[Contribution of the 6-minutes walking test and the plasma NT-proBNP at admission and discharge to the prognostic evaluation of patients with NYHA class II-III Heart Failure.] / Contribution du test de marche de six minutes et des taux de NT-proBNP à l'admission et la sortie dans l'évaluation pronostique de l'insuffisance cardiaque classe II-III de la NYHA.

OBJECTIVE: To study the 6MWT and NT-proBNP contribution to the prognosis evaluation of patients with NYHA class II-III heart failure in the Yalgado Ouédraogo Teaching Hospital. METHODS: We carried out a nine months prospective observational cohort from the 1st February to the 31st October 2020. Patients with NYHA class II-III HF who consented to participate were included in the study. We identified two variables of interest: death and readmission. RESULTS: We included 50 patients with congestive heart failure representing 37.3% of heart failure. The average follow up time of patients was 154.58 ± 74.8 days. Twelve patients (24%) were readmited and 11 passed away with five during hospitalisation. On admission, The average distance on the 6MWT (194.6 ± 85.5 m) on admission and average NT-proBNP (5812.1±4729.4 ng/L) measured on admission and before discharge wasn't significantly correlated to the risk of death and re-hospitalisation. The average distance on the 6MWT before discharge (306.2±84.6) was significantly correlated to an increase risk of death and re-hospitalisation. Patients with an increase in NT-proBNP superior to 30% from measurement on admission to the one before discharge had a high risk of re-hospitalisation and death compare to those with a decrease of more than 30% with a moderate to good correlation coefficient of 0.6 between the two. CONCLUSION: 6MWT and NT-proBNP variations from admission to discharge have been necessary to evaluate the prognosis of patients with CHF.

[Evaluation of the quality-of-life of patients with pacemakers : experience of Burkina Faso about 120 patients paired with the collaboration of doctors from AUVERGNE (France)]. / Évaluation de la qualité de vie des patients porteurs d'un stimulateur cardiaque (pacemaker) : expérience du Burkina Faso à propos de 120 patients appareillés avec la collaboration des médecins d'Auvergne (France).

INTRODUCTION: In Burkina Faso, cardiac stimulation was introduced in October 2000 has grown over time.In orderto evaluate the effectiveness of stimulation on life, we proposed to evaluate the quality of life of patients with a pacemaker. GENERAL OBJECTIVE: to study the effect of the pacemaker on the quality of life of patients PATIENTS AND METHODS: This was a cross-sectional study aimed at describingthe wearers of a pacemaker for at least six months at the Yalgado OUEDRAOGO University Hospital and the Schiphramedical center.The AQUAREL questionnaire has been adapted to our context to establish a quality-of-life score. RESULTS: The mean age of the study population was 68 years with a female predominance (53.3%). Complete atrioventricular block was the main indication of stimulation in 55%. The average duration of implantation was 41.6 months with extremes of 8 and 128 months. The primo implantation was found in 79.1 % of patients against 18.3 % for a first change of case and2.5 % for a second change of housing. Double chamber stimulation was performed in 65% of cases. DDD mode was the most used followed by VVIR. The average quality of life score was 90.12. Negative predictors of quality of life were age and female.A correlation between quality-of-life score and age, hypertension and dyslipidemia was found (p< 0.05). On the other hand, no correlation between the number of implantation, the duration of implantation and the mode of stimulation was found (p> 0.05). CONCLUSION: patients with a pacemaker have a good quality of life. However, quality-of-life is not correlated with the number of pacemakers, nor the duration and mode of stimulation.

[Mitral stenosis and acute hemolytic anemia after mitraclip]. / Sténose mitrale et anémie hémolytique aiguë après mitraclip.

Mitraclip corrects mitral regurgitation in a less invasive way than cardiac surgery. These procedures are becoming widespread with the emergence of new complications. We report a rare case of mitral stenosis associated with acute hemolytic anemia after mitraclip treatment in an 82-year-old patient. The cause of this stenosis in our case is linked to the placement of two clips and an increase gradient in post-procedure. The mechanism of hemolysis could be due to the persistence of mitral leaks resulting in strong collisions against the clip.

[Anemia in patients with acute coronary syndrome in the Vichy Hospital center]. / Anémie chez les patients avec syndrome coronarien aigu au centre hospitalier de Vichy.

INTRODUCTION: Objectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients. PATIENTS AND METHODS: Retrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13g/dL in man and less than 12g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression. RESULTS: Among 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P=0,003), the pulsed pressure (P=0,007), LVEF (P=0,005), the albumin (P=0,010), Creatine kinase (CK) level (P=0,048) and of CRP (P=0,011), were linear factors of variations of the haemoglobin rate (R2=0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P=0,02). CONCLUSION: Anaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.

[Five years assessment of cardiac stimulation in two public hospitals in Burkina Faso: An experiment of collaboration with two hospitals in Auvergne]. / Bilan de cinq ans de stimulation cardiaque dans deux structures hospitalières publiques du Burkina Faso : expérience d'une collaboration avec deux centres hospitaliers d'Auvergne.

OBJECTIVES: Cardiac stimulation becomes a reality in Burkina Faso. The aim of our study was to evaluate this activity over five years and to appreciate the impact of collaboration with French hospitals of Auvergne area in its development. MATERIALS AND METHODS: Prospective study including consecutively patients who underwent pacemaker implantation since June 2011. Data collected included indications, time to care, type of stimulation, complications, cost of treatment, and education and quality of life of the patient. RESULTS: Sixty-nine patients received definitive pacemaker from June 2011 to June 2016, of whom 45.5% were women. The mean age was 69 years (extremes 35 to 89s). Almost all patients (94%) were symptomatic (54% syncope and 30% dizziness and lipothymias). The main indication for definitive cardiac pacing was complete atrioventricular block of degenerative origin (83%). The mean time between indication and surgery was 8.2 days, and only 4% of patients received temporary stimulation. The lack of financial support was the main reason for the delay in taking charge. During the study period, the two health centers received support in the form of stimulation equipment, a technical platform, and regular training and practical training. This collaboration made it possible to overcome the lack of material, human and financial resources. We recorded as complications a case of case exteriorization, two cases of benign local hematoma and two cases of probe displacement. The quality of life of the patients improved markedly, none of patients undergoing surgery remained symptomatic. CONCLUSION: The organization of cardiac stimulation in Burkina Faso is a reality. Efforts must be made to sustain the activity and strengthen collaboration with hospitals in the north.

[Late discover of a coronaro-pulmonary fistula]. / Une fistule coronaro-pulmonaire de découverte tardive.

Anomalies of the coronary arteries mainly concern a pediatric population, bringing together a wide range of defects. In adults, the evolution is linked to the hemodynamic consequences of fistula. Several therapeutic options have been proposed such as surgery or embolization. We report the case of a 55 years old patient addressed because of dyspnea secondary to aortic insufficiency. The preoperative assessment shown the coexistence of coronary abnormality corresponding to a coronaro-pulmonary fistula. This type of coronary anomaly is rarely described in the adult population, because of its consequences secondary to the closure of the foramen ovale, resulting in angina symptoms in childhood. Without treatment, mortality from this type of malformation is important (90%).

[Fast track chest pain pathway in emergency department]. / La prise en charge rapide des douleurs thoraciques aux urgences.

Acute chest pain is a common reason of consultation in the emergency department. The difficulty lies in discriminating patients with acute coronary syndrome or other life-threatening conditions from those non-cardiovascular, non-life-threatening chest pain. Only 15 to 25 % of patients with acute chest pain actually have acute coronary syndrome. Algorithms using high sensitivity troponin at admission and a second assessment 1 or 3hours later are validated to "rule in" or "rule out" the diagnosis of non ST-elevation myocardial infarction. This may reduce the delay for the diagnosis translating into shorter stay in the emergency department. Those algorithms must be interpreted in the context of clinical and ECG criteria.

[Atypical MRI image of Tako-Tsubo syndrome: a case report]. / Aspect IRM atypique du syndrome de tako-Tsubo : à propos d'un cas.

Since the 1990s, a new entity cardiomyopathy is described: the Tako-Tsubo syndrome. The Mayo Clinics' criteria have been defined by to help diagnose: LV dysfunction, electrical modifications, and complete recovery. It is a Caucasian woman aged 66 hospitalized for chest pain syndrome occurred during the funeral. In support, we note the presence of STEMI. The patient received the conventional treatment of acute coronary syndrome. Cardiac ultrasound, angiography is in favor of Tako-Tsubo syndrome. MRI shows an unusual location: a delayed enhancement in epicardial associated pericardial effusion mimicking myopericarditis.

[Interest of emergency coronary computed tomography for exclusion of coronary artery disease in patients with acute chest pain and low to intermediate risk]. / Intérêt du coroscanner en urgence pour l'exclusion de la maladie coronaire chez les patients souffrant de douleur thoracique à risque faible ou intermédiaire.

PURPOSE: To demonstrate the usefulness of the multislice computer tomography coronary angiography (CCTA) in patients with suspected acute chest pain without electrical changes or enzyme rise, and with low cardiovascular risk. PATIENTS AND METHODS: Fifty-three patients at low or intermediate risk for coronary artery disease, who were admitted in the emergency department for an acute chest pain, and who underwent a CCTA, were included in the study. Results of the CCTA were classified as normal, non-obstructive stenosis (≤ 50% stenosis in diameter), obstructive stenosis (> 50% stenosis in diameter). The mortality was assessed during a 4-years follow-up period. RESULTS: Mean age was 61 years (36-86), 43% of patients were women. The CCTA was normal in 35 patients (66%), seven patients (13%) had non-obstructive stenosis and 11 (21%) had obstructive stenosis. In the group of normal CCTA, 8.5% of patients were admitted in cardiac intensive care unit, 57.1% in the non-obstructive stenosis and 90.9% in the group of obstructive stenosis. No deaths occurred during the 4-year follow up in the group of patients with normal CCTA. CONCLUSION: This study confirms the negative predictive value of CCTA for the diagnosis of coronary artery disease and for further clinical events in patients at low or intermediate risk referred to emergency department for an acute chest pain.

[Contribution of magnetic resonance imaging in diagnosis of pericardial mesothelioma: a case report]. / Apport de l'imagerie par résonance magnétique au diagnostic du mésothéliome péricardique: à propos d'un cas.

Pericardial mesothelioma is a rare form of pericardial tumor. The invasive investigations such as biopsy make the diagnosis. Non-invasive imaging techniques provide valuable information about its diagnosis and its clinical impact. We report here the results of magnetic resonance imaging of pericardial mesothelioma in a 65-year-old woman. The originality and purpose of this case is to illustrate the additional value of magnetic resonance imaging that should be systematically performed when assessing this pathology.

[Pseudo-aneurysm of mitro-aortic continuity: a rare complication after aortic valve replacement]. / Le pseudo-anévrisme du trigone fibreux aorto-mitral : une complication rare du remplacement valvulaire aortique chirurgical.

Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.

[Tako-Tsubo syndrome during normal human immunoglobolin perfusion]. / Syndrome Tako-tsubo au décours d'une perfusion d'immunoglobuline humaine normale (Tégeline(®)).

This is a case of an 82 year old female patient with myasthenia gravis, who following treatment with Human Normal Immunoglobulin (Tegeline(®)), developed dyspnoea, chest pain without cardiac insufficiency, inverted T wave on ECG with slight increase in Troponine T 0.43ng/mL (<0.2ng/mL normal value in our hospital) and marked increase in Pro-BNP 4900 (Nl≤450pg/mL for an age greater than 65 years old). Her coronary angiogram showed hypokinesia of apical area but was otherwise normal. Also, MRI ruled out inflammatory and ischemic cardiac diseases. The most likely diagnosis for us was Tako-Tsubo syndrome in relation with injection of Human Normal Immunoglobulin (Tegeline(®)) according to the Mayo clinic criteria.

[Management of patients with ST-elevation myocardial infarction in the French General Hospitals in 2008--reperfusion strategies--additives treatments (2008 study on the practices of General Hospitals)]. / Prise en charge de l'infarctus du myocarde dans les CHG français en 2008--stratégies de reperfusion--traitements adjuvants (enquête 2008 sur les pratiques des hôpitaux généraux). Étude SCA ST+ 2008--CHG.

We have performed a retrospective survey on the management of ACS ST+ in French general hospitals in 2008. The aim was to assess adherence to recommendations of various scientific societies. Sixty-six hospitals responded. The total number of patients was 4741, 63% supported by mobile emergency resuscitation service and 37% by emergencies. The treatment of reperfusion and adjuvants are detailed, the heterogeneity of regimens is emphasized. The median treatment of reperfusion is 107, the median rate of reperfusion was 91% with 72% of primary angioplasty. In general, centers with interventional cardiology use less fibrinolysis and are the only ones to use anti-G2B3A.

[Myocardial infarction after voluntary intoxication by drug interaction between dipyridamole and aspirin]. / Infarctus du myocarde après intoxication volontaire par l'association acide acétylsalicylique et dipyridamole.

A 60-year-old male presented a myocardial infarction after a voluntary overdose of Asasantine(®) started after strokes. He took chronically this association and some psychotropic drugs with vasodilator effects. After an intake of 40 tablets, he presented a cardiogenic shock with a myocardial infarction confirmed by biological samples, EKG, echocardiography and angiocoronarographie. No recent change of his treatment was found and symptoms regressed when dipyridamole was stopped while other vasodilators drugs were continued. Chronological analysis of events led us to suspect dipyridamole as a starter of the myocardial infarction secondary to a coronary artery steal reinforced by the vasodilator effect of combined treatments, in a patient at risk of ischemia. This case shows that, in such particular conditions, a change in dipyridamole dosage can induce a myocardial infarction even if its blood level remains in the therapeutic range.

[Diagnostic schelf: a case of pulmonary embolism with ST elevation]. / Embolie pulmonaire massive et sus décalage du segment ST dans les dérivations antérieures : piège diagnostic.

Some pulmonary embolism may present electrocardiogram changes, which suggest the diagnosis of myocardial infarction. We report the case of a patient with such a confounding presentation. In this patient, the wrong diagnosis of myocardial infarction led to a primary coronarography which was normal and finally, echocardiogram gave us the key leading to a fibrinolitic treatment which improved the patient.

[Myocardial infarction and ovarian stimulation: case report]. / Infarctus du myocarde et stimulation ovarienne : à propos d'un cas.

Female infertility treated by ovarian stimulation can lead to arterial thrombosis particularly when ovarian hyperstimulation syndrome emerges. Myocardial infarction have been reported thrice, in one case even before artificial ovulation induction. A 25-year-old female with primary infertility underwent ovarian stimulation and eight days after ovulation induction and intra-uterine insemination suffered from a troponin positive non-ST-elevation myocardial infarction of the inferior wall. Coronary angiogram was normal and contrast-enhanced cardiovascular magnetic resonance imaging confirmed the subendocardial inferior infarct. This protocol included sole triptorelin administration followed by 23 recombinant follicle stimulating hormone injections and concluded by recombinant choriogonadotrophin. There was no ovarian hyperstimulation syndrome. Large biological screening did not retrieve any predisposition for arterial thrombosis. Clinical outcome was excellent. Despite weak causal link, we emphasize that chest pain during ovarian stimulation protocol should rise clinical concern for acute coronary syndrome.