[Features of the treatment of heart failure in the elderly]. / Particularités du traitement de l'insuffisance cardiaque du sujet âgé.

PHARMACOLOGICAL MODIFICATIONS TO BE TAKEN INTO ACCOUNT: In elderly patients, there is a modification in the distribution columns of drugs, an alteration in glomerular filtration (doses require adaptation) and tubular function (greater sensitivity to low salt diet and diuretics), and a reduction in the hepatic elimination capacity. FOR SYSTOLIC HEART FAILURE: The choice of drugs is in practice the same as that for younger patients: diuretics, antialdosterone agents, converting enzyme inhibitors, angiotensin II receptor antagonists, beta-blockers and digitalics. FOR DIASTOLIC HEART FAILURE: The therapeutic approach combines an etiologic treatment (blood pressure, myocardial ischaemia), prevention and the rapid treatment of the decompensation factors (atrial arrhythmia), a pharmacological treatment (converting enzyme inhibitors, angiotensin II receptor antagonists, and bradycardia lowering agents). Non-pharmacological measures include dietary restrictions, regular physical exercise, and education for the patient and the family.

[Aortic dissection]. / Dissections aortiques.

Most often revealed thanks to chest pain, acute aortic dissection must be suspected and diagnosed without losing anytime, because of their evolutive risks and their specific treatment in a specialised unit. Once the early management is over, survivers must be closely followed, specially for their blood pressure to be kept normal, and to screen for secondary complications that would require surgery. Owing to the improvement of early management and follow up, facilitated by the new non-invasive imaging techniques of the aorta, the severe prognosis of this disease has significantly improved.