[Cardiovascular disorders in patients infected with 2019 novel coronavirus]. / Atteintes du système cardiovasculaire chez les patients atteints de maladie à coronavirus 19.

The coronavirus disease 2019 (COVID-19) outbreak has become a worldwide public health concern. Cardiovascular complications are relatively frequent, reaching 20% of COVID-19 patients and 43% of COVID-19 patients admitted in Intensive Care Unit. Cardiac injury mechanisms are multiple, including hyperinflammation, pro-coagulant and pro-thrombotic states, sepsis related cardiomyopathy, hypoxia in relation with lung severity, hemodynamic instability, cytokine storm, critically illness, direct myocardial insult by acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and stress cardiomyopathy. The authors report a narrative review about cardio-vascular complications and predictive factors of mortality in patients infected with COVID-19.

[The role of spiral computerized tomography in the diagnosis of pulmonary embolism]. / Place actuelle de l'angioscanner spiralé dans l'embolie pulmonaire.

The diagnostic strategy of pulmonary embolism has changed in the last few years with the use of the pulmonary spiral angio-scan. It has become the investigation of first intention for the positive diagnosis of pulmonary embolism. Its limitations are known, essentially the difficulties in visualisation of distal pulmonary embolism. However, the introduction of new 64-slice scanners has considerably improved the resolution. The indications of the spiral angioscanner have recently increased with the study of pulmonary artery vascularisation and the calculation of Qanadli's obstruction index, the study of the peripheral venous system and the evaluation of right ventricular dysfunction by the calculation of the ratio of surfaces (or diameters) of RV/LV.

[Echographic calculation of left ventricular mass in TM mode]. / Calcul échocardiographique de la masse ventriculaire gauche en mode TM. Evaluation de nouvelles techniques d'imagerie.

UNLABELLED: TM sections of the left ventricle (LV) have only been validated in fundamental (F) imaging. We were interested in evaluating the repercussions of new imaging techniques, harmonic (H) and colour tissue Doppler (CTD), on the TM measurement of left ventricular mass (LVM), the reference imaging being F imaging. METHOD: We performed a prospective study, including 26 patients with a valid TM section. The LV and LVM parameters in F, H and CTD mode according to the Penn and ASE conventions as well as the inter-observer reproducibility were studied. RESULTS: The correlations for the LVM measurements between F and H, and between F and CTD were high whichever convention was used (r>0.95, p<0.0001). For each observer, the LVM in H and in CTD was always greater than the LVM in F with both conventions (p<0.02). A false diagnosis of LV hypertrophy was made in 27% of patients in H and in 15% of patients in CTD. The best inter-observer reproducibility was obtained in H: the average inter-observer difference (gr.) was 23+/-15 for H, 32+/-19 for F and 59+/-18 for CTD. CONCLUSION: H and CTD imaging entail an overestimation of LVM, essentially by overestimation of the parietal thickness of the LV. The inter-observer reproducibility was excellent in H and poor in CTD. The use of the harmonic mode for LVM calculation must be validated using new formulae.

[Acute lithium intoxication. Apropos of a case]. / Intoxication au lithium. A propos d'une observation.

Lithium salts are used in psychiatry for the treatment of bipolar depression. An overdose is potentially serious, sometimes fatal, and the clinical signs are variable. The authors report the case of a 70 year old man. He had a recent history of a transient ischaemic attack and was admitted to the coronary care unit for bradycardia at 35-40 BPM and episodes of sino-atrial block with a clinical presentation suggestive of a stroke. The diagnosis of lithium intoxication was made accounting for the present hospital admission and for the previous neurological event which had been diagnosed as a transient ischaemic attack. The difficulty of diagnosis of this condition is discussed.

[Negative D-dimers and peripheral pulmonary embolism]. / D-dimères négatifs et embolies pulmonaires périphériques.

The measurement of D-dimers is a recent addition to the diagnostic strategy of pulmonary embolism and has been shown to be a valuable tool with excellent sensitivity. However, there have been rare reports of patients with pulmonary embolism but negative D-dimer tests. The object of this study was to study patients with pulmonary embolism but negative D-dimers and to compare them with a population of patients with pulmonary embolism and raised D-dimers. One hundred and fifty consecutive patients admitted for pulmonary embolism were included in this study. All underwent measurement of D-dimers (normal <500 ng/ml) by an ELISA technique. The data of clinical examination and complementary investigations were analysed with respect to the D-dimers result. The sensitivity of raised D-dimers for pulmonary embolism was 96% (6 patients had results <500 ng/ml). The finding of chest pain was statistically greater in the group with negative D-dimers (p=0.01). In these cases, the emboli were all distal (p=0.0003), the average Miller index was significantly lower than in patients with high D-dimers (p=0.04) and the diagnostic value of ultrasound investigations (echocardiography, ultrasonography of lower limb veins) was less (p<0.0001). The authors conclude that measurement of D-dimers by the ELISA method may be non-diagnostic in distal pulmonary embolism and one explanation could be the less extensive thromboembolic process. In cases with negative D-dimers, a strong clinical suspicion of pulmonary embolism should lead to the request for further investigations.

[Isolated and asymptomatic Brugada syndrome. A case report]. / Syndrome de Brugada isolé et asymptomatique. A propos d'une observation.

The case report of a 32-year-old man with a Brugada syndrome is presented. He was asymptomatic and without familial history of sudden death or syncope. Diagnosis criteria for Brugada syndrome were 1--a pattern of right bundle branch block and ST-segment elevation in leads V1 and V2 on the ECG, 2--no cardiac structural anomalies. Symptomatic patients with this electrical anomaly are at high risk of sudden death and need an automatic implantable defibrillator. The outcome and the treatment of asymptomatic patients are a matter of debate and are discussed in this report.

[Incidence of acute cor pulmonale and deep venous thrombosis in acute pulmonary embolism]. / Incidence du coeur pulmonaire aigu et de la thrombose veineuse profonde dans l'embolie pulmonaire aiguë.

OBJECTIVE: Ultrasounds are a useful tool when looking for indirect evidence in favor of pulmonary embolism. The aim of this study was to determine the incidence of acute cor pulmonale and deep venous thrombosis revealed by ultrasonographic techniques in a population of patients presenting with pulmonary embolism. METHODS: 96 consecutive patients with a mean (+/- SD) age of 65 +/- 15 years, admitted to our hospital for pulmonary embolism were included in this study. The diagnosis of pulmonary embolism was made either by spiral computed tomography or selective pulmonary angiography. Each patient subsequently underwent both trans-thoracic echocardiography and venous ultrasonography. The diagnostic criterion used for defining acute cor pulmonale by echocardiography was the right to left ventricular end-diastolic area ratio over (or equal to) 0.6. Diagnosis of deep venous thrombosis was supported by the visualization of thrombi or vein incompressibility and/or the absence of venous flow or loss of flow variability by venous ultrasonography. RESULTS: Using ultrasounds, an acute cor pulmonale was found in 63% of our patients while 79% were found to have deep venous thrombosis and 92% of the patients had either acute cor pulmonale or deep venous thrombosis or both. All of the patients with proximal pulmonary embolism had acute cor pulmonale and/or deep venous thrombosis. The presence of acute cor pulmonale on echocardiography was significantly higher in patients with proximal pulmonary embolism (p < 0.0001). CONCLUSION: This study emphasizes the potential value of ultrasonographic techniques in the diagnosis of acute pulmonary embolism.