Presse Med
-
Case Reports
[Digital necrosis in a patient with anorexia nervosa. Association of vasculopathy and radial artery injury].
Patients with anorexia nervosa can develop distal vasculopathy sometimes leading to severe Raynaud's phenomenon or acrocyanosis. We report a cas of anorexia nervosa-related vasculopathy associated with iatrogenic injury to the radial artery that led to digital necrosis. ⋯ We report a case of digital necrosis occurring after arterial puncture for blood gas analysis in a patient with a vascular bed weakened by tobacco and cannabis intoxication but also by anorexia nervosa-related vasculopathy. This observation underlines the potentially dangerous nature of invasive intravascular procedures in this context. Indications for vessel puncture must be assessed with prudence.
-
A WELL-RECOGNIZED ENTITY: Diastolic heart failure is an increasingly common diagnosis. Signs may be misleading and positive etiological diagnosis remains difficult.
-
GENERAL PRINCIPLES: The first step is to determine the absence or the minimal nature of the functional impairment from history taking and, for doubtful cases, with an exercise test. Therapeutic indications differ depending on the valvular lesion. AORTIC STENOSIS: Surgery is indicated only for severe aortic stenosis or in cases with a particular risk. ⋯ Careful patient selection is the rule. Surgery is often needed for cases with multiple valve involvement where different therapeutic options can be used for the different valves. The dominant lesion and the degree of heart dilatation and dysfunction guide decision making.
-
AN INDEPENDENT RISK FACTOR: Pathophysiological and epidemiological data show that fibrinogen is an independent risk factor for atherosclerosis with a synergistic effect on classical risk factors.
-
Comparative Study
[Circulatory assistance while waiting for heart transplantation. Patient selection and choice of the assist system].
TWO CLINICAL SITUATIONS: Mechanical circulatory assistance can be indicated in two clinical situations: i) patients on the waiting list for heart transplantation who have chronic heart failure unresponsive to drug therapy and whose clinical status worsens; ii) patients with acute heart failure.