[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

Echocardiographic factors determining immediate result of percutaneous mitral balloon commissurotomy

Define echocardiographie predictors of the result after percutaneous mitral balloon commissurotomy [PMC]. PMC by the Inoue balloon was attempted in 247 patients -[77% female] with severe mitral valve stenosis. The mean age was 35 years. All the patients had undergone echocardiographie examination before PMC to assess mitral anatomy, commissural calcification, and to determine the Wilkins score. The mean value of Wilkins score was 7,98 +/- 1,61 [range 5-13] and the mean mitral valve area [MVA] before PMC was 1 +/- 0,19 cm2 [range 0,5- 1,4 cm2]. 29 patients [11,7%] had one-commissural calcification and 2 patients [0,8%] had bi-commissural calcifications. After PMC, the mean MVA increased to 1,79 +/- 0,34 cm2 [p <0,001] resulting in a success rate of 83%. Severe mitral regurgitation [>grade 3] occurred in five patients [2%]. Wilkins score was an independent predictor of the immediate result of PMC but, if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. Echocardiography is now the cornerstone for the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the selection of patients to PMC

Hypertenisve emergencies

Hypertensive emergencies include clinical situations with different prognosis. The emergencies are defined by the gravity of acute visceral failures. They need a parenteral treatment. Hypertensive emergency is less severe when blood pressure increase remain isolated and then is controlled progressively by oral treatment. The use of the calcium inhibitors by sublingual way is non controversies. Injectable nicardipine and uradipil represent an important progress in pharmacologic management of hypertensive emergencies