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1.
Ann Cardiol Angeiol (Paris) ; 67(5): 374-380, 2018 Nov.
Article in French | MEDLINE | ID: mdl-30301544

ABSTRACT

Since its first description in Japan in 1990, Takotsubo (stress) cardiomyopathy has gained worldwide recognition. The disease is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wall-motion abnormalities. She predominantly affects elderly women and she is often preceded by an emotional or physical trigger. In the acute phase, the clinical presentation, electrocardiographic findings and biomarker profiles are often similar to those of an acute coronary syndrome. Although, the cause of Takotsubo cardiomyopathy remains unknown, the role of the brain-heart axis in the pathogenesis of the disease has been described. The potential role of catecholamine excess in the pathogenesis of Takotsubo cardiomyopathy has been long debated, and as such beta-blockers have been proposed as a therapeutic strategy. Currently, the treatment is not codified and it adapts according to clinical symptomatology. It seems difficult to summarize all the factors to provoque the cardiomyopathy, we describe a case of Takotsubo after a pacemaker (PM) implantation and to give a recent progress on this heart disease.


Subject(s)
Pacemaker, Artificial/adverse effects , Takotsubo Cardiomyopathy/diagnosis , Aged, 80 and over , Atrial Fibrillation/therapy , Electrocardiography , Female , Humans , Ventricular Fibrillation/therapy
2.
Ann Cardiol Angeiol (Paris) ; 67(5): 381-387, 2018 Nov.
Article in French | MEDLINE | ID: mdl-30301548

ABSTRACT

The pathophysiology of acute coronary syndromes is in most cases due to the erosion or rupture of a plaque with consequent thrombotic obstruction of coronary artery. In a few cases, the mechanism is different, this not modifying the initial management but imposing special techniques for diagnosis and therapeutic management. We report a clinical case of a patient supported for an acute coronary syndrome, in a context of impaired general condition and biological inflammatory syndrome revealing a Horton's disease.


Subject(s)
Acute Coronary Syndrome/etiology , Giant Cell Arteritis/diagnosis , Aged, 80 and over , Giant Cell Arteritis/complications , Headache/etiology , Humans , Male , Myalgia/etiology
3.
Ann Cardiol Angeiol (Paris) ; 65(1): 31-7, 2016 Feb.
Article in French | MEDLINE | ID: mdl-23806865

ABSTRACT

The coronary fistula is a link between one or more of the coronary arteries and cardiac cavity or great vessel. The exact occurrence is unknown. The majority of these fistulas are congenital in origin. However, they may occasionally be detected after cardiac surgery. For a long time, fistulas are asymptomatic, especially if they are small; the frequency of the symptoms and especially the complications rise with age. The potential complications are: cardiac failure, endocarditis, endarteritis, atrial fibrillation, ventricular arrhythmias, rupture, and thrombosis. The main differential diagnosis is patent arterial duct, while other congenital arteriovenous shunts need to be excluded. Even though echocardiography Doppler can help to differentiate shunts, the coronary angiography remains the main diagnostic tool for the description of the anatomy. For a long time, the surgery was the only therapeutic means, up till now, percutaneous occlusion is the first line therapy of coronary fistulas and that the different devices can be tailored to meet different anatomic and functional characteristics.


Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Fistula/diagnostic imaging , Fistula/therapy , Adult , Aged , Angioplasty, Balloon, Coronary , Bradycardia/etiology , Chest Pain/etiology , Coronary Stenosis/etiology , Coronary Stenosis/therapy , Electrocardiography , Female , Humans , Male , Stents
4.
Arch Mal Coeur Vaiss ; 95(12): 1181-7, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12611038

ABSTRACT

Atrial flutter with 1/1 nodo-ventricular conduction is a classical complication of Vaughan-Williams's Class I antiarrhythmic drugs. The increase of the flutter cycle and weak action of the antiarrhythmic on the atrioventricular node leads to 1/1 conduction of atrial depolarisation to the ventricles. In view of their marked action on the atrioventricular node, this type of pro-arrhythmic effect is very unexpected with Class III antiarrhythmics. The authors report 7 cases of 1/1 atrial flutter with oral amiodarone observed between 1994 and 2001. The patients were 6 men and 1 woman with an average age of 58 +/- 14 years. Four of them had underlying cardiac disease; none were hyperthyroid. The initial arrhythmia was 2/1 atrial flutter (n = 4), 1/1 atrial flutter (n = 2) and atrial fibrillation (n = 1). Treatment was preventive with doses of 400 mg/day associated with carvedilol in one patient and 200 mg/day in another. The other five patients all received loading doses of 9200 +/- 2400 mg over 10 +/- 4 days. The symptoms were palpitations (n = 2) associated in one patient with hypotension, one syncope, one near syncope and one cardiogenic shock. The ventricular cycle of the 1/1 flutter was 287 +/- 33 ms. The QRS duration was 136 +/- 35 ms with ventricular tachycardia-like appearances in 3 cases. An adrenergic trigger factor was noted in 5 patients. One patient required emergency cardioversion. The authors discuss the physiopathology of 1/1 flutter and theoretical diagnostic methods are proposed. In conclusion, amiodarone does not always prevent the occurrence of 1/1 nodo-ventricular conduction in atrial flutter.


Subject(s)
Amiodarone/adverse effects , Anti-Arrhythmia Agents/adverse effects , Atrial Flutter/chemically induced , Administration, Oral , Adult , Aged , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Atrioventricular Node/pathology , Female , Humans , Hypotension/etiology , Male , Middle Aged , Syncope/etiology
6.
Curr Cardiol Rep ; 2(6): 498-506, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11203287

ABSTRACT

Arrhythmogenic right ventricular dysplasia (ARVD) is a structural heart disease affecting young adults that leads to cardiac rhythm disorders including supraventricular and mostly ventricular arrhythmias. Sudden death may be the first presentation of the disease. Ablation techniques have been used for the treatment of ventricular tachycardia in cases resistant to drug therapy. Radiofrequency is appropriate as a first approach for ventricular tachycardia ablation in ARVD; however, its effectiveness is less than 40% at the first session. Fulguration is effective for ventricular tachy-cardia ablation and should be used in the same session after ineffective radiofrequency ablation. However, fulguration requires expertise, general anesthesia, and more than one session in half of all patients. Radiofrequency and fulguration plus other common forms of treatment including pacemakers and automatic implantable cardioverter defibrillators provides a clinical success rate of 81% to 93% in a series of 50 consecutive patients studied during 16 years. Earlier poor reputation of fulguration was the result of poorly understood technical problems concerning the physics and biophysics of the procedure under control with presently available methods. This in-depth study of a large population over a long time period demonstrates that fulguration should be rehabilitated.


Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/complications , Catheter Ablation/methods , Tachycardia, Ventricular/surgery , Adolescent , Adult , Aged , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/mortality , Electrocardiography , Female , Follow-Up Studies , Heart Function Tests , Hemodynamics/physiology , Humans , Male , Middle Aged , Probability , Proportional Hazards Models , Retrospective Studies , Survival Rate , Tachycardia, Ventricular/etiology , Treatment Outcome
8.
Ann Cardiol Angeiol (Paris) ; 46(8): 531-8, 1997 Oct.
Article in French | MEDLINE | ID: mdl-9538366

ABSTRACT

M cells as well as vortex like reentrant tachycardia could explain the torsade de pointes pattern leading to sudden death at night in a patient with arrhythmogenic right ventricular dysplasia and saddle-back ST segment elevation in lead V2. The mechanism of the torsade is explained by the two-dimensional structure of the right ventricular free wall reconstructed from paraffin blocks. This case may represent a particular form of Brugada's syndrome and cases of sudden death in young males in South East Asia.


Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/physiopathology , Death, Sudden, Cardiac/etiology , Torsades de Pointes/physiopathology , Arrhythmogenic Right Ventricular Dysplasia/pathology , Coronary Disease/physiopathology , Electrocardiography , Humans , Male , Middle Aged
9.
Arch Mal Coeur Vaiss ; 89 Spec No 1: 99-107, 1996 Feb.
Article in French | MEDLINE | ID: mdl-8734170

ABSTRACT

Radiofrequency energy was used for the ablation of chronic recurrent ventricular tachycardia (VT) in 58 patients who were divided into two groups: 44 cases with structural myocardial disease (36 men and 8 women: mean age 55 years; range: 14 to 85 years) with an average left ventricular ejection fraction of 38% (range: 15 to 80%): these patients had myocardial infarction (28 cases), arrhythmogenic right ventricular dysplasia (11 cases), idiopathic dilated cardiomyopathy (2 cases), operated congenital heart disease (2 cases) and operated valvular heart disease (1 case). The clinical success rate after the first session of radiofrequency ablation was 34%. When (according to our modified protocol of fulguration) 160 joule cathodal shocks were delivered to the same catheter previously used for RF ablation during the same session or secondarily (13 cases), the success rate increased to 76%. The average follow-up period of the 37 survivors was 16.7 months. The second group consists of 14 cases without structural myocardial disease (10 men and 4 women, mean age 41 years, range 14 to 69 years) with an average left ventricular ejection fraction of 61%. These patients had idiopathic ventricular tachycardia (10 cases) and verapamil-sensitive ventricular tachycardia (4 cases). The primary success of radiofrequency ablation alone was 43%. When combined with fulguration during the same of radiofrequency ablation alone was 43%. When combined fulguration during the same of at a later session, the success rate increased to 71.3%. The average follow-up period of the 13 survivors was 19 months (range 0.3 to 39 months). No significant difference was observed between the groups with or without structural myocardial disease after radiofrequency or fulguration ablation, not only with respect to global results but also after analysis of subgroups with, for example, post-infarction ventricular tachycardia or arrhythmogenic right ventricular dysplasia. However, clinical success was obtained after a single session of radiofrequency ablation alone in 8 of the 9 cases of incessant ventricular tachycardia in patients with structural myocardial disease.


Subject(s)
Catheter Ablation/methods , Tachycardia, Ventricular/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Catheter Ablation/adverse effects , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Risk Factors , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/mortality , Time Factors , Treatment Outcome
10.
Arch Mal Coeur Vaiss ; 88(12): 1869-74, 1995 Dec.
Article in French | MEDLINE | ID: mdl-8729368

ABSTRACT

The authors report 8 cases of regular tachycardia with wide QRS complexes during treatment with Vaughan-Williams class 1 antiarrhythmic drugs. These antiarrhythmics, prescribed to prevent atrial fibrillation (3 patients) and atrial flutter (5 patients), were flecainide in 4 cases, propafenone in 2 cases and cibenzoline and hydroquinidine respectively associated with digitoxine and propranolol. These wide complex tachycardias were regular atrial tachycardias with 1/1 conduction to the ventricle. The action of the drug, more pronounced on intra-atrial conduction velocities than on atrioventricular node refractoriness resulted in transformation of flutter at 300 cycles/min with 2/1 conduction and a ventricular rate of 150 cycles/min to atrial flutter at 210 cycles/min with 1/1 ventricular conduction. This acceleration of the ventricular rate was accompanied by widening of the QRS complex. Using the new ventricular tachycardia criteria recently published by Brugada resulted in a diagnostic error in 7 out of the 8 cases. The recording of a wide QRS complex tachycardia in a patient on class 1 antiarrhythmic therapy for an atrial arrhythmia should alert the physician to 1/1 atrial tachycardia despite morphological electrocardiographic criteria of ventricular tachycardia. The 1/1 atrial tachycardia may be poorly tolerated and require emergency treatment. The preventive association of a drug which slows conduction through the atrioventricular node is not always effective.


Subject(s)
Anti-Arrhythmia Agents/adverse effects , Tachycardia, Supraventricular/chemically induced , Adult , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/prevention & control , Atrial Flutter/prevention & control , Drug Therapy, Combination , Electrocardiography , Female , Flecainide/adverse effects , Flecainide/therapeutic use , Heart Rate/drug effects , Humans , Imidazoles/therapeutic use , Male , Middle Aged , Propafenone/adverse effects , Propafenone/therapeutic use , Tachycardia, Supraventricular/physiopathology , Tachycardia, Supraventricular/prevention & control
11.
Arch Mal Coeur Vaiss ; 87(11 Suppl): 1589-607, 1994 Nov.
Article in French | MEDLINE | ID: mdl-7771907

ABSTRACT

Eighty-nine cases of ventricular tachycardia, resistant to antiarrhythmic therapy, were treated over a 10 year period by high energy D ablation (fulguration). This series included 37 cases of myocardial infarction with a mean ejection fraction of 30%. The mean follow-up period of the survivors was 61 months and clinical efficacy was 87.9%. Twenty-three cases of arrhythmogenic right ventricular dysplasia, aged 40 years, and with an ejection fraction of 57%, followed up for 71 months, had a clinical efficacy of 83%. Twelve patients had verapamil sensitive (fascicular) ventricular tachycardia. Their age was 30, their ejection fraction 65%, the follow-up period 55 months, and the clinical efficacy was 100%. Ten patients had primary dilated cardiomyopathy. Their age was 35, their ejection fraction 23%, the follow-up period of 38 months with a clinical efficacy of 80%. Four patients, aged 21, had operated congenital heart disease with an ejection fraction of 60%, a follow-up of 36 months and a clinical efficacy of 100%. Finally, 3 patients had idiopathic infundibular ventricular tachycardia. Their age was 36, the ejection fraction 62%, the follow-up period was 72 months and the clinical efficacy was 67%. Non lethal complications were observed in 16% of cases, mainly haemopericardium requiring pericardocentesis in 4.5% of cases. The operative mortality and in the month following ablation was 9.2%, observed mainly during the learning period. These results show that fulguration is not without risk, but in skilled hands, it gives remarkable results in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Catheter Ablation , Electrocoagulation , Tachycardia, Ventricular/surgery , Adolescent , Adult , Aged , Catheter Ablation/adverse effects , Catheter Ablation/mortality , Electrocoagulation/adverse effects , Electrocoagulation/mortality , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/mortality , Time Factors , Treatment Outcome
12.
Arch Mal Coeur Vaiss ; 86(5 Suppl): 753-6, 1993 May.
Article in French | MEDLINE | ID: mdl-8267503

ABSTRACT

Sustained ventricular tachycardia in the absence of coronary artery disease is mainly observed in diffuse left ventricular cardiomyopathy especially dilated but sometimes hypertrophic, and in right sided cardiomyopathies such as ventricular dysplasia, more difficult to diagnose. More rarely, other localised abnormalities, mitral valve prolapse, cardiac tumour and idiopathic aneurysm, may give rise to this arrhythmia. Irrespective of the case, sustained ventricular tachycardia carries a poor prognosis during the most advanced stages of a myocardial disease. The therapeutic strategy remains the same as that of other cases of sustained ventricular tachycardia, drug therapy generally orientated by the results of programmed ventricular stimulation with the exception of Class I antiarrhythmics when the ejection fraction is under 30%, and non-pharmacological methods when drug therapy fails.


Subject(s)
Cardiomyopathies/complications , Heart Ventricles/abnormalities , Mitral Valve Prolapse/complications , Tachycardia, Ventricular/etiology , Anti-Arrhythmia Agents/therapeutic use , Defibrillators, Implantable , Female , Humans , Male , Prognosis , Stroke Volume , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapy , Ventricular Function, Right
13.
Arch Mal Coeur Vaiss ; 86(3): 363-7, 1993 Mar.
Article in French | MEDLINE | ID: mdl-8215772

ABSTRACT

The authors report the first case of arrhythmogenic right ventricular dysplasia presenting with a sudden death due to primary ventricular fibrillation (ventricular fibrillation not preceded by ventricular tachycardia) recorded by the Holter method. The patient was a 56 year old man whose only complaint was near syncopal case is the fact that it is the first documented case of ventricular fibrillation revealing arrhythmogenic right ventricular dysplasia, the diagnosis of which was made at autopsy. In addition, the Holter recording showed the factors which triggered the arrhythmia: the "trigger" of 4 monomorphic ventricular extrasystoles during the minute preceding the ventricular fibrillation; the arrhythmogenic substrate giving rise to late ventricular potentials and, finally, the analysis of the R-R intervals suggesting a role of the sympathetic and parasympathetic nervous systems. Holter recordings could help identify subjects at high risk of severe ventricular arrhythmias.


Subject(s)
Cardiomyopathies/complications , Death, Sudden, Cardiac/etiology , Electrocardiography, Ambulatory , Heart Ventricles/pathology , Ventricular Fibrillation/complications , Adipose Tissue/pathology , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Cardiomyopathies/pathology , Death, Sudden, Cardiac/pathology , Humans , Male , Middle Aged , Risk Factors , Ventricular Fibrillation/diagnosis , Ventricular Function, Right
14.
Arch Mal Coeur Vaiss ; 85(2): 249-51, 1992 Feb.
Article in French | MEDLINE | ID: mdl-1562230

ABSTRACT

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.


Subject(s)
Angina Pectoris, Variant/complications , Coronary Angiography/adverse effects , Coronary Vasospasm/etiology , Catheters, Indwelling/adverse effects , Coronary Vasospasm/drug therapy , Humans , Iatrogenic Disease , Injections, Intra-Arterial , Isosorbide Dinitrate/therapeutic use , Male , Middle Aged , Vasodilator Agents/administration & dosage , Vasodilator Agents/therapeutic use
15.
Arch Mal Coeur Vaiss ; 84(1): 33-8, 1991 Jan.
Article in French | MEDLINE | ID: mdl-2012483

ABSTRACT

The increasing number of arrhythmogenic idiopathic cardiomyopathies with available histological studies by biopsy or peroperative sampling has prompted the need for data about the normal structure of the right ventricle. A retrospective study of right ventricular tissues was undertaken in 148 autopsies. The quantity of adipose tissue was scored 0 (only epicardial fat visible) to 4 (total replacement of the myocardium by adipose tissue). The topography of the adipocytes was also coded 0 to 4 according to the degree of intermyocytic penetration, irrespective of the total quantify of fat. The amount and extension of adipose tissue in the right ventricular wall was striking. Fifty called "normal" appearances with a myocytic wall of normal thickness and a separate layer of epicardial fat, were only present in 61 of the 148 cases. Adipocytes were present in variable numbers, often unexpectedly high in the majority of cases, with no relationship to the age or gender of the patient with frequent individualization of the myocardial bundles. These surprising findings in normal right ventricles should be born in mind when considering the diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). The histopathological appearances of ARVD are very similar but also differ very significantly, at least in typical cases. The adipocytes are often present in large numbers but this is banal and non-specific. On the other hand, the bundles which penetrate the epicardial fat are usually fibro-muscular and not purely myocytic. In addition, arterioles suggesting segmental diversions are present within the fatty layer with non-specific inflammatory cells.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Adipose Tissue/pathology , Arrhythmias, Cardiac/pathology , Cardiomyopathies/pathology , Aged , Female , Heart Ventricles , Humans , Male , Myocardium/pathology , Retrospective Studies
16.
Arch Mal Coeur Vaiss ; 83(14): 2031-7, 1990 Dec.
Article in French | MEDLINE | ID: mdl-2126710

ABSTRACT

The authors studied the value and limitations of Holter monitoring and electrophysiological investigation in the evaluation of treatment of sustained monomorphic ventricular tachycardia (VT). One hundred and twenty-four consecutive patients were included in the study from January 1981 to February 1988. The etiologies were chronic myocardial infarction (N = 54), dilated cardiomyopathy (N = 24), right ventricular dysplasia (N = 31), and idiopathic VT (N = 15). All the tachycardias could be induced during baseline electrophysiological investigations and presented as complex ventricular arrhythmias on the Holter recordings. The investigations were repeated after treatment which was maintained irrespective of the results, unless the tachycardia which was induced or recorded was over 130 cycles/min and/or poorly tolerated. Recurrence was defined as the recording of VT in the absence of a change of treatment and/or the occurrence of sudden death. The follow-up period averaged 29 +/- 21 months. The Kaplan-Meier method was used to study the prevalence of absence of recurrence and survival rates. We observed 28 recurrences of VT and there were 21 deaths. Eighty-five per cent of patients had normal Holter monitoring after treatment. The prevalence of absence of recurrence was 0.751 when the Holter was normal and 0.485 when an arrhythmia was recorded (p = 0.03). The sensitivity was 25 per cent and the specificity 88 per cent. The survival rates were 0.66 and 0.585 respectively (p = 0.008). Fifty-three per cent of patients remained inducible after treatment with a prevalence of absence of recurrence of 0.572. This value rose to 0.877 when VT could not be induced (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Echocardiography , Electrophysiology , Tachycardia/physiopathology , Actuarial Analysis , Adult , Aged , Ambulatory Care , Female , Follow-Up Studies , Heart Ventricles , Humans , Male , Middle Aged , Prognosis , Recurrence , Stroke Volume , Survival Analysis , Tachycardia/mortality , Tachycardia/therapy
17.
Arch Mal Coeur Vaiss ; 83(2): 167-73, 1990 Feb.
Article in French | MEDLINE | ID: mdl-2106850

ABSTRACT

The authors studied the influence on recurrence and mortality of induced ventricular arrhythmias during electrophysiological studies performed to assess the efficacy of treatment of sustained monomorphic ventricular tachycardia. One hundred and twenty-six consecutive patients investigated from 1981 to 1988 were included. The underlying pathology was chronic myocardial infarction (N = 56), dilated cardiomyopathy (N = 24), right ventricular dysplasia (N = 31) and there were 15 idiopathic cases. All these tachycardias could be induced during the control study. A second test was performed after instituting treatment. This was maintained whatever the result of the electrophysiological study except in patients in whom the tachycardia rate was over 130/mn and/or poorly tolerated. Recurrences were defined as the observation of tachycardia with the same morphology and/or the occurrence of sudden death. Follow-up averaged 29 +/- 21 months. The absence of recurrence and survival were assessed by the Kaplan-Meier method and Logrank's test. It was not possible to induce any arrhythmia after treatment in 52 patients (41%). The prevalence of absence of recurrence in this group was 0.863. If the induction of ventricular fibrillation, doublets or short runs of VT (N less than 6 with no recurrences) are included, the value increased to 0.877. These patients were considered to be non-inducible. The prevalence of absence of recurrence of arrhythmia in patients in whom it was possible to induce sustained ventricular tachycardia of the same morphology as the clinical arrhythmia was 0.512 (p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Electric Countershock , Tachycardia/therapy , Adolescent , Adult , Aged , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/physiopathology , Female , Humans , Male , Middle Aged , Prognosis , Recurrence , Survival Rate , Tachycardia/etiology , Tachycardia/mortality , Tachycardia/physiopathology
18.
Arch Mal Coeur Vaiss ; 82 Spec No 2: 113-7, 1989 Aug.
Article in French | MEDLINE | ID: mdl-2510686

ABSTRACT

Second degree blocks are divided into type I blocks, with an increment in conduction time for two consecutive conducted impulses, and type II blocks which present with constant conduction times for consecutive conducted impulses. This distinction is not only of theoretical interest but also of practical interest, since type I blocks located in the node are benign as a rule, whereas type I blocks in other locations and type II blocks are of poor natural prognosis and require pacing. Major increments of the PR interval, occurrence at night and young age are in favour of type I blocks. 2/1 blocks without 2 consecutive impulses sometimes raise difficult problems. Carotid massage and change from supine to upright posture may display two consecutive conducted P waves. If this does not happen, Holter recordings will show, in almost every case, two consecutive waves which enable the block to be typed. Whenever a doubt persists, electrophysiological exploration makes it possible to determine the exact location of the block. Type I blocks imply the presence of a decremental conduction and therefore of varying conduction velocities which decrease with consecutive impulses. This is compatible with the normal functioning of the atrioventricular node which has calcium-dependent potentials, b ut everywhere else it implies a pathological state of tissues that have sodium-dependent potentials and give an all-or-nothing response. This explains why extranodal type I blocks, like types II blocks, make it necessary to fit the patients with a pacemaker, whereas type I blocks usually are of good prognosis.


Subject(s)
Heart Block/physiopathology , Electrocardiography , Electrocardiography, Ambulatory , Heart Block/classification , Heart Block/therapy , Heart Conduction System/physiopathology , Humans , Pacemaker, Artificial , Prognosis
19.
Arch Mal Coeur Vaiss ; 81(12): 1543-6, 1988 Dec.
Article in French | MEDLINE | ID: mdl-3147645

ABSTRACT

A 25-year old female patient was admitted to hospital for respiratory failure with pulmonary miliary. Subsequently, clinical signs of pericardial tamponade developed. Echocardiography showed a tumour of the right atrium. Malignancy of the tumour was strongly suspected on the basis of magnetic resonance findings. At surgery, the tumour could not be removed and multiple biopsies showed that it was an angiosarcoma with metastases in the lymph nodes and the lungs, the latter presenting as carcinomatous miliary. This case is of interest because of the unusual way the tumour was discovered with a possible alternative diagnosis of cardiac tuberculoma, and because of the usefulness of magnetic resonance imaging to diagnose cardiac tumours and evaluate the extension of those which are malignant.


Subject(s)
Heart Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Magnetic Resonance Imaging , Adult , Diagnosis, Differential , Echocardiography , Female , Heart Atria , Heart Diseases/diagnosis , Humans , Lung Neoplasms/secondary , Tuberculosis, Cardiovascular/diagnosis
20.
Arch Mal Coeur Vaiss ; 81(6): 801-7, 1988 Jun.
Article in French | MEDLINE | ID: mdl-3144953

ABSTRACT

Intracellular microelectrodes were used to study the electrophysiological effects on action and resting potentials, refractory periods and conduction velocities of four contrast media administered either as 1/100 and 1/1000 solutions or as 20 mg bolus injections. The products studied were Telebrix, which has high osmolality (2100 mOsm/kg) and three other contrast media with lower osmolatity (700 mOsm/kg), including Hexabrix, which contains sodium, and Iopamidol and Iohexol which are sodium-free. The parameters measured were not modified by Hexabrix and Telebrix, whereas Omnipaque and Iopamiron induced varied and significant changes in these parameters, notably in concentrations of 1/100 and as bolus injections. It is suggested that the latter contrast media should be used in non-cardiovascular explorations and in patients without confirmed heart disease.


Subject(s)
Action Potentials/drug effects , Contrast Media/pharmacology , Heart Conduction System/drug effects , Iothalamic Acid/analogs & derivatives , Muscles/drug effects , Purkinje Fibers/drug effects , Angiocardiography/methods , Animals , Contrast Media/administration & dosage , Electrophysiology , Iothalamic Acid/pharmacology , Microelectrodes , Sheep
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