Archives des maladies du coeur et des vaisseaux
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The overall cardiovascular mortality in patients with chronic renal failure is about 30 per cent of which 10 per cent is attributed to myocardial infarction. This prevalence led some workers to propose a hypothesis of "accelerated atherosclerosis" due to the hyperlipidaemia observed in 30 to 70 per cent of patients. However, the concept of accelerated atherosclerosis, which was based essentially on clinical studies, has been questioned. ⋯ Left ventricular hypertrophy and fibrosis may give rise to ventricular arrhythmias which could explain some of the cases of sudden death observed in patients with renal failure and often wrongly attributed to ischemic heart disease. Another form of myocardial disease which is observed later is characterised by an alteration of systolic function with left ventricular dilatation and hypokinesia and increased end diastolic pressures without an increase in left ventricular wall thickness. Valvular heart disease may also result from renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Arch Mal Coeur Vaiss · Mar 1990
Case Reports[Floating left atrial thrombus in 2 cases of severe mitral stenosis].
The authors report two operated cases of floating left atrial thrombus. Both patients had severe mitral stenosis, atrial fibrillation and dilatation of the left atrium. ⋯ The diagnosis was made in both cases by two-dimensional echocardiography which, in addition to confirming the severe mitral stenosis, showed a round, free-floating intra-atrial mass, rebounding from wall to wall and repeatedly engaging itself into the mitral orifice. The risk of prolonged engagement of the thrombus in the mitral orifice, causing syncope or sudden death, justifies urgent surgery associating thrombectomy and treatment of mitral stenosis every time this problem is encountered.
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Arch Mal Coeur Vaiss · Feb 1990
[Coronary reperfusion by anistreplase (Eminase) used intravenously during the acute phase of myocardial infarction].
Coronary recanalisation rate is one of the parameters utilized to evaluate the effectiveness of a thrombolytic agent. This parameter can only be measured when the occlusion and reopening of the coronary artery involved are demonstrated by angiography. Moreover, this type of study enables the kinetics of drug activity to be accurately determined. ⋯ The time elapsed between injection and action is 45 minutes on average. The risk of early reocclusion is low (about 5%). The recanalisation rate obtained with Eminase is similar to that obtained with intracoronary streptokinase.
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Arch Mal Coeur Vaiss · Feb 1990
Randomized Controlled Trial Multicenter Study Clinical Trial[Study of survival using anistreplase (Eminase)].
Thrombolytic therapy has been one of the most important advances in the field of cardiovascular medicine. Several agents are available and research is continuing to develop new effective thrombolytics with a rapid onset of action. ⋯ Survival is certainly the parameter of choice for assessing any thrombolytic protocol. The aim of this paper is therefore to review the results of survival studies with Eminase, one of the new thrombolytic agents used in the treatment of acute myocardial infarction.
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Arch Mal Coeur Vaiss · Feb 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of anistreplase on coronary patency in acute myocardial infarction].
Anistreplase or APSAC (anisoylated lys-plasminogen streptokinase activator complex) is a new, third generation thrombolytic agent with a long (90 minutes) elimination half-life, so that it can be administered by bolus intravenous injection over 2 to 5 minutes. In acute myocardial infarction anistreplase in doses of 30 units gives a coronary recanalisation rate of about 65 per cent and an early coronary patency rate of about 80 per cent. ⋯ The time required for recanalisation to occur is short (25 to 45 minutes depending on the time elapsed before administration), and the early (24 hours) coronary reocclusion rate is low (about 5%). These results, together with the ease of administration of the drug, could make anistreplase the first-choice thrombolytic agent in the treatment of recent myocardial infarction, notably in general hospitals and mobile intensive care units.