Delay of fibrinolysis in ST- elevation myocardial infarction: results of an investigation conducted in a single center in Sousse Tunisia

The aim of our study was to assess the delay of fibrinolysis in ST elevation myocardial infarction [STEMI] in our region and to identify characteristics associated with prolonged delay. We analyzed clinical characteristics of a prospective cohort of unselected patients admitted for [STEMI]. The study was conducted over three years 2007-2009 and 250 patients were included in a single center without capability of percutaneous coronary intervention. The mean age of our patients was 58 +/- 13, 7 years. Ninety percent of our patients consult directly the emergency department and 61, [5%] of them were admitted within first 6 hours of onset of symptoms. Median time to reperfusion was 46 min. Predictor of this long delay to initiate fibrinolysis were inter-department decision OR 6; 95% CI 3,48-10,34, diabetes OR 2,25; 95% CI 1,28-3,96 age >58,4 years OR 1,97; 95% CI 1,19-3,25 and transfer from regional hospital to our center OR 1,78; 95% 1,03-3.07. These results suggest that improvement in organization health care system can shorten delay to fibrinolysis in a center without percutaneous coronary intervention capability

[Permanent cardiac pacing: about 234 patients]

Permanent cardiac pacing remains the only effective treatment for chronic, symptomatic bradycardia. In recent years, the role of implantable pacing devices has expanded substantially. To compare the situation of patients with critical brady arrhythmias before and after pacing focusing on indication for pacemaker implantation, frequency of re intervention and early and late complications. Retrospective study performed over 24 years between 1984 and 2007 at the department of cardiology of Farhat Hached hospital. A total of 234 patients were included, and the database was formed by the patients' files and the protocols of implantation. The mean age of patients was 69.5 years. The most frequently reported signs and symptoms before implantation of pace maker were dizzy spells and syncope respectively in 53% and 29.1% of patients. Among the electrocardiographic alterations leading to an indication of pacemaker implantation, atrio-ventricular blocks were the most numerous at 74.4% followed by sinus node disease at 17.1%. Early complications were represented essentially by haematoma and infection of the pocket of pacemaker respectively at 2.9% for each one. After a mean follow up of 6.8 years, 88 patients [45.3%] still free of symptoms. Late complications include lead dislodgement and pacemaker syndrome at 2% for each one. The results of our study demonstrates that even the rate of complications following pacemaker implantation is not high, the follow-up of patients should be fast, complete, safe, and clear, and should include sufficient documentation

Peripartum cardiomyopathy

To analyze the clinical characteristics and to evaluate the different factors that influences the prognosis of the peripartum cardiomyopathy [PPCM]. A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Farhat Hached Hospital [Sousse] between January 1992 and December 2004. Clinically, PPCM shows pulmonary symptoms such as dyspnea and tachypnea. The diagnosis is established by echocardiography that showed decreased systolic function of the left ventricular. Both gynecologist and cardiologist must check the patients regularly. No patient died. Three preterm pregnancies occured with 9 health newborns [2 sets of twins]. One miscarriage took place. PPCM is often undetected or misdiagnosed because of the low incidence and the unspecific symptoms. The treatment is also unspecific and similar to dilated cardiomyopathy or acute cardiac failure. Early diagnosis of the peripartum cardiomyopathy is extremely important. Pregnancy in patients with dilated cardiomyopathy is associated with maternal and fetal morbidity. Left ventricular function is a prognostic factor and must be the most parameter when conseling patients with peripartum cardiomyopathy about a new pregnancy