Changes in characteristics of hospitalized heart failure patients in ten years: a single-center study.

BACKGROUND: Progress in therapy and the ageing patients hospitalized with heart failure may have impacted the characteristics of this patients. AIMS: We compared epidemiological data of patients admitted with heart failure during two periods separated by a 10 year interval. METHODS: Characteristics of 353 heart failure patients recruited between 2002 and 2004 with those of 304 heart failure patients recruited between 1992 and 1994 were compared retrospectively. RESULTS: There is now a majority of male patients (56.4%) not found ten years ago. The average age is unchanged (75.1+/-11 then 76.4+/-11 years) even though the proportion of patients aged over 70 years has increased (75% versus 70%). Hospital length of stay has fallen from 14+/-9 to 10+/-7 days. Hospital mortality (8%) are identical. The two main etiologies remain coronary and hypertensive heart disease at 29 and 24% respectively but these proportions are lower than ten years ago (42 and 28% respectively). The ejection fraction is more often preserved (56%) than before (44%). Increased prescription of inhibitors of the renin-angiotensin system and beta-blockers is confirmed. Post-hospital and total mortality has fallen by 50 and 30% from 30 to 16% and 35 to 24% respectively at the expense of a 25% increase in the frequency of hospital readmissions from 29 to 38%. CONCLUSION: Even if mortality has declined, heart failure remains a major public health burden with a significant number of hospital readmissions. Other approaches such as therapeutic education must therefore be developed.

[Torsades de pointes caused by cetirizine overdose]. / Torsades de pointes induites par surdosage en cétirizine: à propos d'un cas.

Several therapeutic substances can cause torsades de pointes, especially if they prolong the QT interval and/or if there is an associated hypokalaemia. Certain second generation H1 antihistamines have been incriminated in the occurrence of such ventricular arrhythmias, such as terfenadine and astezimole, which have been withdrawn. Cetirizine, widely used in the treatment of allergic reactions, is a second generation H1 antihistamine with as yet no precautions of use regarding rhythm disturbances. No documented case of arrhythmia attributable to this drug has been reported. We report the case of a dialysed patient with chronic renal failure who had symptomatic episodes of torsades de pointes in the context of hypokalaemia and cetirizine overdose. In the light of this observation it would appear that the prescription of cetirizine is contra-indicated under such conditions.

[Paradoxical pulmonary embolism. A rare complication of arteriovenous fistulization of an aorto-iliac aneurysm]. / Embolie pulmonaire paradoxale. Une complication exceptionnelle de la fistulisation artério-veineuse d'un anévrisme aorto-iliaque.

Aneurysms of the infra-renal abdominal aorta or iliac arteries result in ilio-caval compression in about 10% of cases which may cause venous thrombosis by stasis and pulmonary embolism. Fistulisation of these aneurysms into the inferior vena cava or an iliac vein is rare and paradoxical pulmonary embolism from arterial thrombus of the aneurysmal pouch is exceptionally rare. The authors report a new case in which the ilio-iliac arteriovenous fistula caused high output cardiac failure, ischaemia of the homolateral leg and pulmonary embolism. Doppler ultrasonography diagnosed the fistula and excluded a deep vein thrombosis. This case illustrated the essential value of clinical examination and of Doppler ultrasonography, especially of the abdomen, in the investigation of the causes of pulmonary embolism.