[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

[Right ventiular function by the tricupid annular motion in inferior myocordial infarction]

Summary To assess the method of tricuspid annular motion and tricuspid annular velocity in the study of the right ventricular function after inferior myocardial infarction. 65 patients with myocardial infarction were studied prospectively. The infarction site was anterior in 30 cases and inferior in 35 cases. 9 patients with inferior infarctus had electrocardiographic signs of right ventricular infarction. 24 healthy individuals served as control patients. The standard echocardiography was completed by the analysis of systolic motion of the tricuspid annulus with the use of M-mode and the recording of tricuspid annular velocity with the use of pulsed-move tissue imaging. The tricuspid annular motion was significantly reduced in inferior myocardial infarction compared with that in healthy individuals [20 and 25 min, p<0.001]. The peak systolic velocity of the tricuspid annulus was significantly reduced in inferior myocardial infarction compared with that in healthy individuals and patients with anterior infarction [11.5; 15; 14 cm/s, p<0.001]. In the group of patients with inferior infarction, the tricuspid annular motion was significantly lower in patients with right ventricular infarction than in patients without right ventricular infarction [16 and 13 mm, p<0.001]. The patients with right ventricular infarction had also a significantly decreased peak systolic tricuspid annular velocity [11 and 1305cm/s, p<0.001], peak early diastolic velocity [9 and 12.5cm/s, p<0.001] and late diastolic velocity [14 and 18 cm/s, p<0.001]. The method of recording the motion and velocity of tricuspid annulus is simple and can be used to assess right ventricular function in patients with inferior myocardial infarction

Heart diseases in pregnant women

Diagnosis end treatment of heart diseases, physiopathologic changes in pregnancy. Pregnancy in woman with heart disease increases the risk of maternal and fetal complications. The aim of the study is to precise the physiopathologic, diagnostic, and therapeutic characteristics of heart diseases in pregnant woman extensive electronic search of the relevant literature was carried out using Medline. Key words used were: pregnancy, heart disease, maternal outcome, fetal outcome, cardiac complications. Rheumatic heart disease represent the most common cardiopathy found in pregnant woman in our country. Regurgitant valvular diseases are often well tolerated with medical therapy. Severe aortic stenosis is associated with poor prognosis. The use of percutaneous mitral balloon valvuloplasty has transformed treatment of mitral stenosis in symptomatic patients. In developed countries, congenital heart diseases are the most common cause of cardiopathy in pregnant women. Left-to-right shunts are generally well tolerated. Patients with Eisenmenger syndrome should be advised against pregnancy. Obstructive form of hypertrophic cardiomyopathy is associated frequently with hemodynamic deterioration in pregnancy. Dilated cardiomyopathy is usually considered as a contrindication of pregnancy. In the absence of underlying structural heart disease, cardiac arrythmias are uncommon in pregnancy and usually don't require pharmacological treatment. Drug therapy of arrythmias in pregnant woman is limited by side effects on the fetus. The prenatal counsel is based on the assessment of maternofetal risk. The management of pregnant woman requires a multidisciplinary team for optimal maternal and fetal outcomes

Peripheral arterial disease: where are we in 2005?

The prevalence of obstructive arterial disease is between 3.5 and 12.1% in 60 aged populations. It's a current disease which has a pernicious influence in quality of life. Management of patients with peripheral arterial occlusive disease has to be planned in the context of natural history, epidemiology, and apparent risk factors that predict deterioration. The purpose of this review is to take stock of the consensus and the controversies about terminology, epidemiology, diagnosis and management of peripheral arterial occlusive disease

[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

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