[Cardiac involvement in polymyositis]. / Manifestations cardiaques au cours de la polymyosite.

Cardiovascular involvement in polymyositis constitutes a major cause of death. However, the cardiac location is rarely symptomatic and does not usually represent the principle clinical feature at the time of the initial presentation. We present here an unusual case of polymyositis with severe and polymorph cardiac disturbances that predominant the muscular signs.

[Oral anticoagulants and atrial fibrillation]. / Anticoagulation orale et fibrillation auriculaire.

INTRODUCTION: Oral anticoagulants (OA) are effective in the prevention of cerebrovascular events among patients with atrial fibrillation (AF). However, several studies showed OA to be widely underused in these patients. The purpose of this study was to assess the use of OA and associated factors with non-use of this treatment. METHODS: We conducted a retrospective study of 233patients affected by non valvular AF hospitalized in our institution between 2005 and 2007. Patients were stratified in three groups for stroke's risk (high, moderate and low) according to the international antithrombotic therapy recommendations. RESULTS: The average age of our patients was 64+/-14 years, with 35% of subjects being older than 75years. Hypertension was the more frequently reported risk factor for stroke (61%), followed by diabetes mellitus (19%) and congestive heart failure (12%). Five percent of the patients reported a stroke or a systemic embolic event history. Of the 233patients studied, 48% were stratified to the high risk group, among them 75% were being treated with OA, 20% with Aspirin and 5% were taking no medications. To explore possible reasons for not prescribing anticoagulation, we analysed 27patients at high risk who did not receive OA. We found a low benefit/risk ratio (37%), neuropsychological impairment in 5%, a past bleeding episode in 6% but almost 50% of those patients reported no risk factors for haemorrhage. CONCLUSION: In our retrospective study, among 25% high-risk patients with non valvular AF were not treated with OA and one half of the patients report none of the factors associated with perceived or actual risk factors for bleeding. These data confirmed OA underuse, despite guidelines that delineate higher-risk patient populations for whom anticoagulation is recommended.

Systemic embolism and septic shock complicated left atrial myxoma: case report.

Myxoma is the most common primary tumor of the heart. The rarity of infected cardiac myxomas leads to numerous diagnostic and therapeutic difficulties. We present a case of infected left atrial myxoma caused by methicillin-sensible Staphylococcus aureus in a 48-year-old woman complicated by systemic embolism and septic shock.

[Impact of diabetes on mortality after myocardial infarction]. / Impact du diabète sur le pronostic de l'infarctus du myocarde.

UNLABELLED: Myocardial infarction is a common cause of mortality in people with diabetes. The aim of this study was to determine early and mid-term mortality in diabetic patients with myocardial infarction and to determine if hyperglycemia was predictor of mortality. We conducted a retrospective study of 100 diabetic patients compared with 100 non diabetic patients who were hospitalised in our institution between 1999 and 2003 for myocardial infarction. RESULTS: Hospital and one year mortality were highest among diabetic patients compared with non diabetic patients. Multivariate analysis showed that admission plasma glucose was a consistent predictor factor of in hospital mortality RR 1.2 (IC 1.02-1.47). Admission plasma glucose was significantly higher in nonsurvivors diabetic patients than in survivors (22.7 vs 16 mmol/l P = 0.04). The predictor factors of one year mortality was age, female sex and no beta blocker at discharge RR5.3 (1.9-14.3). CONCLUSION: Diabetic patients with myocardial infarction have poor prognosis and hyperglycemia was associated with in hospital mortality.

[Evaluation of the hemodynamic profile of mitral Saint Jude Medical prostheses in the early and late postoperative period]. / Evaluation du profil hémodynamique des prothèses Saint-Jude Médical en position mitrale en postopératoire précoce et tardive.

This study was to estimate the Doppler haemodynamic profiles of 56 prosthetic mitral valves (St Jude prosthesis) in the premature post-operating period, to study the correlation of the prosthetic area calculated by Doppler method (continuity equation (CE) and pressure half times (PHT)) and the area of the effective orifice in the post-operating premature period, in 6 weeks and after 6 months. The values of peak gradient and mean gradient at six week and at 12.5 months were not significantly different from those obtained in the premature exam. The prosthetic area calculated by continuity equation (ACE) in the premature postoperative period was significantly different between the various size (p = 0.0001). The (ACE) measured at 6 weeks and late (12.5 months), was not significantly different from that calculated in the premature exam (respectively p = 0.79 and p = 0.8). The (PHT) was very variable even within the different size of the prosthesis, however values measured at six weeks and in the late exam was not different from that calculated in the premature exam. In absence of complications, it seems to us that we can satisfy with using as reference exam data obtained in the premature exam.

[Familial hypertrophic cardiomyopathy associated with Wolff-Parkinson-White syndrome]. / Cardiomyopathie hypertrophique familiale associée à un syndrome de Wolff-Parkinson-White.

Familial hypertrophic cardiomyopathy (HCM) with Wolff-Parkinson-White (WPW) syndrome is extremely rare and associated with a high risk of ventricular tachyarrhythmia and sudden death. We report a familial form of hypertrophic cardiomyopathy associated with Wolff-Parkinson-White syndrome in two siblings 7 and 12-year-old. These patients showed progression to left ventricular dilatation. Early recognition and treatment of such forms can improve such evolution and the risk of sudden death.

[Delays in the management of AMI: Results of an investigation conducted in Sousse (Tunisia)]. / Délais de prise en charge de l'IDM en phase aiguë: résultats d'une enquête dans la région de Sousse (Tunisie).

UNLABELLED: The goal of our work was to assess the delays of admission for Acute Myocardial Infarction (AMI) in Sousse (Tunisia) and to identify predictors of these delays. Our prospective survey was led from January 1999 to December 2001; 232 patients with AMI were included. The onset of symptoms usually occurred in the patient's home (80.6%). The chest pain was atypical in 19.4% of cases; 91% of patients directly consulted the emergency departments, whereas the ambulatory emergency services were used in only in 2.2% of cases. Delays of hospitalization in coronary care units were on average too long (14 h 21 min +/- 19 h 16 min). This prolongation was essentially caused by a too long period between onset of symptoms and first patient call. In bivariate analysis, dyslipidemia, diabetes, absence of smoking and an atypical symptoms were associated with prolonged hospitalization delays. However in multivariate analysis, only diabetes and atypical symptoms were independent factors associated with a hospitalization delay of more than 12 h. In 23% of the patients, a prolonged pre-hospital time period prevented the use of thrombolysis. CONCLUSION: Pre-hospital delays should be shortened by a multidisciplinary action that especially focuses on a better sanitary education of patients to risk.