[Which sports after 50 years of age?]. / Quels sports après 50 ans?

Between the ages of 30 and 80, the physiological abilities decrease: muscular, cardiovascular, respiratory, neurological, etc. The consequences on sports activities are obvious: limitation of the performance per se, quantitatively as well as qualitatively as well as the ability to recover. This is combined with a danger: coronary atherosclerosis responsible for 90 p. cent of the sudden deaths episodes seen in sports, in men over the age of 40/50. Even in France, a country that is not traditionally sports oriented (Pierre de Coubertin and a few occasional champions are really exceptions masking the non-existent sports activities in school)-sports have become a society phenomenon, on a par with the development of leisure, a younger retirement age, increased unemployment and the ageing of the population. Twelve millions of french people hold a sport license and more that twenty millions practice a sport more or less regularly. As epidemiologic studies are in a great majority as well as secondary prevention, it is possible to assert that there is no topic more frequently discussed today than that of physical activities in cardiology consultations. Often, french physicians are not well equipped to answer questions of provide judicious advice: because, very often, these physicians do not practice any sport and/or they are not convinced of the advantages of physical exercise and unfamiliar with the specific restrictions of each sport. In addition, they cannot perform a stress-test in their office--as in this domaine our country is also far behind.

[Is computed interpretation of electrocardiograms suitable for a general medicine department?]. / La lecture informatique des électrocardiogrammes répond-elle aux besoins d'un service de médecine générale?

Computed interpretation of electrocardiograms may be needed as French hospitals are divided into units in which physicians belonging to other specialities than cardiology may be in charge of internal medicine patients. We experimented two rival systems: SADE and CARDIONICS. Recordings were taken in the wards, on paper and magnetic tape. The computer, called by telephone, read the tape, interpreted the data, and printed conclusions and measurements. No useful information was provided in any of the 32 first patients studied (mean age: 71). The machine made our situation worse, as we were repeatedly prompted to call in a cardiologist without sufficient reason. A rejection reaction was observed. Telephone problems in French hospitals, losses of time, errors of manipulation, sometimes unintelligible language, and inappropriate material are discussed from the point of view of the internist. We did not consider the problems of cardiologists, screeners and archivists. In non-universitary hospitals, the needs may be greater, calling for improvements in software and hardware.

[Severe hyperkalemia in cardiac patients]. / Les hyperkalièmies sévères chez les cardiaques.

Hyperkalaemia with severe myocardial consequence may complicate the treatment of heart failure. In five patients who developed kalaemia ranging from 6.5. to 8.6. mEq/l, the ECG showed altered auriculogram and/or widened QRS, the latter change being associated with ST segment elevation and very large T wave in one case. Such hyperkalaemia cannot be termed iatrogenic, although it is promoted by diuretic-induced hyponatraemia and dehydration. The essential part is played by an aggravation of the haemodynamic status, responsible for acute renal insufficiency with oligoanuria, and by the attendant metabolic acidosis. The correction of this metabolic acidosis promotes diuresis, causing potassium depletion and the rapid regression of electrocardiographic abnormalities. Parenteral alkalinization with sodium bicarbonate, associated with furosemid to prevent sodium overload, instituted in emergency, is the only way to prevent asystole or ventricular fibrillation when kalaemia exceeds 8 mEq/l.

[Epicardial cartography and surgical treatment by simple ventriculotomy of certain resistant re-entry ventricular tachycardias]. / La cartographie épicardique et le traitement chirurgical par simple ventriculotomie de certaines tachycardies ventriculaires rebelles par réentrée

Intraventricular reentry has been prooved by pre-operative electrophysiological studies in two patients without coronary artery disease and resistant ventricular tachycardia. A simple ventriculotomy oriented by epicardial mapping during tachycardia was successfull with a background of 9 and 14 months respectively. In addition, delayed epicardial potentials put into evidence an intraventricular reentry in human myocardium. This new method holds promises for the treatment of some resistant ventricular tachycardia.