[Catecholaminergic polymorphic ventricular tachycardia in adult: a case report]

Catecholaminergic polymorphic ventricular tachycardia [CPVT] is a primary electrical myocardial disease characterized by exercise- and stress-related ventricular tachycardia manifested as syncope and sudden death usually in child and teenager and was rarely described in adults. The management includes betablockade, with the use of implantable cardioverter defibrillators if medical treatment is insufficient. Report a new case of CPVT. We report a case of a 43 years old patient in whom CPVT diagnosis was made during his exploration for palpitations occurring with the effort. Registration Holter ECG revealed several episodes of supraventricular tachycardia and episodes of nocturnal sino-atrial block. The patient had an ICD and betablockade treatment. The TVPC in adult can manifest with attenuated symptoms that can be summarized with palpitations with the exertion. The supraventricular arrhythmias and sinus dysfunction may be at the forefront of Electrocardiographic manifestations. The prognosis of this form seems better than the TVPC of the child. Treatment with betablockade appears to be effective but existing dysfunction sinus facilitates decision to implant the ICD

[Haemorrhagic serious accident in anti vitamin K descriptive study and prognostic]

The use of the antivitamines K for more than 50 years, has largely been the proof of its interest: well shown effectiveness, weak cost. However, these drugs are the cause of complications of which most frequent and most serious are the hemorrhagic accidents. To determine the characteristics of the patients hospitalized for grave bleeding under antivitamins K and identify the predictive factors of these accidents. Retrospective study of pilot case type carried out in the service of cardiology of the hospital Habib Thameur of Tunis during the period going from January 2001 to December 2006. It related to a group of 50 patients admitted for "serious haemorrhage under antivitamines K". This group was compared with a reference group including/understanding 100 patients treated by antivitamines K and not having never presented a haemorrhage. The reserved criteria of gravity are the following ones: the location: intracerebrale, rdtro peritoneale, articular, intra-ocular with blindness, muscular, subcutaneous if the nasty bruise is voluminous, hematurie, metrorragie, digestive bleeding [high or low], hemoptysie, hemorhorax, hemopericarde; The deglobulisation [fall of the haemoglohin of 2g/dl or more] requiring or not a transfusion; the necessity of a surgical haemostatic gesture or endoscopique; the transfer in care unit or death. The Middle Age of the patients was of 55 +/- 14 years, the sex ratio was of 0, 85. The intermediate duration of the treatment was of 243 +/- 225 weeks. The most frequent indications were the disorder of the supra-ventricular rate/rhythm [72%] and the mechanical valves cardiac [40%]. These indications appeared debatable to us at 16%of the patients. One or more supporting factors the hemorrhagic accident were found at half of the patients, the first cause being medicamentous association [20%of the cases]. The hematurie was the most frequent complication [28%]. The evolution was favorable in all the cases. An internal injury under unclaimed ignored was found at 24%of the patients. The hepatic dysfonction and medicamentous association were in our study of the risk factors of which has occurred of haemorrhage under antivitamines K. of multivariate analysis, medicamentous association was an independent risk factor [Odds ratio adjusted 4,9]. At least 50%of the hemorrhagic accidents under antivitamines K are avoidable with the help of a rigorous evaluation of the benefit ratio/risk and a vigilance with respect to medicamentous associations. The creation of centers of anticoagulation in our country is essential in order to improve quality of the clinical and biological monitoring

[Diagnosis of restrictive cardiomyopathy: place of the bidimensional echocardiography]

The restrictive cardiomyopathies are sporadic diseases, their diagnosis is often made tardively. Their main differential diagnosis is the chronic pericardiac constriction. The non invasive diagnostic techniques don't permit always to differentiate this two pathologies of different prognosis and treatment. The target of our work is to specify the place of the echocardiography in the diagnosis of the restrictive cardiomyopathies [RCM]. We collected between January 1993 and January 2005 four patients presenting a RCM. The circumstance of discovery was in any case a global cardiac insufficiency. The echocardiography showed a dilatation of the atrium in all patients, whereas the ventricles were of normal size three times. The study of the endocardium showed an apical fill in all patients, whereas the endocardic calcifications had not been recovered except one time, All patients had a valvular thickening. The systolic function was normal three times over four

Les indications chirurgicales des endocardites bacteriennes evolutives en insuffisance cardiaque

The authors compared 2 groups of patients with bacterial endocarditis the first was treated medically as a first intention with a subsequent surgical treatment or not - The second was treated surgically from the begining. They concluded with the legitimity of the surgical treatment ever in the septic stage

La trombolyse dans l'infarctus du myocarde: a propos de quatre cas

Our first exprerience of thrombolysis is about 4 cases. It is a simple treatment necessiating a biological, clinical and electrical rigourous supervision. One death among the four patients is to deplore, but this one relies on the coronal disease. The coronarography exploration is precociously indispensable for judging the ulterior be-haviour. It is absolutely necessary that patient be precociously hospitalized [be fore the 4th.hour]. Actually this represent 9% of the service recrutement. This number is only increasing it the information is done with all the physicians but with patients too