Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Jul 1996
Case Reports[Penetrating atheromatous ulcer of the thoracic aorta. Apropos of a case].
The authors report a case of penetrating atheromatous ulceration of the descending thoracic aorta complicated by a haemothorax. Atheromatous ulceration of the aorta is usually observed in elderly hypertensives. It is caused by rupture of the internal elastic layer under an atheromatous plaque extending into the media and resulting in a parietal haematoma of the aorta. ⋯ The treatment of choice is not established because the natural history of the condition is not well known. Penetrating ulcer would seem to progress slowly to development of an aortic aneurysm. Surgery is mainly reserved for forms complicated by painful recurrences or rupture and for cases involving the ascending aorta.
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Although physiologists have recognised for many years that cardiac performance is based on two functions, systolic and diastolic, it has only been in the last 15 years that clinicians have acknowledged the essentiel role of diastole in the physiopathology of cardiac disease. Many studies have shown that left ventricular diastolic dysfunction resulting from abnormal active relaxation or changes in passive visco-elastic properties of the myocardium modulating its rigidity were responsible for decreased distensibility of the ventricle and an increase in its filling pressures. ⋯ With respect to advanced forms of restrictive cardiomyopathy, as their clinical and haemodynamic characteristics resembling constrictive pericarditis show, they demonstrate caricatural diastolic dysfunction. Finally, although the main abnormality in dilated cardiomyopathies is poor contractility, a decrease in ventricular compliance is constantly observed.
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Arch Mal Coeur Vaiss · Feb 1996
ReviewRisk assessment and prevention of sudden cardiac death in hypertrophic cardiomyopathy.
One of the principle aims in the assessment of the patient with hypertrophic cardiomyopathy is assessment of risk for sudden cardiac death. Conventional risk stratification is reviewed together with other non-invasive techniques such as exercise physiology; the signal averaged electrocardiogram and heart rate variability. ⋯ A novel electrophysiological technique is described in detail which aims to measure the electrophysiological effects of myocardial disarray and seems safer and more sensitive and specific than conventional electrophysiological techniques. Current therapeutic strategies are discussed including the role of drugs, the implantable cardioverter defibrillator, surgery and dual chamber pacing.
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Arch Mal Coeur Vaiss · Feb 1996
New generations of implantable pacemaker defibrillators for ventricular and atrial tachyarrhythmias.
Implantable defibrillation devices have now been extensively applied to patients requiring cardioversion and defibrillation of sustained ventricular tachyarrhythmias. The focus of new developments is in improving technology, achieving physiologic operation in the atrium and ventricle, seeking new indications and identifying patient populations amenable to this therapy. Ventricular application technology is focusing on simplifying and improving robustness of lead systems yet seeking lower defibrillation thresholds. ⋯ New applications include atrial defibrillation combined with atrial pacing in future devices. These devices are planned to have capabilities of ventricular defibrillation as a backup to address proarrhythmia concerns. It can be anticipated that implantable cardioverter defibrillator devices will be used for arrhythmia reversion in an expanding group of patients in the future.
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Cocaine is a drug which has been relatively little used in France until recently but its abuse seems to be on the increase with nearly 1% of 20 year-old-men admitting to having taken it more than 10 times in 1993. The cardiovascular manifestations of cocaine consumption should be known to all cardiological emergency units because of their prevalence and severity. Acute toxicological expertise and retrospective analysis allows formal diagnosis.