Utility of Stress cardiography to identify myocardial ischemia

The dobutamine echocardiography takes more and more an important place in diagnosis, prognosis and therapeutics strategies of the coronary disease. We prospectively enrolled 130 consecutive patients followed for a coronary insufficiency. The aim of determinating the diagnostic value of the dobutamine echocardiography in the myocardial ischemia compared with the classic means as the exercise test and the myocardial scintigraphy. Our results are comparable to the data of the literature, the dobutamine echocardiography is more specific than the exercise test and the myocardial scintigraphy [96%, 61% and 53%], more sensitive than exercise test [75% versus 47%] but less sensitive than the myocardial scintigraphy [75% versus 96%]. The stress echocardiography has the best diagnosis precision 87%, against 72% for the scintigraphy and 56% for the exercise test. The dobutamine echocardiography is a very feasible, tolerated well exam and especially very reliable in term of detection of the coronary disease in the feminine population, with a sensibility at 66,7%, a specificity at 100% and a diagnostic precision at 92%, also in patient with hypertension the stress echocardiography is much more specific and reliable than the exercise test [100% vs 22% and 93% vs 54%, respectively], and it's superior to the exercise test in the presence of electric signs of systolic excess load and to the myocardial scintigraphy in case of left ventricular hypertrophy. The dobutamine echocardiography can be considered as safety and reliable means of investigation of the coronary insufficiency

[Double chamber right ventricle: about 3 cases]

The double chambered right ventricle is a rare congenital abnormality. It creates an obstacle for the right ventricular ejection. The cardiac ultrasonography examination allows the diagnosis in most majority of cases. The angiography is performed in difficult cases. We report 3 cases of infundibular stenosis with normal interventricular septum. The diagnosis was suspected for the 3 cases by the constellation of clinical findings pointing to systolic murmur over the precordium. and the electrocardiography showing right ventricular hypertrophy. It is confirmed by the echocardiogram and the hemodynamic exploration with a trans stenotic gradient evaluated at 72,80 and 80 mmHg. The 3 patients underwent surgery and had all good post operative follow up. These 3 observations allow us to recall the epidemiological. embryological. clinical and echocardiographic particularities of pure infundibular stenosis and to determin the adequate treatment and the prognosis

[Screening and management of coronary artery disease in diabetic patients]

Diabetes represents as independent risk factor for coronary artery disease [CAD] and the prognosis in term of survival rates is worse for diabetic patients who have CAD with report to those with CAD but no diabetes. The coronary artery disease in diabetes has specificities and, in particular, more extensive atherosclerosis. Diabetic patients are also more fre-quently asymptomatic. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities. Diabetic patients benefit from secondary prevention by drug therapy [aspirin, lipid lowering with statines, beta blocker and ACE inhibitors] to the same extent as, or more than, non-diabetic patients. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes. A recent randomized trial has shown a significantly improved outcome after surgical revascularization. But, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising

[Stress echocardiography and mitral stenosis: what interest?]

The stress echocardiography is used extensively as a diagnostic and prognostic tool and the assessment of ischemic cardiopathies. Its use in valvulopathies is more limited, but is increasing with time. The discrepancies between the functional symptoms and hemodynamics at rest is frequently met in patients with mitral stenosis. By assessing changes of pressures, gradients and surface stress echocardiography helps to identify the real hemodynamic conditions permitting to recommend a more aggressive approach in certain situations

Infarctus du myocarde sur coronaires angiographiquement saines: etude descriptive de 46 cas

This a retrospective study on 46 patients conducted over a 9-year period. These patients had an acute myocardial infarction [AMI] confirmed with changes on the electrocardiogram and raised cardiac enzymes. However, the subsequent coronary angiography was normal in all these patients. The purpose of our study is to assess epidemiologic, clinical, prognostic and therapeutic features of AMI with angiographically normal coronary arteries and compare the results obtained with those of AMI with coronary artery disease. AMI with angiographicalIy normal coronary arteries is a first coronary event in young patients [mean age 47.7 years] having few coronary risk factors [54.3% have only one risk factor] mainly smoking [73.9%]. The anterior location is prevalent. The patients with AMI and angiographically normal coronary arteries have a better prognosis than those with coronary artery stenosis. Indeed, their left ventricular function is unaltered [mean ejection fraction 48.7%]. Hypokinesis is the most frequent abnormality of wall motion noticed. The patients' post infarction course is bengin when the coronary arteries are angiographically normal. The incidence of hemodynamic complications and ischemic recurrences are lower than in AMI with coronary stenosis. The choice treatment remains fibrinolysis

[Introduction of the myocardal dopler tissue imaging]

Introduced in 1989, the myocardial doppler tissue imaging has now many clinical applications. The doppler tissue imaging explores the proper systolic and diastolic regional function of myocardial fibers. We can measure myocardial velocities by recording signals of low v‚locitiy and high magnitude, the strain and the strain rate are then derived from velocities. Specific softwares are therefore necessary. There are many ways of recording and representing myocardial doppler tissue parameters. Diagnostic and prognostic value of myocardial doppler tissue imaging is now proved and this method has many applications in ischemic cardiopathy and in cardiomyopathies. The development of powerful softwares is promising for the applications of the strain in the future

transition epidemiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie

We aim at analyzing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey [TNMMS]. In order to assess the CVDs [CHDs vs RHDs] trend, two representative samples of Cardiology Departments patients were compared one is selected from the TNMMS and the second from the hospitalizations recorded in 1992. Causes, stay duration, status at the end of the hospitalization, transfer to an other hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectively 58,8% and 38, 2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological. social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities

Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres

We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year [from March 2000 to February 2001]. Method: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender [OR=2.3, p<0.001], age [OR=l.02, p<0.01] and health insurance [OR=1.5, p<0.01]. 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularization of thrombolysis, 51% on men vs 31% on women [p <0.01]. The fatality rate was higher on women 14% vs 6.4% on men [p<0.01] at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age [RR=l.08, p < 0,001] and delay [2.56 p <0.001] and tobacco smoking [RR=2,83, p <0.0001]. this study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance

Rupture chronique cloisonnee d'un aneurysme de l'aorte abdominale: Une cause inhabituelle de dorsalgies

Chronic contained rupture of abdominal aortic aneurysm is a rare event which can cause diagnostic difficulties. It can present as a chronic back pain and the delayed diagnosis and delayed surgical repair may compromise the final results. The outcome of urgent repair of a chronic contained leak is equivalent to that of elective aneurysm repair. We report a case of contained rupture of a small abdominal aortic aneurysm with delayed diagnosis, evaluated by computed tomography showing a beginning erosion of the lumbar vertebral body. The patient was operated on within 24 hours on admission with uneventful surgical outcome

Place of definitive cardiac stimulation in cardiomyopathies and atrial arythmia

Definitive cardiac stimulation ralatually used for brady cardia are going to be in the third millennium the specific therapy of arythmia and cardiomyopathy. In the last 10 years, may progress occur in the use of cardiac stmulation as hemodynamic therapy of obstructures hypertrophic and dialted cardiomyobathies resistant to conventional medical treatment. Moreover auricular stimulation present antiarythmic effects in somme atrial arythmias as auricular fibrillations auricular diseases and atypical flutters. It confirmed by prospective multicentric randomized trials cardiac stimulation may represent in the future a good physiopathologic and efficient treatment free from the sidee effects of drugs that remain partially active. These perspectives needs to be modulated by the known and acceptable resks of a definitive cardiac stimulation

Enterococcal infections endocardites associated to laubry and pezzi syndrome

Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocardits risk. Authors report a case of an 18 years old young girl prescruling an enteracoccus infectious endocarditis associated to Laubry and Pazzi syndrome. Initial course is not favourable requiring a surgical treatment in the acute stage. Bacterial endocarditis combined with Laubry and Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoriging factor is present