[Phonomechanographic evaluation of left ventricular function in hyperthyroid states]. / Evaluation phonomécanographique de la fonction ventriculaire gauche dans les états hyperthyroïdiens.

Hyperthyroidism is associated with a hyperkinetic syndrome, the mechanisms of which are not fully understood but which include an increase in heart rate, a reduction in systemic arterial resistance and a debatable increase in myocardial contractility. The limitations of radioimmunological assay of the hormonal mediators underline the diagnostic value of an atraumatic method of quantifying left ventricular systolic function. In view of the variable sensitivity of phonomechanographic and echocardiographic indices with respect to changes in heart rate, pre- and after load, we studied apex cardiographic indices during the phase of isovolumetric contraction. Fifty-eight patients with hyperthyroidism but without patent cardiovascular disease were divided into two subgroups: Grave's disease: 38 cases, and toxic adenoma: 22 cases. The results of the measurements of systolic time intervals and the calculation of "indices of contractility" obtained from the apex cardiogram and its first derivative, were compared with those of 36 young, normal subjects. The results show that: the pre-ejection period of the study population was much shorter than normal (65,7 ms +/- 2,5 vs 84,6 ms +/- 3,4; p less than 0,001); this was clearly related to the chronotropic factor (p less than 0,05). The pre-ejection/ejection period ratio did not differentiate hyperthyroid from normal subjects (0,265 vs 0,283, p greater than 0,20), except in Graves' disease (0,249, p less than 0,02). On the other hand, measurements made from the apex cardiogram showed significant differences in both types of hyperthyroidism. (Formula: see text). In conclusion, phonomechanography may be used to quantify the increase in left ventricular function in hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bacterial endocarditis and mitral valve prolapse]. / Endocardite bactérienne et prolapsus valvulaire mitral.

The suspected diagnosis of bacterial endocarditis is based on a presumption. Over the last few years, ultrasound, which can identify valvular lesions and their repercussions, has established itself as a supplementary diagnostic tool in the early stages of this disease. The existence of false negatives should not be underestimated, but one must also be aware of the possibility of false positives. These false positives are mostly due to mitral valve prolapse. An unusual cas serves as an illustration of the potential diagnostic difficulties of this association and confirms the value of the ultrasound examination, provided it is performed under optimal conditions and repeatedly. However, the abnormalities of ventricular kinetics in the course of mitral valve prolapse limit the evaluation of the haemodynamic repercussions of the regurgitation. The authors stress the supplementary contribution of phonomechanographic examinations. In this particular case, they gave an idea of the severity of the mitral leak and of its recent onset and they strongly suggested the integrity of left ventricular function and the presence of major valvular dysplasia.