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1.
Ann Cardiol Angeiol (Paris) ; 67(6): 429-438, 2018 Dec.
Article in French | MEDLINE | ID: mdl-30342829

ABSTRACT

The choice of revascularization of coronary patients, if it is well codified in the general population, remains in the elderly subject a daily dilemma for the clinician. We report 4 clinical cases (80 years and over) elective for coronary artery bypass or percutaneous coronary transluminal angioplasty (PTCA). No randomized studies dedicated to this population are available. Nevertheless, according to the registries, surgery versus PTCA has a superior benefit in the medium and long term, despite higher mortality and stroke. The coronary lesions in this population are actually more complex, usually leading to surgery compared to a younger population. However, the choice of the revascularization method is difficult depending on the co-morbidities and the higher surgical risk. What must be taken into account here are the cognitive abilities, the risk of cognitive decline, the frailty of the patient (correlated with mortality), frailty being a subjective data given without a consensually recognized scoring system. The indication of the revascularization method should include mortality risks as well as morbidity, in particular the potential risk of deterioration of the general condition and autonomy of patients, particularly the elderly. Randomized studies dedicated to this population, taking into account mortality and morbidity, and in particular the "concept of frailty", would make it possible to describe the specificities of aging subjects in recommendations and good practices.


Subject(s)
Angina, Stable/therapy , Coronary Artery Bypass , Patient Selection , Percutaneous Coronary Intervention , Referral and Consultation , Aged, 80 and over , Comorbidity , Coronary Stenosis/diagnosis , Coronary Stenosis/therapy , Female , Humans , Male
2.
Ann Cardiol Angeiol (Paris) ; 62(3): 132-8, 2013 Jun.
Article in French | MEDLINE | ID: mdl-23743000

ABSTRACT

To improve the management of hypertension in the French population, the French Society of Hypertension has decided to update the national guidelines with the following characteristics: usefulness for practice, synthetic form, good readability, comprehensive writing for non-doctors, emphasizing the role of patient education in the management of hypertension, wide dissemination to health professionals and the population of hypertensive subjects, impact assessment among health professionals and the public health goals. These guidelines include the following 15 recommendations, divided in three chapters, according to the timing of the medical management. BEFORE STARTING TREATMENT: 1. Confirm the diagnosis, with blood pressure measurements outside the doctor's office. 2. Implement lifestyle measures. 3. Conduct an initial assessment. 4. Arrange a dedicated information and hypertension announcement consultation. INITIAL TREATMENT PLAN (FIRST 6 MONTHS): 5. MAIN OBJECTIVE: control of blood pressure in the first 6 months (SBP: 130-139 and DBP<90 mmHg). 6. Favour the five classes of antihypertensive agents that have demonstrated prevention of cardiovascular complications in hypertensive patients. 7. Individualized choice of the first antihypertensive treatment, taking into account persistence. 8. Promote the use of (fixed) combination therapy in case of failure of monotherapy. 9. Monitor safety. LONG-TERM CARE PLAN: 10. Uncontrolled hypertension at 6 months despite appropriate triple-drug treatment should require specialist's opinion after assessment of compliance and confirmation of ambulatory hypertension. 11. In case of controlled hypertension, visits every 3 to 6 months. 12. Track poor adherence to antihypertensive therapy. 13. Promote and teach how to practice home blood pressure measurement. 14. After 80 years, change goal BP (SBP<150 mmHg) without exceeding three antihypertensive drugs. 15. After cardiovascular complication, treatment adjustment with maintenance of same blood pressure goal. We hope that a vast dissemination of these simple guidelines will help to improve hypertension control in the French population from 50 to 70 %, an objective expected to be achieved in 2015 in France.


Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Hypertension/diagnosis , Hypertension/drug therapy , Risk Reduction Behavior , Adult , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Blood Pressure Monitoring, Ambulatory , Disease Management , Drug Combinations , Drug Therapy, Combination , France , Humans , Hypertension/physiopathology , Medication Adherence , Patient Education as Topic , Precision Medicine
3.
Ann Cardiol Angeiol (Paris) ; 60(6): 317-23, 2011 Dec.
Article in French | MEDLINE | ID: mdl-22055431

ABSTRACT

Spastic angina is considered rare but its prevalence is probably underestimated especially in case of atherosclerotic coronary lesions. Its diagnosis remains important due to its poor prognosis and therapeutic characteristics. We report three clinical cases illustrating two different clinical presentations and the problem of diagnosis of spastic angina. We performed a review of the literature essentially concerning commonly used diagnosis means and especially provocative testing for coronary spasm. This test needs to be adapted to the evolution of techniques and uses of coronary angiography in 2011, particularly the wide spread use of radial approach. Therefore new recommendations are needed, specifying the terms of provocative testing and establishing clear diagnosis criteria including clinical, electrocardiographic and angiographic data. Such guidelines would probably help to better diagnose and treat these patients in our practice.


Subject(s)
Angina Pectoris, Variant/diagnosis , Angina Pectoris, Variant/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Angina Pectoris, Variant/diagnostic imaging , Angina Pectoris, Variant/etiology , Coronary Angiography/methods , Diagnosis, Differential , Drug Therapy, Combination , Dyslipidemias/complications , Echocardiography , Electrocardiography , Humans , Hypertension/complications , Male , Middle Aged , Prognosis , Radial Artery , Risk Factors , Treatment Outcome , Vasodilator Agents/therapeutic use , Verapamil/therapeutic use
4.
Ann Cardiol Angeiol (Paris) ; 38(9): 535-8, 1989 Nov.
Article in French | MEDLINE | ID: mdl-2690724

ABSTRACT

The abnormal origin of the left coronary artery from the trunk of the pulmonary artery is rarely encountered, difficult to diagnose and has a severe prognosis because of the major risk of sudden death. The authors report the case of a 63 year-old male patient, presenting this anomaly which creates a true left-to-right shunt with myocardial ischemia secondary to the steal of coronary blood toward the pulmonary artery. The diagnosis is evoked by bidimensional cardiac sonography, pulsated and color Doppler, which permit to confirm the left-to-right shunt while this is confirmed by coronary angiography. The treatment is essentially surgical.


Subject(s)
Coronary Vessel Anomalies/diagnosis , Echocardiography, Doppler , Pulmonary Artery/abnormalities , Angina Pectoris/etiology , Angiocardiography , Cardiac Catheterization , Coronary Angiography , Coronary Vessel Anomalies/complications , Humans , Male , Middle Aged , Prognosis , Pulmonary Artery/diagnostic imaging
5.
Ann Cardiol Angeiol (Paris) ; 36(2): 85-6, 1987 Feb.
Article in French | MEDLINE | ID: mdl-2435204

ABSTRACT

Two case-reports of thrombopenias induced by pentosane polysulfate (PSP) are reported. PSP may play a direct role in the genesis of the thrombopenia appearing between the 5th and 15th day of treatment, or a sensitizing role where the thrombopenia occurs quite rapidly following heparin treatment. The clinical complications are haematomas, arterial or venous thromboses and haemorrhages. The platelet aggregation test is always positive in the presence of PSP. The immunological origin is probable. Monitoring of the platelet count is recommanded with this treatment.


Subject(s)
Pentosan Sulfuric Polyester/adverse effects , Polysaccharides/adverse effects , Thrombocytopenia/chemically induced , Aged , Female , Humans
6.
Arch Mal Coeur Vaiss ; 79(10): 1475-9, 1986 Sep.
Article in French | MEDLINE | ID: mdl-3099681

ABSTRACT

20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.


Subject(s)
Echocardiography/methods , Mitral Valve/surgery , Adolescent , Adult , Aged , Bioprosthesis , Child , Child, Preschool , Evaluation Studies as Topic , Heart Valve Prosthesis , Humans , Methods , Middle Aged , Mitral Valve Insufficiency/surgery , Reoperation
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