[Cardiac effects of dermatomyositis. A case report]. / Atteintes cardiaques des dermatomyosites. A propos d'un cas.

The cardiac effects of dermatomyositis and polymyositis are found frequently at autopsy, even though the clinical manifestations are rare. We report the observation of a patient with dermatomyositis, in whom ventricular tachycardia, and dilated hypokinetic cardiomyopathy were in the foreground of the cardiac anomalies. This rhythm disturbance responds to treatment, as opposed to the associated dilated cardiomyopathy. Electrocardiographic anomalies are frequent, notably conduction disturbances. Ventricular rhythm disturbances are of poorly defined frequency. Cardiac insufficiency is often stabilised with treatment. The other effects are much rare.

[Ischemic pseudo-normalization of T waves and ST segment]. / Pseudo-normalisation ischémique des ondes T et du segment ST.

The development of acute myocardial ischaemia in a territory with baseline repolarization abnormalities can be reflected by transient pseudo-normalisation of the T wave and/or ST segment. These repolarization abnormalities can occur spontaneously, during a stress test or during of an isoproterenol test. Clinicians should be familiar with these unusual electrocardiographic changes of acute ischaemia, which require appropriate surveillance and treatment.

[Late recurrence of a large post-infarction left ventricular pseudo-aneurysm. A case report]. / Récidive tardive d'un volumineux faux anévrysme ventriculaire gauche postinfarctus. A propos d'une observation.

Left ventricular pseudo-aneurysm is a neo-cavity characterised by the presence of a narrow neck and a wall consisting of fibrous tissue and thrombotic debris without any muscular cells. The diagnosis must be made as soon as possible by non-invasive methods (echocardiography, CT scan, MRI ...) or by angiography before early surgical treatment, in view of the high risk of secondary rupture. The authors report this original case of a post-infarction left ventricular pseudoaneurysm which recurred five years after initial surgical cure.

[False traumatic aneurysm of the internal mammary artery caused by a stab wound. Apropos of a case]. / Faux anévrysme traumatique de l'artère mammaire interne par arme blanche. A propos d'une observation.

The authors report the case of embolism by a false aneurysm of the internal mammary artery: a 57 years old woman with no previous medical history was admitted to the emergency unit with a kitchen knife stuck in the 3rd left intercostal space. After withdrawing the knife, in the operating theatre, radiological controls revealed a blurred opacity in the left antero-superior mediastinum. The patient signed her own discharge from hospital against medical advice on the 7th day. She was readmitted 10 months later for left retrosternal chest pains. Chest X ray demonstrated a rounded opacity in the antero-superior mediastinum. Computed tomography with injection of contrast confirmed the vascular nature of the opacity. Arteriography in the aortic arch confirmed the diagnosis of false aneurysm of the left internal mammary artery. Selective angiography of the internal mammary artery was undertaken and the aneurysm was embolised with coils. The clinical outcome was immediately improved with relief from the chest pains.

[Congenital aneurysm of the coronary arteries. Apropos of 2 cases]. / Anévrysme congénital des artéres coronaires. A propos de deux observations.

Two cases of aneurysm of the coronary arteries were diagnosed by coronary angiography in the course of a myocardial infarction. The first aneurysm was located at the level of the left coronary trunk in a 32 year-old woman; it was complicated with a massive anterior infarction which led to a heart transplant in the following months. The second aneurysm was located on the right coronary artery in an 18 year-old man; the inferior infarction was rudimentary and the subsequent course was quite favorable. Congenital aneurysm of the coronary arteries is a rare anomaly, often localized on the left coronary trunk and almost always diagnosed in young patients following myocardial infarction.

[Coronary angioplasty immediately after intracoronary thrombolysis during the acute phase of myocardial infarction]. / L'angioplastie coronarienne immédiatement après thrombolyse intracoronarienne en phase aiguë d'infarctus du myocarde.

Since the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction, all workers have observed a high incidence of coronary reocclusion (about 20%) essentially in the first hours and days after coronary recanalisation (CR). This had led to some groups carrying out transluminal coronary angioplasty (TCA) at the same time as CR by thrombolysis in situ to treat significant residual postthrombolysis stenosis. This french multicentre study carried out in 5 centres concerned 9 men (average age: 46.1 years) with 5 anterior infarcts (total thrombosis of the LAD artery) and 4 inferior infarcts (total thrombosis of the right coronary artery-RCA). Intracoronary trinitrate was ineffective in relieving the occlusion in all cases. In 5 cases, the thrombolytic protocol was streptokinase (SK) 3 000 u/min for 60 minutes; in the other 4 cases, the plasminogen-urokinase (Pg-UK) protocol was used. Thrombolysis was successful in all 9 cases. The results of TCA performed at the same time were also good (8/9 successes; 4 LAD and 4 RCA) without any complications during the procedure. There was only one immediate post-TCA reocclusion on a LAD artery. In all cases the initial ECG appearances of infarction remained, CR only appearing to prevent extension of the necrosis. The successful results of CR + TCA were maintained in 6 out of 7 patients reinvestigated 2 days to 6 months (average 6 months) after the initial procedure: the only case of reocclusion occurred after 48 hours on a RCA. The overall procedure never exceeded 2 hours.

[Conduction disorders in infarction. Prognosis and therapeutic impact]. / Les troubles de conduction de l'infarctus. Pronostic et impacts thérapeutiques.

The natural history of conduction disorders in infarction and their prognostic significance are now well known and determine the choice of treatment. In the acute phase of inferior infarction without bundle branch block, temporary pacing is only indicated in cases with poor clinical tolerance or with a bradycardia of less than 50. Prophylactic pacing, on the other hand, appears to be necessary in cases of anterior infarction with branch block, at least in the high risk group in which the block is recent and bifascicular. In this case, the pacemaker is only permanent in cases of high degree atrio-ventricular block in the acute phase. The subsequent prognosis of anterior infarction with branch block and without high degree atrio-ventricular block in the acute phase carries a high incidence of sudden death. Primary delayed ventricular fibrillation during the first eight weeks seems to be the cause for this sudden death. Prolonged hospital surveillance of these patients would appear to be indicated.

[2 cases of aortocaval fistula]. / A propos de 2 cas de fistules aorto-caves.

We report two cases of fistula between the aorta and inferior vena cava that were admitted recently to the Intensive Care Department of this hospital. They are a perfect illustration of the aetiologies most frequently encountered in this disorder, viz. The spontaneous rupture of an atheromatous aneurysm in the vena cava and the occurrence of an aorto-caval fistula following surgery for a herniated disc. Aorto-caval fistula is a serious condition without typical presenting signs, so that diagnostic errors are frequent and appropriate treatment often delayed. It is at any event a true cardiovascular emergency for which surgery is the only answer.

Persistent sinus nodal electrograms during abnormally prolonged postpacing atrial pauses in sick sinus syndrome in humans: sinoatrial block vs overdrive suppression.

A transvenous electrode catheter technique was used for direct recording of bipolar sinus node electrograms during postpacing atrial pauses. Multiple repetitive local sinus node electrograms during atrial quiescence validate sinus node electrograms. Such atrial pauses with sinus node electrograms are due to sinoatrial block; atrial pauses without sinus node electrograms are due to overdrive suppression or improper recording. Eight consecutive patients were prospectively selected on the basis of a corrected sinus node recovery time greater than 1500 msec during diagnostic electrophysiologic evaluation. Six patients had atrial pauses with sinus node electrograms; three patterns of sinus node electrograms during atrial pauses were observed. We conclude that (1) sinus node electrogram recording is of value in understanding the mechanism underlying postpacing atrial pauses; (2) atrial pauses are usually (6/8) caused by sinoatrial block; (3) three patterns of sinus node electrograms are observed, thus making indirect interpretation unreliable.