ABSTRACT
In the setting of acute myocardial infarction [AMI], several investigators have demonstrated that emergency coronary angioplasty [PTCA] reduces in-hospital mortality of primary cardiogenic shock [CS] from 90% to less than 50% however, few studies have focused on the current outcome of non selected patients in whom the onset of AMI is immediately complicated by CS.To evaluate in-hospital mortality of the patients admitted to our institution for Q wave AMI presented in CS. Between 05/93 and 05/03, 30 consecutive pts, 26 men and 4 women, in CS following AMI were treated with direct PTCA, 26 without thrombolysis and 4 as rescue after failed streptokinase. AMI was defined by prolonged chest pain and 1 mm ST segment elevation in 2 contiguous peripheral leads or 2 mm for precordial leads on the admission ECG. The diagnosis of CS was based on the combination of systolic blood pressure of r 90 mm Hg, unresponsive to volume expansion, signs of acute circulatory failure [cyanosis, cold extremities, restlessness, mental confusion or coma] and congestive heart failure secondary to myocardial dysfunc-tion. In 40% of cases the diagnosis of CS was only clinical and in 60% of cases was confirmed by a Swan Ganz catheter. Mean age was 62,3 +/- 12,3 years, 7 had triple vessel disease, 14 a double vessel disease, 8 a single vessel disease and in one case a left main disease. The AMI was anterior in 22 pts [73%], inferior in 8 [27%]. Intraaortic balloon was used in 3 pts, CPR in 16 [47%], transitory pacemaker in 1 pt, inotropes in 25 pts, emergency coronary artery bypass grafting [CABG] in 1 pt. Success for PTCA with a residual stenosis r 50% and a TIMI flow III was obtained in 26 pts [87%]. Mean time between CS and revascularization was 219 +/- 302 minutes. 19 pts [63%] survived and 11 pts [37%] died while at the hos-pital, 6 from intractable shock, 4 from multiple organ failure and in 1 case from pulmonary hemorrhage. Mean time of revascularization for the surviving was 190 +/- 329 min, and for the dead 295 +/- 212 min. Hospital mortality for inferior infarction is 12.5% after successful angioplasty. Comparison of surviving and non surviving number of patients according to revascularization time showed a significant difference of these groups whether the revascularization was accomplished before or after 120 minutes
ABSTRACT
Syncope is a frequent medical problem that causes much difficulty in order to explain its etiology. Recently, tilt table testing became an investigation of choice in patients presenting with unexplained syncope. To present a series of patients presenting an unexplained syncope, investigated with a tilt test and to compare our results to the literature. 257 patients [mean age of 42.7 +/- 15.4 years] presenting an unexplained syncope between 1997 and 2002 were assessed with a usual tilt test, then in case of negative test a sensitization with iso-proterenol intravenously or sublingual trinitrin was realized. 88 patients [34.2%] had spontaneous positive test, 79 patients [30.8%] had positive test after sensitization and 90 patients [35%] had negative test in spite of sensitization. With a diagnostic return of 65% in this series, the tilt test seems to be the non-invasive investigation of choice in unexplained syncope
Subject(s)
Humans , Disease Management , Hospitals, University , Retrospective Studies , Risk Factors , Angioplasty , Coronary AngiographyABSTRACT
Objectives: study the efficacy and side effects of low doses dopamine [3 gamma/kg/mn] in non shocky patients with heart failure. Methods: evaluate change in diuresis, blood pressure, heart rate, ureas, creatinine before and after administration of dopamine. Sample: prospective study on 28 patients cohort with average age of 67 years in decompensated heart failure secondary to various causes. Results: dopamine improved significantly diuresis in 75% of patients even in resistant cases of diuretics. No alteration of renal function has been noted and side effects were considered negligible. Conclusions: dopamine at diuretic dose may be used in any non shocky heart failure patients regardless the etiology
Subject(s)
Heart Failure/drug therapy , Cardiac Output, Low/drug therapyABSTRACT
The new protocol of amiodarone was proposed to treat and to prevent some paroxysm and refractory arrhythmias with classic treatments. It is to administrate an oral charge dose of 30mg/kg/day of amiodarone taken in one time during three days, then reduce progressively that posology. This protocol was applied on 60 patients with a success of 75% and a recur of 3.5%. few secondary effects were observed all reversible with the end of protocol. But no cardiac decompensation, no pro-arrhythmogene effect were signaled and especially no cardiac failure