[non-Q wave myocardial infarction: study of 31 cases]. / Infarctus sans onde Q: etude descriptive de 31 cas.

The frequency of non-Q wave myocardial infarction is permanently increasing. In this retrospective study, we have tried to establish the clinical features, the prognosis and the therapeutic possibilities in this entity. We have studied the clinical history, the physical examination data, the results of the different explorations and the short and long term general course in 31 patients with a non Q wave myocardial infarction. The main feature of this acute coronary syndrome is the preservation of the myocardial function (normal in 64% of the patients). Concerning the angiographic finding, we note a high prevalence of severe coronary damages particularly of the stenosis of the left main coronary artery (13.5%); but also an important proportion of normal coronary angiographies (20%). In addition to the known factors associated with a poor prognosis in coronary artery disease, we insist on the severity of the initial depression of the ST-segment. The prognosis of the non Q wave myocardial infarction is better at the initial phase than that of the "transmural infarction". However, it becomes similar or worse at the long term general course. The important progress in the prognosis markers and in the anti-thrombotic and interventional therapies may maintain at the long term course the good initial prognosis.

[Myocardial infarction revealed by ischemic stroke]. / Infarctus du myocarde révélé par un accident vasculaire cérébral.

Ischemic cerebral infarction associated with myocardial infarction is yet a real diagnosis challenge. If during the acute myocardial phase the mechanism is mostly embolic, at long-term, the mechanism is not clearant and other causes should be searched. We report a 50 year old man with ischaemic stroke with strong evidence of myocardial infarction in the late phase with wall-motion abnormality and mural clot revealed by echocardiography and Q waves. Atrial fibrillation was suspected and no other abnormalities could be found. The diagnosis of cardio-embolic ischaemic stroke could not be made with certainly.

[Prognostic value of echocardiographic parameters in chronic cardiac insufficiency]. / Valeur pronostique des parameters echographiques chez l'insuffisant cardiaque chronique.

This work was interested in 72 patients (81% males) with chronic heart insufficiency. Ail these patients had a sinusal rythme. The etiology was mainly idiopathic (36%) but also ischemic (64%). 15% of patients were at stage I of NYHA, 37.5% at NYHA II, 40.5% at NYHA III and 7% at NYHA IV. All patients had taken a medical treatment (in 85% of cases, this treatment was based on diuretics and IEC). Transthoracic echocardiography was performed in these patients to determine the telediastolic diameter (TDD = 69 mm), the telesystolic diameter (TSD = 57), the velocity of E wave (0.66 mis) and A wave (0.55 mis) and the E wave deceleration time (DT = 0.196 s), 11 from ali patients were dead after a period of observation 21 months. The factors of pejorative prognostic were: the stages III and IV of NYHA, the cardiothoracic ratio > 0.60 and the echocardiographic parameters: TDD, TSD and DT (p = 0.03, p = 0.02 and p = 0.0001 respectively). But the E and A velocity seems don't influence the prognostic.

[Permanent ventricular tachycardia: prognostic and therapeutic problems: three case reports]. / Les tachycardies ventriculaires incessantes: problèmes pronostiques et thérapeutiques: a propos de trois observations.

The permanent ventricular tachycardia (PVT) represent a rare and dangerous arrhythmia that causes prognostic and therapeutic difficulties. Three patients admitted during last year for PVT complicating ischemic cardiomyopathy in two cases and idiopathic cardiomyopathy in the last case. These patients were admitted from emergency department for sustained monomorphic ventricular tachycardia. The ECG showed wide QRS tachycardia of ventricular origin. The direct current shock (DCS) has revealed ECG criteria of old myocardial infarction in two cases. The transthoracic echocardiography displayed dilated left ventricule (LV) with 35% mean ejection fraction. It also showed the presence of LV aneurysm in one case. The cardiac catheterization showed proximal left anterior descending artery obstruction in one patient and left circomflex artery stenosis in other patient. There was no indication of revascularization because of the age of myocardial infarction. The follow-up of these patients demonstrated the persistence of the VT for at least 6 days with recurrence after the DCS and resistant to Lidocaïne-Amiodarone association. The sinus rhythm was established by the propranolol-Amiodarone in one patient, Amiodarone added to treatment of congestive heart failure for the patient with ventricular aneurysm. The third patient died after one week of PVT complicated by cardiogenic shock just before a trial of radiofrequency ablation (RFA). We concluded through these cases that PVT is a troublesome arrhythmia for more than one reason. It appears of tewly in patients with advanced cardiomyopathy worsening the hemodynamic conditions oftenly the pharmacological treatment is mostly always difficult. The treatment of choice is RFA for those resistant to medical treatment.

[Doppler echocardiography and arhythmogenic right ventricular dysplasia]. / Echocardiographie-Doppler et dysplasie arythmogène du ventricule droit.

The aim of this study is to evaluate new echocardiographic modes in diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). Our study is prospective, including ten patients with ARVD and a control group of ten healthy subjects. Transthoracic echocardiography included evaluation of classical criteria's, cross sectional measurements of the right ventricular. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral and septal positions. Assessed by M mode, the total amplitude of the tricuspid annular motion was decreased in the lateral and septal positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (Ea) velocity and an accompanying decrease in early (Ea) to late diastolic(Aa) velocity ratio in all positions; the systolic annular velocity was decreased only in the lateral position. Tricuspid annular measurement are valuable, easy to obtain and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non specific sign of disease.

[Congenital auriculo-ventricular block in the adult]. / Le bloc auriculo-ventriculaire congenital en milieu adulte.

In this work we report a consecutive series of ten patients having auriculoventricular block "presumed" congenital which is seen in adulthood between 1990 and 2001 to determine their clinical profile and forecast, and to deduct the therapeutic consequences. Our criteria of inclusion requires the existence of patients with a second or third degree heart block, who are less than 40 years old at the time of diagnosis, which is not totally regressive in the effort test and the atropine injection, and whose congenital origin was strongly suspected because of the notion of slow pulse during their youth and the absence of acquired affect which enables us to explain this disease. The population contains ten patients whose average age in hospitalization is 23 years old with the range of 11 to 39, while the average age of the discovery of the disease was 20 years old with the range of 8 to 34. Our patients were referred to us because of cardiac symptoms such as syncope or an equivalent, effort intolerance, asthenia, thoracic pain (like angina), or palpitations. The clinical exam, the electrocardiogram, and additional exams (holter, effort test, echocardiography, electrophysiological investigation) allowed us to retain six indications for the definitive cardiac stimulation, associating to different degrees the existence of worrying symptoms such as a syncope, a congenital heart disorder, a low heart frequency, the association in a sinus dysfunction. Short-term and long-term evolution is favorable for patients of the stimulated group as well as the non-stimulated group.