Insuffisance mitrale aigue ischémique place de l'angioplastie coronaire. A propos d'un cas / Acute ischemic mitral insuffi ciency instead of coronary angioplasty. About a case report

Introduction. L'insuffi sance mitrale ischémique est une complication fréquente et représente un facteur de mauvais pronostic. Sa prise en charge thérapeutique est diffi cile. L'objectif de ce travail est de réévaluer l'intérêt de la revascularisation par angioplastie en cas d'insuffi sance mitrale ischémique importante. Observation et conclusion. Nous rapportons le cas d'un patient âgé de 48 ans ayant comme facteurs de risque cardiovasculaire ; une hypertension artérielle non suivie et un tabagisme actif (20 Paquets/année) qui s'était présentait pour un syndrome coronaire aigu compliqué d'une insuffi sance mitrale sévère et d'une insuffi sance cardiaque gauche avec une altération de la fraction d'éjection ventriculaire gauche à l'échocardiographie. La coronarographie montrait une atteinte tritronculaire. La revascularisation complète par angioplastie a permis une bonne évolution à cinq (5) ans

Predictors of incident heart failure in a cohort of patients with ischemic heart disease

Introduction: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD. Methods: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded. Results: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol.Conclusion: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment

L'ischémie myocardique silencieuse du diabétique au service de diabétologie du CHU de Yopougon Abidjan

objectif: identifier les aspects épidémiologiques et diagnostiques de l'ischémie myocardique silencieuse du diabétique à abidjan.Matériel et Méthode :cette rétrospective et descriptive s'est déroulée sur une année ( du 1er janvier au 31 Décembre 2016) dans le service de consultation d'endocrinologie diabétologie du chu de yopougon. Elle a porté sur l'analyse de 282 dossiers de patients diabétiques de type 2 ayant réalisés un electrocardiogramme de repos. Nous avons pris en compte certains faacteurs de risque cardiovasculaire tels que les dyslipidémies , l'HTA, lamicroalbuminurie, le tabagisme actuel et l'obésité abdominaleRésultats : Sur un total de 282 dossiers, 135 patients avaient un ECG de repos ischémique (47,87%) et 137 patients avaient un ECG de repos normal (48,58%). l'age moyen des patients était dde 56,35 +/- 11,83 ans; la durée d'évolution du diabète était de 11,05 +/- 6,5 ans avec un HBAC moyen de 7,5 +/-1,05 %. Les patients étaient asymptomatiques dans 92,90% des cas. L'association diabète et HTA étaient dans 78% des cas. L'ECG de repos ischémique était associé de facon significative à de nombreux facteurs de risque cardiovasculaires étudiés tels que l'obésité abdominale ( p=0,04);lamicroalbuminurie (p=0,03); le tabac (p=0,01); ladyslipidémie (p=0,02).conclusion:Ce trravail confirme la réalité de l'ischémie myocardique silencieuse chez le diabétique à Abidjan, comme en témoigne la prévalence de 51,41%

Xanthine oxidase inhibitors in ischaemic heart disease

Increased uric acid levels are correlated with cardiovascular disease, particularly with ischaemic heart disease. Xanthine oxidase inhibitors, especially allopurinol, lower the risk of ischaemic heart disease due to their effects on reactive oxygen species and endothelial function. In chronic stable angina pectoris, allopurinol increases the median time to ST depression, time to chest pain, and total exercise time. On the other hand, it has been reported that allopurinol has a beneficial effect on ischaemic patients referred for angioplasty, but there are insufficient data regarding its effect on acute myocardial infarction patients. Moreover, other important actions of allopurinol are regression of left ventricular hypertrophy and improvement in the results of cardiac rehabilitation. The efficacy of allopurinol has recently been acknowledged by the European Society of Cardiology guidelines for stable angina pectoris, but the particular role of allopurinol in ischaemic heart disease patients is not fully established.

Assessment of indirect inflammatory markers in patients with myocardial bridging

Introduction: Myocardial bridging (MB)is a congenital variant of the coronary artery in which a portion of the epicardial coronary artery takes an intramuscular course. Although it is considered a benign anomaly, it may lead to such complications as myocardial ischaemia, acute coronary syndrome, coronary spasm, exercise-induced dysrhythmias or even sudden death. MB may be related to increased inflammatory and atherosclerotic processes. This study was conducted with the aim of evaluating the relationship between neutrophil/lymphocyte ratio (NLR) and MB.Methods: Taking into consideration the inclusion criteria, 86 patients with MB and 88 with normal coronary angiographies (control group) were included in the study. The association between MB and laboratory and other clinical parameters was evaluated.Results: The platelet distribution width (PDW) (17.3 ± 0.40 vs 16.1 ± 0 .5; p < 0.05), NLR (3.2 ± 1.3 vs 2.2 ± 0.9; p < 0.05) and red cell distribution width (RDW) (14.3 ± 1.3 vs 13.1 ± 1.1; p < 0.05) were significantly higher in the MB group than in the control group.Conclusions: This study demonstrated that compared to normal coronary arteries, PDW, NLR and RDW were significantly higher in MB patients. Further studies are needed to clarify the increased inflammatory parameters in patients with MB

Novel Cardiovascular Risk Markers in Women with Ischaemic Heart Disease : Review Article

The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However; mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation; both of which play a key role in the pathogenesis of microvascular angina; which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers; markers of haemostasis; and other biomarkers

Electromagnetic Energy Radiated from Mobile Phone Alters Electrocardiographic Records of Patients with Ischemic Heart Disease

Electromagnetic energy radiated from mobile phones did not show significant effect on the blood pressure; heart rate; and electrocardiographic (ECG) parameters in animals and humans. Aim: This study aimed to investigate the effect of radiofrequency of mobile phone on the electrocardiographic parameters in patients with history of ischemic heart disease; taking into consideration the gender factor . Subjects and Methods: A total number of 356 participants (129 males and 227 females) were admitted in this study. They were grouped into: subjects without cardiac diseases (Group I); patients with ischemic heart disease (Group II); and patients with history of cardiac diseases not related to myocardial ischemia (Group III). Electrocardiogram was obtained from each patient when the mobile phone was placed at the belt level and over precordium in turn-off mode (baseline) and turn-on mode for 40 sec ringing. The records of ECG were electronically analyzed. Results: Prolongation of QTc interval was significantly observed in male gender of Groups I and III (P 0.001). Male patients of Group II showed significant QTc interval prolongation (P

Phaeochromocytoma and Reversible Myocardial Ischaemia in a 23-year Old Female

Background : Phaeochromocytoma is a rare neuroendocrine tumour with highly variable clinical presentation including serious and potentially lethal cardiovascular complications. Aim: to present a case of myocardial ischaemia in Phaeochromocytoma which was reversed after surgery. Setting: University of Port Harcourt Teaching Hospital (UPTH). Case report: A young female undergraduate aged 23 years presented with recurrent blackouts; paroxysmal hypertension which was resistant to several anti- hypertensive drugs and marked postural drop was referred from a private clinic to UPTH. Rest electrocardiogram (ECG) showed ischaemic changes and right axis deviation. Ultrasound scan and compu- terised tomographic (CT) scan showed a mass on the anteromedial portion of the left kidney with centrally located cystic areas. The 24-hour urine level of vanillyl mandelic acid (VMA) was normal. The tumour was excised by open surgery and histopathological findings confirmed Phaeochromocytoma. The ECG changes reversed after surgical excision. There was no recurrence or metastasis postoperatively after a long term follow up of 5 years. Her blood pressure remained normal postoperatively without taking antihyperten- sive medication. Conclusion: Phaeochromocytoma is a catecholamine secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality. ECG features of myo-cardial ischaemia can be reversed by surgical intervention