Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Feb 2005
[Cardiac arrest outside hospital: initial and subsequent cardiological management].
The prognosis of cardiac arrest outside hospital is directly related to the initial management. The aim of this work was to evaluate the characteristics of the initial and subsequent cardiological management of victims of cardiac arrest outside hospital with a retrospective analysis of data from the SAMU 35 (Emergency Medical Service, IIIe et Vilaine region) in the period April 1998 - April 2002. ⋯ the prognosis of cardiac arrest outside hospital remains bleak, with a mortality of 90%. The survival rate is higher if the initial management is optimal, associated with bystander resuscitation and an immediate emergency service response allowing rapid defibrillation. Diagnosis and management of acute coronary syndrome in a cardiological setting must be integrated into the strategy.
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Obesity alone is the cause of 11% of cases of cardiac failure in men and 14% of cases in women in the United States. The frequency of obesity continues to rise in our country, 41% of our compatriots being obese or overweight. It is expected that obesity will become an important cause of cardiac failure in the coming years. ⋯ From the prognostic point of view, in the global population of patients with cardiac failure, obesity improves survival because it counteracts the adverse effect of cachexia; however, obesity increases the risk of sudden death. In fact, obesity is associated with dynamic change in QT interval. In cases of cardiac failure secondary to obesity-related cardiomyopathy, loss of weight leads to an improved functional status and a reduction of left ventricular remodelling and an increase of the ejection fraction.
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Arch Mal Coeur Vaiss · Sep 2004
ReviewHeart failure, platelet activation and inhibition of the renin-angiotensin-aldosterone system.
Heart failure is a highly prevalent disease in aging western populations, associated with a substantially increased risk of thromboembolic events, not only in severe but even in mild to moderate stages. This can partly be attributed to concomitant atrial fibrillation, a well-known risk factor for stroke, as well as a "hypercoagulable state" including formation of intraventricular thrombi. Left ventricular dysfunction results in decreased cardiac output, pulmonary congestion and neurohumoral activation with marked stimulation of the renin-angiotensin-aldosterone system. ⋯ Enhanced platelet activation has recently been described in patients with heart failure in sinus rhythm. This article summarises the potential contribution to platelet activation of vascular endothelial dysfunction and reduced formation of the platelet inhibitor nitric oxide, which increase further the risk for thromboembolic events in heart failure. Beneficial modulation of cardiac remodelling, left ventricular function, neurohumoral activation, endothelial dysfunction and platelet activation can be achieved by inhibition of the renin-angiotensin-aldosterone system.
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Arch Mal Coeur Vaiss · Sep 2004
[Predictive value of aortic atherosclerosis detected by transoesophageal echocardiography for the presumption of coronary artery disease].
The aim of this study was to determine the relationship between plaques of aortic atheroma detected by transoesophageal echocardiography and the condition of the coronary arteries at coronary angiography. Two hundred and seventeen consecutive patients were included for systematic transoesophageal echocardiography blinded to the results of coronary angiography. Significant coronary disease was defined as stenosis of at least 70% of the artery lumen. ⋯ Significant coronary artery disease was correlated with the presence of aortic atheroma, especially of the ascending aorta. The specificity and positive predictive values were 100% but the negative predictive value was poor, irrespective of the aortic segment involved (32% for the ascending aorta, 36% for the transverse and 35% for the descending aorta). The authors conclude that transoesophageal echocardiography of the thoracic aorta is a good method of predicting severe coronary atherosclerotic disease.