[Echocardiography under perfusion with dobutamine. Experience of Tunisian cardiologic service. About 70 cases]. / Echocardiographie sous perfusion de dobutamine. Experience d'un service de cardiologie Tunisienne: a propos de 70 cas.

We report a prospective study which began on February 1st, 1999. 70 consecutive and non selected patients got dobutamine stress echocardiography. The major indication, in 53% of cases, was detection of coronary disease in patients suffering from chest pain but whose stress testing were not conclusive. Dobutamine was continuously and intravenously administered at doses ranging from 5 to 40 microg. Maximal dose was obtained in 73% of cases. The most frequent reason that led us to stop the test was the reach of the target cardiac frequency (85 of FMT). We observed 7 severe rhythmic complications (2 auricular fibrillation, 1 flutter, 2 episodes of frequent and polymorphic ESV, 2 TVNS). One patient presented a myocardial infarction during dobutamine echography whereas the basic kinetics was normal. 26 patients got a coronarography within 3 days following echography. Stress echography detected a significant coronary stenosis (> or = 50%), with a sensitivity of 86%, a specificity of 83% and a precision in the diagnosis of 84%.

[Therapeutic strategies of atrial fibrillation in patients aged 65 and over. Report of 86 cases]. / Modalités thérapeutiques de la fibrillation auriculaire du sujet âgé de 65 ans ou plus. A propos de 86 observations.

Auricular fibrillation is the most common sustained cardiac arrhythmia, yet the optimal strategy for its management remains unclear. Since the study AFFIRM from which resulted them final were deferred in December 2002, the assumption of responsibility of the fibrillation of the old subject tends to become clarified. 86 patients at least 65 years or more were enrolled in our retrospective study from January 1997 to June 2003. The mean age is 70 years (65 to 82 years) and sex ratio to 0.79. 34% had a history of hypertension and 12% had a coronary artery disease. 2 groups were individualized, according to the year of admission before or after 2002. It comes out from these work 2 points: the restoration of the sinusal rhythm was the first choice. In the event of failure, the option was to maintain fibrillation and this, in the 2 groups. The AVK were founded in the large majority of the cases only after year 2002.

[Angiosarcoma of the right atrium detected by transesophageal echocardiography. A case report]. / Angiosarcome du coeur révélé par l'échographie trans-oesophagienne. A propos d'une observation.

Primary tumors of the heart are uncommon. 75% of these tumors in the adult are benign and 25% are malignant. Angiosarcoma was the most frequent malignant tumour. 75% occurred on the right side, especially in the right atrial. This tumour was generally discovered in post-mortem because the non specificity of functional symptomatology. Echocardiography is the first non invasive tool for diagnosis and evaluation of cardiac mass. Angiosarcoma was associated with an unfavourable outcome. We reported a case of an atrial angiosarcoma revealed by transoesophageal echocardiography in a 42 years old woman.

[Indications for dobutamine stress echocardiography]. / Indications de l'echocardiographie sous perfusion de dobutamine.

Since its introduction in 1986, Dobutamine stress echocardiography has become an established method for the diagnosis of coronary artery disease. For its logistic, this exam needs the same equipment for the monitoring than treadmill testing. Its indications are codified and validated. Dobutamine stress echocardiography is proposed especially for patients unable to exercise or when treadmill testing is not conclusive. Since she has the same indications than thallium scintigraphy, its advantages are its availability and less cost. Its major limitation is the poor echogenicity of patients. Recently the introduction of contrast agents allows a better definition of endocardial border.

[Cardiovascular complications of sleep apnea syndromes]. / Les complications cardiovasculaires du syndrome d'apnées du sommeil.

The high incidence of association between sleep apnea syndrome and cardiac disturbance was widely descripted during the last decade and has been the target of intensive investigation. Our retrospective study included 12 patients with sleep apnea syndrome diagnosed by polysomnography. 7 patients had HTA with left ventricular hypertrophy (5 cases). The CPAP stabilise blood pressure in 6 of them, 3 patients had ventricular or atrial arrhythmia. CPAP resolved 2 of them. 3 other patients had coronaropathy. Another one presented stoke. The sleep apnea syndrome has been descripted in association with heart failure or unstable HTA.