[Right ventricular infarction caused by isolated right ventricular branch occlusion: a case report]. / Infarctus du ventricule droit lié à une occlusion isolée de la branche ventriculaire droite: aspect électrocardiographique et angiographique à propos d'un cas.

It is rare to observe right ventricular infarction caused by isolated right ventricular branch occlusion. Isolated right ventricular infarction accounts for less than three percent of all cases of infarction. Generally, it is associated with occlusion of a non dominant right coronary artery or of a right ventricular branch. ECG can be misleading with ST segment elevation in anterior leads. We describe a patient admitted for chest pain with ST segment elevation in leads V1 to V3 associated with ST segment elevation in leads V3R and V4R. Coronary angiography demonstrated isolated total occlusion of the right ventricular branch. Thus, right precordial leads need to be done in every patient presenting with ST segment elevation in precordial leads V1 to V3 and not only in inferior myocardial infarction.

[A case of chest trauma-induced acute myocardial infarction]. / Infarctus du myocarde secondaire à un traumatisme fermé du thorax: à propos d'un cas.

The occurrence of an acute myocardial infarction (MI) after chest trauma is a rare complication. We report a case of a 58-year-old man presenting with an acute anterolateral MI secondary to blunt chest trauma. Coronary angiography revealed a non significant lesion of a first diagonal branch without any atherosclerosis lesion on coronary artery. He was conservatively managed and resulted in a good prognosis. Based on this case, we discuss the path physiologic mechanism of MI following chest trauma.

[A high troponin value: about a favourable evolution case]. / Valeur élevée de troponine: à propos d'un cas d'évolution favorable.

Cardiac troponin I (TnIC) is a sensitive and specific marker for myocardial injuries. A part from its diagnosis character, troponin is a major element for mid term prognosis with regard to occurred cardiovascular events. We are reporting the case of a 56-year-old man admitted to hospital for an inaugural myocardial infarction with positive evolution despite a very high level of troponin (1200 ng/ml) in post re-vascularisation. The context of moderate risk factors and the early re-vascularisation probably contributed to a favourable evolution of the patient. A very high troponin value seems to be more in favour of an effective re-perfusion rather than a mid term prognosis factor in this case.

[Education for chronic cardiologic diseases in a transversal multidisciplinary unit: the experience of a general hospital center]. / Education des maladies chroniques en cardiologie au sein d'une unité transversale d'éducation multidisciplinaire: expérience d'un centre hospitalier général.

Treatments for congestive heart failure, hypertension and cardiovascular risk have significantly changed and have become more complex. The have also become more and more effective thanks to the results of great clinical studies that have enabled European and North-American societies to issues recommendations. The observance of the pharmacological and non-pharmacological treatments requires the education of patients and their family following guidelines that have been clearly defined by the European Society of Cardiology. This education, in which the technic of communication is very important, is common to a lot of chronic diseases and requires adequate material and human resources in order to have an optimal quality of treatment. In a society in which spending is on rise, getting such resources is not easy. However, putting in common resources of several departments can be a good solution. The experience of the Hospital Center of Douai (France) lead to the creation of a Transversal Education Unit at the end of the year 2003. This unit centralizes the efforts of several departments of care like pneumology, pediatrics, diabetology, nutrition and cardiology and allows patients suffering from co-morbidities to have access to various programs of this unit.

[Reflux nephropathy and arterial hypertension]. / Néphropathie par reflux vésico-urétéral et hypertension artérielle.

This case-report emphasizes an uncommon cause of hypertension in an adolescent: reflux nephropathy. Reflux nephropathy is a frequent hypertension and renal failure etiology. Medical treatment is unknown from cardiologist.

[Pacemaker syndrome after dual-chamber implantation: consequence of a very long atrial activation delay]. / Syndrome du pacemaker en mode double chambre: conséquence d'un temps d'activation atriale très allongé.

Many circumstances, generally occurring in inappropriate device's adjustment or in specific myocardial conduction's disturbances, can result in dual chamber indications in pace maker syndromes. Our case report is about a man implanted with a dual chamber device with a dilated right atrium and intra atrial conduction delay resulting in a delayed post pacing atrial activation time. The consequence was an atrial contraction occurring during closed atrioventricular valves.

[FACT: French national registry of acute coronary syndromes. Specific study of French general hospital centers]. / FACT: registre national français des syndromes coronaires aigus. Etude particulière des centres hospitaliers généraux français.

UNLABELLED: The FACT registry is currently the French registry including the greatest number of patients with acute coronary syndromes. PURPOSE: The study presents epidemiologic data, modalities and delays for medical admission. METHOD: Three thousand nine hundred and two patients were included in FACT by 362 French centers of cardiology between 06/01/2003 and 03/02/2003. One thousand eight hundred and ten patients, who had been placed in the cardiology departments of French general hospitals, were isolated from this registry. The French general hospitals represented 50.8% of the 362 centers. In order to clarify the study, these patients were divided into three groups: group A: patients without ST segment elevation but with suggestive ECG modifications; group B: patients with ST segment elevation; group C: all other patients. The results were mainly studied for groups A and B and compared. These results were also compared to those of the FACT registry and of other registries. RESULTS: The results show that the average delay for admission is 2.9 h after a first delay between the pain and the help of 6.7 h. The first intervening party is a general practitioner (36.4%) then the SAMU (31.6%) and finally the emergency departments (18.7%). 16.6% of the patients from group B undergo pre-hospital thrombolysis. The recommendations of the European Society of Cardiology are widely applied except for the most recent of them since only 27.6% of the patients from group A having a TIMI score > or = 5 receive an anti-GIIB IIIA treatment. The reasons of the non-prescription of the recommended classes are mostly linked to contra-indication and intolerance. The strategy of coronary reopening mainly depends on the presence or the absence in the department of an available medical equipment for angioplasty. If there is one, the percentage of primary angioplasty reaches 54.2% and the percentage of thrombolysis 7.9%. On the opposite, there is 8.3% of angioplasty and 54.2% of thrombolysis for the unequipped centers. The global mortality reaches 5.8% but is inversely proportional to the level of equipment of the departments: 5.9% for the departments with angioplasty, 11% for the departments with coronarography but without angioplasty and 13.8% for the departments without any interventional equipment. Nevertheless, the age of the patients is different and this influences the results: we notice that the less equipped the department is, the older the patients are. CONCLUSION: The FACT registry and the data from the general hospitals give the opportunity to think about the possibilities to improve the delays of call to the first intervening party (more particularly to the SAMU) but it also allows us to think about how to better organize the geographical distribution giving access to a medical equipment for angioplasty. All these information will also help the cardiologists to gather around the recommendations by convincing them that the benefit/risk ratio is positive.

[A case report of Cardiobacterium hominis endocarditis]. / Endocardite a Cardiobacterium hominis.

We here report a case of endocarditis due to Cardiobacterium hominis in a 53-year-old patient, who presented with large vegetations on the mitral valve. Good cooperation between clinicians and microbiologists and an efficient automated blood culture system were the decisive factors in establishing the diagnosis. Early and appropriate treatment prevented the septic embolisms often observed in this pathology.

[Registry of heart failure patients hospitalized in 2000. Data from the National College of Cardiology and General Hospital]. / Registre des insufisants cardiaques hospitalisés en 2000. Données du Collége national des cardiologues des hôpitaux généraux (CNCHG).

The French epidemiological data on cardiac insufficiency in the hospital environment are scarce. A register collecting 1772 patients was produced by the services of the National College of General Hospital Cardiologists (C.N.C.H.G.) during two periods: autumn 1999 (November) and spring 2000 (June). It involved completing a form for each of the first 20 patients with cardiac failure hospitalized over a month. 1011 and 761 observations from 59 and 47 centres (that is 17 and 16 observations per centre) were collected during the autumn and spring periods respectively. In France, in the general hospital centres (CHG) cardiology services during the year 2000, the characteristics and the medical treatment of hospitalized patients with cardiac failure are very similar to those presented in 1998 by A. Cohen-Solal in the name of the working group "Cardiomyopathy and Cardiac Insuficiency of the French Society of Cardiology". The hospitalized patient with cardiac failure is very old, usually male, has an ischaemic cardiopathy in one in two cases, and is at stage II and III on the New York Heart Association (NYHA) scale in 83% of cases. There is practically always an electrocardiographic anomaly. Loop diuretics are prescribed nine times out of ten, digitalis one in three, anagiotensin converting enzyme inhibitors are underused being prescribed two out of three times, but an increase in the prescription of anti-aldosterone and betablockers is found. The majority of patients improve during their stay, 7.8% dying and this mortality is influenced by age, ejection fraction (FE), functional NYHA class, causal cardiopathy, and the existence of severe renal failure. The data collected by the cardiology services of the C.N.C.H.G. are representative of the profile of the population affected and are important to know in order to improve the management of these patients.

[Coverage of pointed acute coronary syndromes in the general hospital centers]. / Prise en charge des syndromes coronariens aigus dans les centres hospitaliers généraux. Résultats du registre RICA 2000.

This study presents data on the management of acute coronary syndromes collected in a national registry organized by the french Collège national des cardiologues des hôpitaux généraux in September 2000. In all 86 institutions participated and data from 607 patients (mean age: 67 years; 413 men) were analysed. The final diagnosis was unstable angina in 38%, non-Q wave myocardial infarction in 21% and Q-wave myocardial infarction in 40.5%. Median time to admission was 4 h. At symptom onset, patients called their general practitioners in 46% of cases, emergency ambulatory units in 31% of cases and arrived to the hospital on their own in 23% of cases. Observance of the European Society of Cardiology guidelines was good for patients without ST segment elevation. In patients with ST segment elevation, 9% had pre-hospital thrombolysis, 28% hospital thrombolysis, and 27% had angioplasty within 48 h of admission, including 9% with rescue angioplasty. Overall, 57% of patients with ST segment elevation received reperfusion therapy. In hospital mortality was 6% for the whole cohort, and 11% for patients with acute myocardial infarctions. By multivariate analysis, predictors of in-hospital mortality were age, type of acute coronary syndrome, absence of beta-blocker therapy, and absence of coronary angiography.

[Primary biliary cirrhosis associated with pericardial effusion]. / Cirrhose biliaire primitive associée a un épanchement péricardique.

The authors report a case of primary biliary cirrhosis, associated with moderate pericardial effusion, in a patient with antiphospholipid antibodies. The pericardial effusion resolved, and did not recur, in response to treatment with Colchicine and ursodesoxycholic acid.

[Hyperthyroidism associated with pulmonary hypertension]. / Hyperthyroïdie associée à une hypertension artérielle pulmonaire.

The association of pulmonary hypertension and polyendocrinopathies or connective tissue diseases has been reported by several authors. The causes of this form of pulmonary hypertension are not clear but an autoimmune process has often been proposed. The authors report a case of non-autoimmune hyperthyroidism and reversible pulmonary hypertension after total thyroidectomy and normalisation of thyroid function. This case supports the hypothesis of a non-autoimmune aetiology of some causes of pulmonary hypertension in diseases of the thyroid.

[Detection of multivessel lesions after myocardial infarction. Improvement of the predictive value of early exercise stress test by discriminant analysis]. / Détection des lésions multitronculaires après infarctus du myocarde. Amélioration de la valeur prédictive de l'épreuve d'effort précoce à l'aide d'une analyse discriminante.

The aim of this study was to assess, by a discriminant analysis, the different parameters of exercise stress testing associated with multivessel disease after uncomplicated myocardial infarction and to determine whether their combination improved the diagnostic value of ST depression alone, the usual diagnostic criterion. One hundred and seventeen out of 240 consecutive pts admitted for acute myocardial infarction between october 1992 and may 1994 underwent early exercise stress testing and coronary angiography 8.5 +/- 3 days and 13 +/- 8 days respectively after infarction. The population was divided into two groups: a "study" group (pts recruited between october 1992 and october 1993) for whom a diagnostic equation had been established based on a discriminant analysis, and "a control" group (pts recruited between november 1993 and may 1994) allowing validation of the diagnostic equation. Of the 9 clinical and 14 exercise stress test variables, only 3 remained statistically significant after discriminant analysis in this study group: the number of METS achieved (p < 0.0005), maximal ST depression in V5 (p < 0.005) and maximal heart rate (p < 0.01). Using these three parameters, a discriminating equation was established in the study group and then validated in the control group. Using this equation, the percentage of pts correctly identified as having multivessel disease was 75% in the study group and 79% in the control group, whereas ST depression, the most commonly used criterion, only classified 68% of the study group and 60% of the control group correctly. This study confirmed the good tolerance of early maximal exercise stress testing after uncomplicated myo-cardial infarction. The combination of three easily discernable parameters improved the diagnostic performance of the stress test in identifying multivessel disease after myocardial infarction.

[Drug-induced major anomalies of ventricular repolarization masked by a left branch block]. / Anomalies majeures de la repolarisation ventriculaire d'origine médicamenteuse masquées par un bloc de branche gauche.

The presence of a left bundle branch block (LBBB) may hamper the electrocardiographic diagnosis of diseases that involve the QRS complexes. That it may conceal, or even completely erase, major abnormalities of ventricular repolarization induced by certain drugs is not so well known. In this paper, two highly demonstrative examples of such abnormalities observed with bepridil (case 1) or with the amiodarone-aprindine combination (case 2) are reported. In both cases, the intermittent character of the LBBB revealed the phenomenon which deserves to be known as it is not without practical consequences: in patients under treatments likely to modify repolarization and induce severe dysrhythmias (notably torsades de pointes) the presence of a LBBB indicates that the QT and/or QU intervals must be very carefully measured. In case of phase 3 LBBB compression of the carotid sinus or intravenous ATP injection helps the diagnosis since in the presence of even moderately prolonged ventricular cycles such manoeuvres create a refinement of QRS complexes which then demonstrate the major alteration of the underlying repolarization.

[Popliteal venous aneurysm. Apropos of 3 cases]. / Anévrysme veineux poplité. A propos de 3 observations.

The popliteal venous aneurysm is a rare cause of recurrent phlebitis and pulmonary embolus. In reference to 3 personal cases, their etiology, their role in the occurrence of phlebitis, the place of phlebography and vascular sonotomography respectively, are discussed. The treatment is essentially surgical.

[Malignant pheochromocytomas. Apropos of a case with multiple metastatic localizations]. / Les phéochromocytomes malins. A propos d'un cas avec localisation métastatique multiple.

We are reporting a case of malignant pheochromocytoma surgically treated initially for an isolated left pararenal localization, and which recurred several years later accompanied with numerous metastases. Despite of a treatment with Iodine 131 MIBG, the evolution was rapidly fatal with a picture of cardiac failure. This cardiac involvement would be linked to a myocarditis directly secondary to the catecholamines and causing a marked increase of the free fatty acids concentration in the heart tissue. In reference to this case, all the data which may tend to suspect the malignant nature of a pheochromocytoma, present in 10 p. cent of the cases, are successively reviewed. There is no clinical specificity. The presence of a mixed secretion with marked urinary dopamine secretion, would not present, for all authors, the same criteria of specificity. Thoraco-abdominal scan and scintigraphy with iodine 131 MIBG are the two tests permitting to demonstrate, with a great sensitivity and specificity, an extra-adrenal localization, which is the best argument in favor of a malignancy since 30 to 40 p. cent of extra-adrenal pheochromocytomas are malignant, more especially as the metastases are located in areas where there are no embryonic remnants of tissues containing chromaffin cells. This permits to appreciate the difference between a non-malignant multicentric pheochromocytoma and a malignant pheochromocytoma. The ideal treatment of a malignant pheochromocytoma rests on surgery under the condition that there are ony one or two metastases. This procedure is preceded by a sodium nitroprusside preparation and followed with an alpha-blockers treatment. In case of multiple metastases, the therapeutic use of iodine 131 MIBG seems to be a tempting alternative.