Transesophageal echocardiography revealed a DOMV. Each orifice was provided with a subvalvular apparatus. No associated congenital abnormalities were present. Our case demonstrates that even in elderly patients with a double regurgitant jet, DOMV should be suspected and assessed by transesophageal echocardiography.

[Recommendations for management of acute chest pain. Report of the Belgium Interdisciplinary Working Group on Acute Cardiology]. / Recommandations pour la prise en charge de douleurs thoraciques aiguës. Rapport du Groupe Interdisciplinaire Belge de Cardiologie Aiguë (BIWAC: Belgium Interdisciplinary Working group on Acute Cardiology).

The Belgium Interdisciplinary Working group on Acute Cardiology, including cardiologists, intensivists and urgentists was formed to provide consensus regarding the management of acute chest pain in the prehospital and the early hospital phase. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.

[Recommendations for the management of acute chest pain. Report of the Belgian Interdisciplinary Group on Acute Cardiology]. / Recommandations pour la prise en charge de douleurs thoraciques aiguës. Rapport du Groupe Interdisciplinaire Belge de Cardiologie Aiguë.

The Belgium Interdisciplinary Working Group on Acute Cardiology (BIWAC), including cardiologists, intensivists and urgentists was formed to give consensus regarding the management of acute chest pain in the prehospital and the early hospital phases. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.

Incidence and prognostic significance of asymptomatic ischaemia in patients with sustained ventricular arrhythmias.

The role of ischaemia in the natural history of sustained monomorphic ventricular tachycardia not related to acute myocardial infarction is not well documented. We examined 38 patients (mean age 60 years, mean ejection fraction 33%) with programmed electric stimulation and thallium scintigraphy to study the presence of perfusion defects and to assess its prognostic significance. Reversible perfusion defects (RPD), alone or in combination, were seen in 17 patients (44.7%), persistent perfusion defects (PPD) in 31 (81.5%), and RPD and PRD combined existed in 14 patients (37%). Normal scintigrams were obtained in only four patients. Segmental analysis gave a mean 'infarction score' (number of PPDs on a total of 15 segments) of 4.2; the mean 'ischaemia' score (number of RPDs) was 1.2. Recurrence of tachycardia or sudden death was observed in 14 patients during a follow-up of 17 +/- 13 months. The predictive value (PV) of the presence of a RPD for recurrence was 63%, the PV of its absence was 82%; the predictive accuracy was 74% (P = 0.0069). This was as important as the data obtained with the drug studies (+PV 83%; -PV 86%; overall PV 83%, P = 0.002). The mean ischaemia score was 3.3 in the group with recurrence and 2 in the patients without recurrence. As pharmacological studies are only feasible in a subgroup with inducible tachycardia, thallium scintigraphy is of benefit to a larger group for predicting effective drug therapy and the risk of recurrence.

A six years review on 53 cases of infective endocarditis: clinical, microbiological and therapeutical features.

Microbiological features, diagnostic investigations, treatment, and complication rate in 53 cases of infective endocarditis were reviewed in this study. Infection occurred both on prosthetic (47%) and native valves (38%), while in 15% of the cases no prior valvular disease was known. Streptococcal (38%) and staphylococcal (30%) infections were predominant. In 17% of the cases apparent negative blood cultures were obtained. The most frequent portal of entry was dental infection or manipulation (45%), however in 28% of the patients etiology remained obscure. Major clinical signs and symptoms included heart murmurs (96%), fever (91%), dyspnoea (32%), and splenomegaly (30%). Echocardiography revealed vegetations in 78%, aortic and mitral valve being nearly equally affected. All patients were medically treated and 53% received antibiotics prior to blood cultures. Associations of ampicillin or penicillin with an aminoglycoside (43%) and penicillinase-resistant antibiotics (30%) were most frequently administered. In 28% of the patients, it was necessary to insert a prosthetic (aortic or mitral) valve. During follow-up, heart failure (28%), embolization (11%), and infections (11%) were the major complications.