Contribution à l'étude de la fonction ventriculaire gauche par la scintigraphie des cavités cardiaques

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Aspects particuliers de l'insuffisance cardiaque du patient âgé

The prognosis of heart failure in elderly patients is poor. The knowledge of the particular aspects of this pathology could certainly increase the prevention and the therapeutic approach of this disease. The presence of many precipitating factors and comorbidities is typical of this pathology. The clinical diagnosis is particularly difficult, especially because the signs and symptoms are similar to those of frequent disorders in elderly patients. Moreover, cognition and sensory impairments and the spontaneous reduction of the physical activity, masking symptoms, may also disturb the diagnosis. Diastolic heart failure, frequent in old patients, contributes sometimes to perturb the diagnosis. The treatment of heart failure in elderly people is based in first line on the control of the precipitating factors. The pharmacotherapy is not fundamentally different from the younger patient and must follow the recommendations of the literature (Evidence Based Medicine). The underutilization of proven therapy must indeed be avoided. However, the careful beginning, at very low doses, and a careful titration to obtain the recommended doses, is essential. Moreover, the susceptibility to side effects and the frequent contra-indications in the elderly require meticulous precautions in the prescription of the drugs. Diuretics remain the cornerstone to promptly control the pulmonary congestion and the edema. The angiotensin-converting-enzyme inhibitors, the antagonists of the angiotensin-receptors and the β-blockers must be prescribed as in the younger patients. Digoxin plays also a role in several precise indications. Coronary angioplasty, heart surgery and technique of resynchronization have indications in certain cases. Multidisciplinary approach and vigilant follow-up are essential to improve the prognostic of heart failure in elderly patients.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Bilan actuel de l'angioplastie coronaire endoluminale.

The morphological and clinical indications of coronary angioplasty have been widely extended. This technique occupies now a place of choice in the treatment of ischemic heart disease. The high success rate is obtained with a minimal rate of complications and death. New technical approaches are now proposed in order to reduce the incidence of the restenosis, which remains the major problem limiting the long-term efficacy of the procedure.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Prise en charge des comorbidités de l'insuffisance cardiaque

We will review some diseases that interfere most with management of heart failure: anemia, chronic renal failure, chronic pulmonary diseases, diabetes, atrial fibrillation/flutter, sleep apnea, angina, systemic arterial hypertension, rheumatic disease, depression and anticancer chemotherapy. We will retain principally their therapeutic implications. Anemia can be partially corrected by administration of intravenous iron or erythropoietin. Chronic renal failure requires adaptation of the treatment, in particular for drugs of the renin-angiotensin-aldosterone system. Chronic pulmonary diseases complicate diagnosis of heart failure and may lead to sub prescription of p-blockers. Diabetes does not alter the usual recommendations for the treatment of heart failure but some hypoglycemic medications should be prescribed with caution. In the presence of atrial fibrillation or flutter, the main purpose of the treatment is to improve the quality of live and to diminish the thromboembolic risk; it may be obtained by rhythm or rate control. Therapeutic approach of sleep apnea is based on optimal treatment of heart failure and weight loss. In the presence of angina, systemic arterial hypertension, rheumatic disease or depression, certain drugs usually prescribed are contraindicated or must be prescribed with caution. Finally, chemotherapy can be cardiotoxic and require careful monitoring of cardiac function.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Contribution à l'étude de la fonction ventriculaire gauche par la scintigraphie des cavités cardiaques

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Predictors of the variation of the ejection fraction during exercise in patients with and without coronary heart disease

The aim of this study was to determine the factors influencing the different response of the ejection fraction (EF) of the left ventricle at exercise observed in patients with and without significant coronary heart disease. We have studied 98 patients referred for coronary angiography (82 men, 16 women), of whom 49 patients had a previous myocardial infarction and 71 patients had significant coronary heart disease. Exercise testing was performed and combined with a cardiac blood pool imaging at equilibrium. The variation of the EF between rest and peak exercise (ΔEF) was measured. Twelve clinical, exercise-related, isotopic, and coronary arteriographic variables were examined in a linear univariate and statistical analysis. In the univariate regression, seven variables were significant regressors on the ΔEF. In the multivariate regression, only four variables were significant regressors on the ΔEF. Three independent predictors were found: the rate-pressure product, the ST depression, and the occurrence of a previous myocardial infarction. These three independent predictors reflect the myocardial functional reserve.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Transaortic saphenous patch angioplasty for left main coronary artery stenosis. An alternative to coronary artery bypass

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A predictive model of restenosis after percutaneous transluminal angioplasty

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Radiofrequency ablation of bundle branch reentry ventricular tachycardia: an easy way to avoid an implantable defibrillator

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Color flow imaging during biplane transoesophageal echocardiography: a clinical assessment

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