Iatrogenic cardiac tamponade after central venous catheter.

Myocardial perforations with a central venous catheter are rare in adults (67 cases published since 1968). These accidents are fatal in more than two-thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (18 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac rhythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically. Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and performed. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.

[Bepridil and torsades de pointes. Apropos of 11 cases]. / Bépridil et torsades de pointes. A propos de 11 observations.

The authors report 11 cases of spikes occurring under bepridil treatment. It concerns an elderly population, predominantly female, receiving most of the time 300 mg of bepridil. The frequency of associated hypokalemic or arrhythmic medications is emphasized. The comparison of these results to those from other series in the literature, enables to propose precautions for the use of this molecule.

[Pneumopathy caused by amiodarone. An often unrecognized iatrogenic entity]. / Pneumopathie à l'amiodarone. Une entité iatrogène sovent méconnue.

Three cases of interstitial pneumopathy secondary to amiodarone are reported, in addition to almost 200 cases previously published in the literature. The main clinical, radiological, biological and evolutive characteristics are reminded in emphasizing the advantages of bronchioalveolar irrigation. Some factors seem to be predisposing, without any definite proof however. They are: high daily dosage, long term treatment, high cumulative dose, concomitant ingestion of another anti-arrhythmic medication, especially in elderly patients, and in patients who, before any treatment, presented a decreased total pulmonary capacity and a CO transfer capacity lower than 80 p. cent of the theoretical values. Discontinuation of amiodarone and administration of steroids usually produce a rapid regression of the clinical and radiological symptoms.

[Automatic quantitative analysis of myocardial tomography thallium-201 scintigraphy]. / Analyse quantitative et automatique de la tomoscintigraphie myocardique au thallium 201.

An automatic and quantitative analysis method for tomographic scintigraphy was applied to 104 patients with myocardial infarction (anterior 37, inferior 67, lateral 20, involving 2 territories in some cases). All patients underwent exercise and redistribution scintigraphy and coronary arteriography which served as reference. Two types of tomographic sections were used: 2 short axis sections exploring the left ventricle at different levels, and 1 apical section at a right angle with the first ones. A circumferential analysis program studied the isotopic activity of each section and drew an activity profile curve which was compared with those obtained in normal subjects. Exercise curves proved superior to redistribution and wash-out curves and were therefore used exclusively. Two sectoring methods for territories with infarcts were defined: conventional sectoring, which gives a 90 degrees angle to the anterior region and a 180 degrees angle to the inferior lateral region, and real sectoring established from the scintigraphic abnormalities observed in patients whose infarction was not accompanied by significant lesions in other territories. Real sectoring divides the territory into two regions (anterior and infero-lateral) and determines the extension territory and the territories specific to each necrotic region. The sensitivity and specificity of these two methods for the diagnosis of necrosis and the detection of a significant abnormality (greater than 70% stenosis, or necrosis) in a territory other than the one with infarct were compared. In the diagnosis of infarction: conventional sectoring sensitivity 92%, specificity 46% for anterior infarcts, 94% and 25% for inferior and lateral infarcts; real sectoring 94% and 63% respectively for anterior infarcts, 92% and 68% for inferior infarcts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Short and intermediate-term hemodynamic study at rest and during exercise of cardiac insufficiency treated by captopril]. / Etude hémodynamique, au repos et à l'effort, à court et moyen termes, de l'insuffisant cardiaque traité par captopril.

Administration of 25 mg of captopril to 10 patients with heart failure (NYHA II, III) produces at rest after 60 min bradycardia (-7 per cent, p less than 0.01), hypotension (-8 per cent) and improvement of the preload (-30 per cent, p less than 0.01). This effect is still apparent after two months of treatment where PAP is decreased by 20 per cent (p less than 0.05). A prolonged effect of captopril is present in these 10 patients. The capacity to perform a muscular exercise on an ergometric bicycle is prolonged by 10 per cent (p less than 0.01) on the first day and by 18 per cent (p less than 0.01) after two months of treatment. This improvement seems to be related to improvement of the hemodynamic parameters, especially of preload indices. In 5 patients, lactacidemia, the arterio-venous difference and the extraction coefficient of O2 were studied at rest and during exercise. No significant difference are noted after the treatment with the inhibitors of conversion enzymes.

Effects of captopril on myocardial perfusion in patients with coronary insufficiency: evaluation by the exercise test and quantitative myocardial tomoscintigraphy using thallium-201.

Nine patients with coronary insufficiency were investigated using an exercise test coupled with quantitative myocardial tomoscintigraphy with thallium-201 before and after 48 hours' treatment with captopril. After captopril treatment, an improvement in ST segment depression was noted during exercise. The quantitative tomoscintigraphy showed a reduction in the ischaemic zone with captopril during exercise. However, in three patients, although there was an overall improvement in myocardial perfusion during exercise, aggravation of wash-out was observed in some regions, reminiscent of a coronary steal effect.

[A case of electrically and mechanically stunned myocardium]. / Une observation de sidération électrique et mécanique du myocarde.

The authors report the case of a 72 year old patient with ECG changes of anterior myocardial infarction complicated by left ventricular failure and shock which has a favourable outcome with regression of the pathological Q waves on the 7th day. Radionuclide investigation and coronary angiography showed no myocardial sequellae and the coronary arteries appeared normal. This case, an example of stunned myocardium, confirms that severe myocardial ischaemia, even of short duration, may induce reversible but prolonged metabolic disturbances. The practical implications of this concept are discussed.