[Acute myocardial infarction in elderly patients]

Age is the most important determinant of outcome for patients with acute coronary syndromes [ACS] and ischemic heart disease is the leading cause of death among elderly patients. To determine the epidemiologic particularities, the clinical presentation, and the treatment of Acute Myocardial Infarction [AMI] in patients over 65 years. One hundred patients >65 years of age with myocardial infarction were hospitalized in intensive care of cardiologic unit of Military Hospital of Tunis between 2000 and 2008. Clinical characteristics, reperfusion therapy and outcomes of in-hospital period and for one year follow-up were seen for every patient. The mean age of our population was 77 years. Sex-ratio was 3/1.Our population was divided into tow groups; patients aged between 65 and 75 years [48 patients] and those aged more than 75 years [52 patients]. Only 44% of our patients had arrived at the hospital within the first 12 hours. STEMI was found in 65% of our patients. At admission, 40% had congestive heart failure [[3] Killip II], 10% were in cardiogenic shock. Urgent reperfusion therapy was given to 58% of our patients; 33% received a thrombolytic therapy and 25% were allocated to primary PCI. During in-hospital period, 40% have developed congestive heart failure, 20% have had a cardiogenic shock and 12% were died. All these events were more frequent in patients aged over 75 years and reperfusion therapy was associated with best outcome. In our study invasive treatment such as fibrinolysis and PCI was associated to better outcome in acute period and at 12 months of follow up in elderly patients treated for AMI

[Cardiac conduction disorders in atheletes: diagnosis and management]

The sino-atrial or atrio-ventricular conduction disturbances are commonly seen in athletes. They are due to predominant effect of the parasympathetic tone. To describe the physiological cardiac adaptation to physical exercises and to specify the limits of this activity in front of persons with conduction abnormalities. Review of literature and lecture of recommendations. Conduction disturbances in athletes disappear during physical activities. Their frequency is variously reported in literature. These disorders should be well considered particularly when they are priors to sport practice and need definitive implantable devices. Such decision must be taken after a detailed evaluation of the nature of the physical activity wished and the conduction disturbance type. The decision to allow competition should be take after a careful evaluation of the conduction disorder and the type of sport