[Results of cardiac pacing: about 188 patients]

Indications for permanent pacing are currently well codified. This treatment may, however, present complications. To report the results of cardiac pacing and to identify predictive factors of pacing's complication. We conducted a retrospective study of 188 consecutive patients admitted to the cardiology department of Mongi Slim university hospital in La Marsa between January 2005 and June 2011 and implanted with a single or dual chamber pacemaker. In our study, we had 92 men and 96 women [sexratio= 0.95]. The mean age was 70.21 +/- 13 years. The indication for cardiac pacing was a high degree heart block in 74.46% of cases and a sick sinus syndrome in 15.95% of cases. The degeneration conduction tissue was the main etiology [72.34% of patients]. Success implantation was obtained in 98.4%of cases. The main operative complication was the pneumothorax in 3 patients [1.59% of cases]. At Long term, cumulative survival rate was 78.95%. Only operating time affects significantly the rate of early complications [p<0.001]. Late complications were related to the valvular heart disease [p = 0.007], the ischemic etiology [p = 0.05], the oral antivitamine K treatment [p = 0.04] and the occurrence of early complication [p = 0.002]. Our hospital, which is considered as a small Center of cardiac pacing [less than 80 procedures/year] had a low complication rate as well as big centers

[In hospital mortality of ST segment elevation myocardial infarction treated with primary angioplasty: monocentric Tunisian study of 250 patients]

Myocardial reperfusion is the " corner stone " in the treatment of myocardial infarction. Primary percutaneous coronary intervention has proved its superiority upon intravenous thrombolysis. To evaluate in hospital mortality of acute myocardial infarction treated with primary angioplasty and to determine its predictive factors. We performed a retrospective study including 250 patients admitted to Mongi Slim university Hospital at la Marsa between January the 1st, 2006 and June the 30th, 2011. All these patients had an ST segment elevation myocardial infarction and underwent primary percutaneous coronary intervention within 24 hours after symptom onset. In our study, males were predominant with a sex-ratio of 4.55. Our patients were aged 59.8 +/- 11.19 years old. Diabetes mellitus was present in 42% of our population. In 60.4% of the cases, myocardial infarction was located in the anterior wall. Cardiogenic shock was present in 13.6% of patients. The culprit coronary artery was the left anterior descending artery in 57.6% of the cases. The coronary flow in the culprit artery was TIMI 0 in 64% of the patients and TIMI 1 in 13.2% of the patients. Angiographic success [TIMI 3 flow and residual stenosis <20%] was achieved in 84% of cases. Our in-hospital mortality rate [cardiogenic shock excluded] was 6.9%. Predictive factors of in-hospital mortality were: female gender, diabetes mellitus, hypertension, renal failure, multi-vessel lesion,TIMI flow before percutaneous coronary intervention, proximal left anterior descending artery lesion, initial cardiogenic shock and acute stent thrombosis. In our local context, primary percutaneous coronary intervention is an efficient and safe treatment of myocardial infarction with persistent ST-segment elevation

[Non alcoholic fatty liver disease: a new risk factor for cardiovascular disease?]

Non-alcoholic fatty liver disease [NAFLD] is frequently diagnosed in daily practice. This condition is represented by a large spectrum of chronic liver diseases going from pure hepatic steatosis to cirrhosis and its complications, including hepatocellular carcinoma. NAFLD is usually associated to glucose and lipoproteins metabolism increasing the cardiovascular risk. To review new advances in the knowledge of the pathophysiological links between NAFLD and cardiovascular risk, evaluation of cardiovascular risk in this special situation and the different therapeutics proposed. Systematic review of the literature using medical data bases [Medline] with the following key words: non-alcoholic fatty liver disease, hepatic steatosis, cardiovascular risk, metabolic syndrome. We'll report pathophysiological links between NAFLD and cardiovascular risk, propose an evaluation of cardiovascular risk in this special situation and expose a therapeutic strategy. The discovery of a non alcoholic fatty liver disease should lead to a cardiovascular risk evaluation

Comparison of coronary calcifications detections by angiogram versus intravascular ultrasound

The presence, extent and location of calcium in coronary artery lesions are important determinants of the success of per cutaneous coronary intervention [PCI]. Although coronarography remains the gold standard for coronary disease detection, Intravascular ultrasound [IVUS] is proposed as a superior technique for identifying patients with coronary artery calcification .To define sensibility and specificity of coronary angiography in detecting calcifications considering the IVUS as gold standard. Target lesion calcification was assessed in 40 patients [35 men; mean age 57.4 +/- 10 years] by angiography and intravascular ultrasound. Ultrasound detected calcium in 51 of 85 target lesion [60%], whereas angiography showed calcifications in only 16 lesion [19% p<0.001 compared with IVUS]. Coronary angiography detected 8% of 0-45[degree sign] arc calcium category, 7% of 45-90[degree sign] calcium category, 58% of 90-180[degree sign] calcium category, and 80% of more than 180[degree sign] calcium category. The overall sensitivity of angiography in identifying calcium was 31% and increased with an increasing arc of lesion associated calcium. The overall specificity of the angiographic detection of target lesion calcium was 100%. Intra coronary ultrasound analysis shows that target lesion calcification is much more widespread in coronary artery disease than what angiography reveals. The sensitivity of angiography was poor, with although a very high specificity

A Successful Dissolution of an Obstructive Prosthetic Mitral Valve Thrombus: Sequential Two and Three Dimensional Transesophageal Echocardiography Examination

No abstract available.

[Sudden cardiac death of rhythmic origin in athletes: literature review]

The sudden death in athletes is, in the vast majority of cases, related to ventricular fibrillation, often in a subject with unknown cardiovascular abnormality; this dramatic event has a significant impact on society and the medical profession. We conducted through a literature review an analysis of data on sudden cardiac death of rhythmic origin in athletes; sudden death may be cardiovascular in 95.3% of cases and related to ventricular arrhythmia in 88% cases. The main causes are: hypertrophic cardiomyopathy, congenital anomalies of coronary arteries, and arhythmogenic right ventricular dysplasia for athletes under 35 years, and atherosclerosis beyond 35 years. Prevention is based on three main areas: the medical assessment and screening for cardiovascular disease; the chain of survival; the education of the athlete and the public. All these measures should improve significantly the survival prognosis of patients suffering from these accidents

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

Cout direct medical de la prise en charge de l'infarctus du myocarde en phase algue

to assess the medical direct cost of acute myocardial infarction. Method: data are recorded through a prospective study in 7 wards of cardiology of the District of Tunis during one year: from November 2001 to October 2002. cost of hospital stay, biologic analyses, drugs, functional investigations and possible non surgical cardiologic intervention [IC] was calculated. 632 AMI cases are recorded, the death rate is 7.8%. The average of hospital stay was 13.3 days. 49.1% of patients benefited from thrombolytic therapy, 55.5% benefited from a coronary angiography and 16.1% of an act of IC. The mean of direct cost [CGM] was 2171 Tunisian Dinars and the median was 1731 DT, of whom room costs 31.7%, 22.5% acts of IC, 7.2% drugs, 26.2% functional investigations and 12.4% biological analyses. The mean cost of IC was 3030 +/- 401 DT. The methodology of our study remains original in our country and can be used to assess the other aspects of AMI as other diseases cost management

[Cardiac failure with normal systolic function]

Cardiac failure with normal systolic function representes 30 to 50% of all the cardiac failures. There is no clinical radiographicaln electro cardio graphical symptorn to characteize this Kind of Cardiac failure. It's diagnosis and its valuation could be done with doppler echocardiography. The etiology is dominated by the ischemic cardopathy, the hypertrophic myocardis fathies and senile heart. It's traiternent isn't codified yet

[Sino atrial block induced by therapeutic doses of diltiazem: about 3 observations]

We report three observations of Diltiazem intoxication at therapeutic doses with occurence of sino auricular block. The situation evolute favorably for two patients while the thind die. The electro systolic stimulate seems to be justified in case of Diltiazem intoxication