[Cardiovascular complications of doping products]. / Complications cardiovasculaires des produits dopants.

Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.

[Inferior myocardial infarction complicated by complete heart block and cardiac arrest following a gadolinium injection: A case of Kounis syndrome]. / Infarctus du myocarde inférieur compliqué de bloc auriculo-ventriculaire complet et d'arrêt cardiocirculatoire dans les suites d'une injection de gadolinium : à propos d'une observation de syndrome de Kounis.

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

[Initial management of ST-elevation myocardial infarction in 2014: From guidelines to practices, survey of 176 French interventional cardiologists]. / Prise en charge initiale du syndrome coronaire aigu avec sus-décalage du segment ST en 2014 : des recommandations à la pratique, enquête auprès de 176 cardiologues interventionnels français.

BACKGROUND: Real life management of myocardial infarction has not recently been evaluated in France. AIMS: To describe ST-elevation myocardial infarction management in France in 2014 and to compare it with current guidelines. METHODS: A multicentre study was performed. An e-mail questionnaire was sent to French interventional cardiologists. Demographic data of interventional cardiologists, procedural aspects of percutaneous coronary intervention, antithrombotic treatments and patient rehabilitation have been investigated. RESULTS: One hundred and seventy-six answers were analysed. Most of centres realized more than 600 annual angioplasties. An average of 209 myocardial infarctions were managed per centre in 2014, more often in academic than in general or private centres (respectively 51, 32 and 17% of infarctions). Anti-GPIIbIIIa (34% of the cases) and thromboaspiration were not systematic but depend on patient's characteristics, according to guidelines. Radial access was favoured in 85% of the cases and increased for the last decade. Drug eluting stents were used in 62% of cases. Unfractionated heparin and enoxaparine accounted for more than 80% of anticoagulants treatments. Overall, use of clopidogrel was as high as that of prasugrel or ticagrelor although clopidogrel is recommended in second-line. Cardiovascular rehabilitation was proposed to more than 50% of patients. CONCLUSION: In spite of heterogeneity of ST-elevation myocardial infarction management in 2014, real-life practices generally comply with current guidelines.

[Infective endocarditis: Clinical features and prognosis between 2004 and 2014 in a non-teaching hospital]. / Endocardite infectieuse : caractéristiques cliniques et pronostic entre 2004 et 2014 dans un hôpital non universitaire.

AIMS: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a severe disease. The aim of the study was to describe clinical features and prognosis of patients with IE in a non-teaching hospital and compare them with current data and a similar study conducted 10 years earlier in the same center. METHODS: We performed a single institution retrospective study including all patients with Duke-Li definite IE between 2004 and 2014. RESULTS: Ninety-four patients were included. Results are consistent with current French and international data, including in-hospital death rate of 16%. In accordance with literature, we report on an increase in Staphylococcus and health care-associated IE and endocarditis on pacemaker leads, but without significant difference compared to our previous study. In univariate analyses, renal failure, age over 77 years and Staphylococcus aureus IE were associated with in-hospital mortality. In multivariate analyses, predictors of in-hospital death were renal failure and lack of surgery. There was a non-significant trend of excess mortality in Staphylococcus endocarditis and in patients with heart failure. CONCLUSION: IE remains a severe disease and S. aureus is more often involved. IE seems to be safely managed in a peripheral hospital provided that there is a partnership with a reference hospital.

[Painless anterior acute myocardial infarction in a transplanted heart]. / Infarctus du myocarde antérieur indolore chez un transplanté cardiaque.

Cardiac allograft vasculopathy is the major determinant of long-term survival in patients after heart transplantation. Clinical presentations are congestive heart failure, ventricular arrhythmias and sudden cardiac death. Acute coronary syndrome is a rare presentation of cardiac allograft vasculopathy due to myocardial denervation. We present the case of a 31-year-old patient, who had undergone heart transplantation 6 months earlier and who developed a painless anterior myocardial infarction revealed by syncope. He was successfully treated by percutaneous coronary intervention with drug eluting stent implantation.