[Management of infarction with ST elevation in the acute phase: the current guidelines]. / Prise en charge de l'infarctus avec sus-déalage de ST au stade aigu: recommandations actuelles.

The 2002 and 2005 recommendations of the European Society of Cardiology for the management of ST-elevation myocardial infarction at the acute stage are reviewed. Primary angioplasty should, whenever possible, constitute the default strategy, but intravenous thrombolysis still has an important role, particularly in the first few hours following symptom onset.

[Admission and fasting blood glucose are important prognostic markers in acute coronary syndromes]. / Glycémie d'admission et glycémie a jeun, marqueurs pronostiques dans les syndromes coronaires aigus.

This paper reviews current evidence on the role of admission and fasting glycaemia as prognostic markers in patients with acute coronary syndromes. Though both parameters are correlated, they give different prognostic information and are related to both in-hospital complications, including death, and long-term outcomes. As hyperglycemia at the acute stage of myocardial infarction is an independent predictor of untoward cardiovascular events, blood glucose measurements should become routine in all patients presenting with acute coronary syndromes.

[Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)]. / Prise en charge par le Samu de l'infarctus du myocarde avec sus-décalage du segment ST en milieu urbain chez le sujet agé de plus de 80 ans.

More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.

[Study of blood pressure, hemodynamic, ventilatory and metabolic responses to isometric exercise performed during dynamic exercise in health subjects]. / Etude des réponses tensionnelles, hémodynamiques, ventilatoires et métaboliques à l'exercice isométrique réalisé au cours d'un exercice dynamique chez le sujet sain.

The object of this study was to study the blood pressure, haemodynamic, ventilatory and metabolic changes on isometric exercise during a dynamic effort in healthy subjects. Twelve healthy subjects underwent isometric exercise by manual prehension at 40% maximal capacity under these conditions: isolated (A), five minutes after the onset of rectangular dynamic exercise on a cycle at 60% of ventilatory threshold (B) and at the fourth minute of the recovery phase of dynamic exercise (C). The blood pressure, heart rate, stroke volume and cardiac index measured by Doppler echocardiography, systemic arterial resistances, respiratory flow and respiratory rate, were measured before and after each isometric exercise. The results showed blood pressure and heart rate to increase in a similar manner during isometric exercise under all conditions. The cardiac index increased by 29.5% +/- 8.3% (p < 0.01) under condition A and by 38.1% +/- 10% (p < 0.01) under conditions C but did not change significantly under conditions B. On the other hand, the systemic arterial resistances increased by 15.5% +/- 6.5% (p < 0.05) under conditions B, decreased by 8.8% +/- 3.9% (p < 0.05) under conditions C but did not change significantly under conditions A. The respiratory flow increased under all three conditions although the respiratory rate was only increased under conditions B. The authors conclude that, in healthy subjects, the increase in blood pressure during isometric and dynamic exercise is the result of an increase in systemic resistances whereas, during isometric exercise, it is flow-dependant.