[Physiological limits of variations in heart rate measured by the Holter method in 134 normal subjects]. / Etude des limites physiologiques des variations de la fréquence cardiaque par la méthode de Holter chez 134 sujets normaux.

Ambulatory 24 hour electrocardiography by the Holter method was carried out in 134 normal subjects (59 men, 75 women, mean age: 42.5 +/- 14 years). The average heart rate over 24 hours was 75 +/- 9 bpm, 82 +/- 10 bpm during the daytime and 64 +/- 8 bpm at night. Maximal and minimal momentary variations (over 5 minutes) were small during the night (+23% and -7%) and greater during the daytime (+47% and -16%). The heart rate slowed progressively over a two hour period before going to bed an increased progressively over a three hour period, reaching a peak and then slightly falling before getting up. The average heart rates of women were faster than in men (+5 bpm). The average heart rate fell with age from 30 years onwards (-0.4 bpm per year). Tobacco consumption did not seem to affect the heart rate. Supraventricular extrasystoles were observed in 68% of subjects during the day, and in 50% during the night; ventricular extrasystoles occurred in 42% of subjects by day and in 23% by night. Only 22% of subjects had no extrasystolic activity. Tobacco consumption and sex were unrelated to the incidence and frequency of extrasystoles. On the other hand, the incidence and frequency of extrasystoles were very significantly related to age.

[Dihydralazine treatment of cardiac insufficiency in children]. / Traitement par la dihydralazine de l'insuffisance cardiaque de l'enfant.

The action, efficient dosage and tolerance of a pure vasodilator, dihydralazine, used for the treatment of severe heart failure were studied in 30 children aged 1 month to 14 years. All of them presented with heart failure from various causes, not controlled by the usual medical treatment. Dihydralazine was administered orally, without interrupting the digoxin-diuretic treatment, with a dose of 34 to 140 mg/m2/day given in 4 equal doses. Clinical efficacy was considered null in 12 cases, low in 12 cases and good in 6 cases, without relationship with the original heart defect. Five of the 6 good results were obtained with doses greater than or equal to 100 mg/m2/day. In the group of 16 children who were given doses greater than or equal to 100 mg/m2/day, a significant improvement of the ECG indexes of left ventricular performance was obtained: decrease in systolic left ventricular internal dimension (p less than 0.05 at day 5), increase of the shortening fraction (p less than 0.05 since day 1) and of velocity of shortening (p less than 0.01 since day 1), while the diastolic left ventricular internal dimension remained unchanged. The only transitory undesirable effects observed were headache, vomiting and/or rash in 9 cases.

[Infectious endocarditis of a healthy heart in an infant]. / Endocardite infectieuse sur coeur sain chez un nourrisson.

The case of a 22 months old child with no previous medical history hospitalised for an acute infection with pyrexia, arthritis, meningitis and leukocytosis with polynucleosis is reported. All bacteriological investigations were sterile; the search for soluble antigen and serological tests were negative. Antibiotic therapy (Ampicillin and Thiamphenicol) cured the meningitis and arthritis. On the 10th day of treatment the temperature rose, a systolic murmur was detected and echocardiography showed the presence of a large vegetation on the anterior mitral leaflet. Three weeks later (on Ampicillin and Amikacine), asymptomatic abolition of the femoral pulses and disappearance of the vegetation on echocardiography were observed. Angiography confirmed obstruction at the bifurcation of the aorta. Surgical removal of the embolism resulted in revascularisation of the femoral artery and was followed by apyrexia. This infant probably developed endocarditis on a healthy heart. It was complicated by systemic embolism and mitral regurgitation which at present is well tolerated.

[The heart of the nonagenarian]. / Le coeur du nonagénaire.

Clinical, radiological and electrocardiographic abnormalities found at cardiovascular examination of 140 patients in their nineties admitted into hospital, were listed and a systematic comparison was established between 36 subjects in their nineties in a home for the aged and subjects in their eighties in the same home. Comparison with previous similar series.