[Association of an epsilon wave and syncope]. / Association d'une onde epsilon et d'une syncope.

BACKGROUND: Epsilon waves, rarely observed in clinical practice, result from late potentials favoring the development of ventricular rhythm disorders by reentry. CASE REPORT: A 53-year-old man with sequellar myocardial infarction experienced a syncope. The surface ECG recorded an epsilon wave. Programmed ventricular stimulation before and after anti-arrhythmia drugs triggered ventricular tachycardia which was hemodynamically poorly tolerated. A defibrillator was implanted and confirmed retrospectively the rhythmic origin of the syncope. DISCUSSION: The association of an epsilon wave and syncope should guide the etiology search towards severe ventricular rhythm disorders such as ventricular tachycardia. An electophysiologic study is required in order to determine the appropriate therapy and thus help avoid possibly fatal recurrence.

[Should Doppler echography in the diagnosis of the extra-cardiac sites of atherosclerosis be routine in patients with coronary disease? Apropos of 248 cases]. / La recherche, par échographie-doppler, des localisations extra-cardiaques de l'athérosclérose chez le coronarien doit-elle être systématique? A propos de 248 observations.

Doppler ultrasound investigation of cervical and aorto-iliac arteries, performed in 248 patients investigated by coronary angiography (including 80% with coronary heart disease: 23% single-vessel, 23% two-vessel and 34% three-vessel disease) confirmed the frequency of dissemination of the atheromatous process (in the cervical vessels: non-stenotic atheroma: 45%, significant single- or multi-vessel stenoses: 16%, in the aorto-iliac vessels: non-stenotic atheroma: 32.8%, significant stenoses: 17.2%), which has been known for a long time. The unreliability of clinical examination, the reliability, safety and low cost of ultrasound, the discovery of a considerable number of critical, potentially dangerous arterial lesions, some of which may require a surgical procedure or angioplasty (3.4%), the value of assessing, either before coronary angiography or before cardiac surgery, certain specific arterial territories such as the aortic bifurcation and subclavian vessels, justify systematic use of this examination in coronary patients, particularly before coronary angiography and always before coronary surgery.

[Pseudo-coronary form of hemorrhagic rupture in pheochromocytoma. Apropos of a case]. / Forme pseudo-coronarienne de rupture hémorragique d'un phéochromocytome. A propos d'une observation.

The authors report a case of non-malignant pheochromocytoma which presented by its hemorrhagic rupture in two stages and with a clinical picture of threatened myocardial infarction. The progressive nature of these events enabled full laboratory, angiographic, computed tomography and nuclear magnetic resonance investigation and, as a result, planned surgery with hemodynamic monitoring and postoperative intensive care crowned by success with a follow-up period now exceeding a year.

[Repair of post-infarction interventricular communication in a 81-year-old patient]. / Réparation d'une communication interventriculaire post-infarctus chez un sujet de 81 ans.

Post-infarction interventricular fistula (IVF) is a complication with a poor prognosis, particularly when it occurs very early after myocardial necrosis, when it is wide in diameter and even more so if it is at a posterior site, and if there are associated lesions which require surgery. An operation is often considered as contraindicated in cases where the patient is elderly. The authors report on the case of an 81-year-old diabetic patient operated for a wide post-infarctus posterior IVF and aorto-coronary artery bypass surgery. The operation is still a clinical success after 23 months of follow-up, showing that old age is not an absolute contraindication for surgery in cases of post-infarction IVF.