[Professional future after myocardial infarction (author's transl)]. / Devenir professionnel des patients victimes d'infarctus du myocarde (d'après quatre-vingt-six cas).

After a first myocardial infarction, the professional future of 86 patients is studied. 80 men and 6 women are included in the study. The mean age is 50.68 years. Manual workers prevail among affected patients, regardless of their age or of the site of the infarct. 78% of patients under 60 years resumed work, during the first threa months in more than half the cases, without any readjustments. The mean age of patients who resumed work is 47.6 years. Work was more often completely discontinued among office clerks and business managers than among other professions. Difficulties in finding readjusted jobs are greater for manual workers, especially if they belong to a small firm or if they are over 50. From a psychological and professional point of view, rehabilitation should be included in the management of myocardial infarction, even if it's impact on long-term mortality remains unknown.

[Mitral valve prolapse and severe rhythmic trouble (author's transl)]. / Prolapsus mitral et trouble du rythme grave.

Mitral valve prolapse is usually a benign affection, and yet but rather seldom, severe rhythmic troubles and even a sudden death may happen. The authors relate an observation about a seventeen years old young man presenting syncopes caused by ventricular fibrillation fit. The existence of a mitral valve prolapse is demonstrated by phonomecanogram and specially by echocardiogram which shows a telesystolic depression of the small valve. The observation is followed by commentaries about the frequency and clinic of Barlow syndrome. The rhythmic troubles liable to accompany this mitral damage are analysed and so is the evaluation of the risk of a sudden death by ventricular fibrillation.

[Radionuclide inferior vena cavography and iliac venography (author's transl)]. / Aspects scintigraphiques des thromboses ilio-caves.

Method of detection entirely harmless, the vena cava and iliac phlebography informs us about the degree and the lower level of a venous obstruction. This accuracy as to diagnosis is dependent on a dual imaging requiring the use of a gamma camera connected to a data processing system.

[Investigation of the thrombo-embolic disease by simultaneous lung scintigraphy and lower limb gamma-phlebography (author's transl)]. / Maladie thrombo-embolique. Etude par gamma-phlébographie des membres inférieurs et scintigraphie pulmonaire simultanée.

A venous thrombosis in the territory of the inferior vena cava and a possible embolus of the lung can be detected in one single examination by injecting 99 m Tc microagregates into a dorsal blood flow by this method, which associates radionuclide phlebography of the lower limbs and lung scanning, was carried out 140 times in 127 patients and resulted in the detection of 107 cases obliged us to investigate only one limb, gamma-phlebography appears to be a harmless procedure well suited to the study of the thrombo-embolic disease.

[Secondary pericarditis after myocardial infarction (author's transl)]. / Les péricardites secondaires à un infarctus du myocarde.

Our study concerns 480 observations about myocardial infarctions. In 10% of the cases, we have found a premature pericarditis diagnosed on the pericardic friction, electric and biologic signes. Some complications such as rythmical troubles, left ventricular dificiency, parietal anevrism are more frequent and increase the prognosis. In 1,2% of the cases, we find a post-infarction syndrom of Dressler, the prognosis of which is mild. The diagnosis is founded on the revival of the thoracic pain, the fever, the pericarditis and an inflammatory syndrom. The corticothérapy is efficient but seems to favour relapses.

[Paroxysmal junctional tachycardia with simultaneous supra-nodal and infra-nodal 2/1 block]. / Tachycardie jonctionelle paroxystique avec bloc 2/1 simultané supra et infra-nodal.

It is rare to find 2:1 second degree block in paroxysmal junctional tachycardia. In the case described, atrial stimulation at 200/mn during supra-ventricular tachycardia triggered off simultaneous atrio-ventricular and ventriculo-atrial block. This unusual occurrence was very useful because it localised the re-entry circuit to the junctional region by excluding possible accessory pathways.

[Posterior mycardial infarction with or without the initial complication of atroventricular block. Short and long term comparative clinical study (author's transl)]. / Infarctus myocardiques postérieurs compliqués initialement ou non d'un bloc auriculo-ventriculaire. Etude clinique comparative à court et long terme.

Comparison of the short term clinical course of 2 groups of patients who had suffered a first posterior myocardial infarction complicated during the acute phase (group A) by 2nd or 3rd degree atrioventricular block, or free of such a complication (group B), confirmed two classical concepts: the onset of this complication in one case out of five and a two-fold increase in mortality when it occurs. In the mid- and long term, however, the course is relatively similar in both groups, which do not differ initially in terms of average age, sex distribution nor the usual risk factors of coronary artery disease. In addition, the absence of sudden deaths in group A would suggest that AV block is a definitively regressive complication.

[Complete bundle-branch block and myocardial infarct. Natural history. Comparative study]. / Bloc de branche complet et infarctus du myocarde. Histoire naturelle. Etude comparative.

Myocardial infarction (MI), (and especially anteriorly situated necrosis) was complicated by complete branch block (CBB) in 9.7% of cases (45 patients out of 462). A comparison of the short- and long-term outcome in two groups of patients (group A: 45 cases of MI complicated by CBB; group B: 45 cases of MI with no atrio-ventricular or intra-ventricular conduction defects) showed that there was a much bigger immediate mortality in group A, which was not changed by temporary cardiac pacemaking, and depended on the extent of myocardial destruction. A study of the long-term outcome showed that there were more deaths in group A (recurrence of MI, intractable cardiac failure). However, the incidence of sudden death was equal in the two groups (group A 15%, group B 13%), and there was no obvious explanation in the absence of electrocardiographic tracings. Therefore this study lends no support to the argument which favours prophylactic implantation of a cardiac pacemaker during the course of MI complicated by CBB.

[Complete auriculo-ventricular block. A study of supplemental pacemakers]. / Blocs auriculo-ventriculaires complets. Etude des stimulateurs de suppléance.

The following conclusions have been drawn from a study of 20 cases of total atrio-ventricular block, which were supra-His in 7 cases, intra-His in 4 cases, infra-His in 9 cases, and were with (11 cases) or without (8 cases) recent Stockes-Adams (1 case was excluded): resumption of the basal rhythm after the post-stimulatory pause is slower in cases of infra-His A-V block; automatic discharge from the focus is easily upset by rapid stimulation, whatever the site of the focus (ventricular or junctional); subsidiary foci of stimulation would behave from the electro-physiological standpoint like a sinus focus with reduced autonomy, and deprived of its peripheral zone of physiologically slow conduction; unfortunately electro-physiological investigation of this group does not allow us to separate with confidence those patients who have had Stockes-Adams attacks from those who have not.

[Short-term outcome of a 1st myocardial infarct preceeded or not by a premonitory sign. Comparative study]. / Evolution à court terme d'un premier infarctus myocardique précédé ou non d'un syndrome prémonitoire. Etude comparative

A comparative study of two groups of patients after their first myocardial infarction, distingusihed by the presence (group A, 149 cases) or absence (group B, 184 cases) of premonitory signs has shown no difference between the two groups in the short-term (5 weeks). The only differences were in the age (younger patients and in the larger number of anteriorly situated infarcts in the 45% of patients in this series who had premonitory signs.

[Recent myocardial infarction and complete bundle branch block. Comparative macroscopic pathological study]. / Infarctus myocardique récent et blocs de brache complets. Etude anatomique macroscopique comparative

Fifty five anatomo-clinical cases of patients who died of a recent myocardial infarction were divided into two groups according to existence of a complete block of one of the branches of the bundle of His, which occured at the same time as the myocardial necrosis: group A: 14 cases comprising 13 complete right blocks and only one complete left block, or absence of intraventricular conduction disorders: group B: 41 cases. The macroscopic anatomical study separated the two groups: in group A there was a very high frequency of healed posterior infarction, extensive recent anterior infraction, transeptal through the anterior and upper half of the interventricular septum by occlusion of the anterior interventricular artery in its proximal segment, above the origin of the second anterior septal artery, associated to severe stenosing lesions of the other coronary trunks, in particular the right coronary artery.

[Myocardial and coronary lesions in anterior and posterior myocardial infarction. Comparative macroscopic anatomical study]. / Les lésions myocardiques et coronariennes dans l'infarctus myocardique antérieur et postérieur. Etude anatomique macroscopique comparative

Comparative anatomical macroscopic study of two groups of 24 cases of recently fatal first myocardial infarction (anterior or inferior) confirmed certain classical notions: higher age in females (p less than 0.02), inferior necrosis less extensive (p less than 0.05), higher occurrence of rupture of the myocardium in the case or an anterior lesion, and less frequent rupture but more often involving the septum in the case of inferior infarction. Furthermore the study showed the virtually constant presence of an intracoronary thrombus responsible for the infarction, the wider extent of atherosclerotic lesions in the right coronary system, and, above all, a fairly direct opposition between stenotic lesions most often proximal, and affecting the single anterior trunk (75%), in the case of anterior infarction, whilst significant atherosclerotic occlusion of the anterior (87%) and left (67%) systems were seen in the case of inferior infarction due to complete occlusion of the right coronary artery. These anatomical findings indicate the need for routine coronary arteriography after inferior infarctions, the recurrence of chest pain being related not to changes "in sity" but rather to significant occlusion of another coronary system.

[Myocardial infarction in patients over 75 years old. Comparative macroscopic anatomical study]. / L'infarctus myocardique des sujets de plus de 75 ans. Etude anatomique macroscopique comparative

The macroscopic anatomical study of 27 cases of patients aged over 75 years did not show any significant difference between the myocardial and established coronary artery lesions, and those of a numericaly related group of young subjects. These anatomical facts are inducive to take more into account the physiological age of patients, and not to statistically exclude certain old patients from the eventual benefit of therapy and full investigation, at present reserved for younger patients.