[In hospital prognosis of right ventricular myocardial infarction]

To identify prognostic risk factors for in-hospital outcome of right ventricular myocardial infarction [RVI]. A retrospective study of 20 patients admitted with acute myocardial infarction with a RVI defined by ST segment elevation 1mm in V3R and V4R leads. The mean age was 62 years. RVI was associated with an inferior myocardial infarction in 18 patients. Half of the patients had hemodynamic complication on admissioc [cardiogenic shock in 4 cases, right ventricular failure in 6 cases] and third degree atrio-ventricular block was present H 5 patients. Sixteen patients [80%] received thrombolysis and 3 went to an emergency angioplasty. The in-hospitv mortality was 25%caused by a cardiogenic shock in patients and a ventricular fibrillation in 1 patient. Statistic: analysis showed that cardiogenic shock on admission. e absence of thrombolytic therapy and the low ejection fraction of the left ventricle were associated with a high in-hospital mortality [p=0.004, p=0.03, p=0.03 respectively]. In-hospital outcome of RVI is characterized by hemodynamic complications leading to a high incidence-mortality. Thus RVJ must be diagnosed quickly and maxims therapeutic efforts must be done to procure the opening of the occluded coronary artery

[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