Search

Takotsubo cardiomyopathy (TK-CM) is a reversible acute left ventricular dysfunction that cannot be explained by an obstructive coronary lesion. The aim of our study was to explore the possible correlation between the incidence of TK-CM in summer and the average temperature, number of heat waves or number of days hotter than 30°C. 482 patients presented an acute coronary syndrome in the summers of 2012 until 2017 in our region. 15 patients met the inclusion and exclusion criteria and were diagnosed as TK-CM. The study analysis showed a statistically correlation between the number of heatwaves and the incidence of TK-CM (coefficient of correlation: 0.77; p = 0.04). This comforts the hypothesis of climatic influence on this pathology.Le syndrome de Takotsubo (STK) est une dysfonction ventriculaire gauche aiguë, le plus souvent réversible, sans rapport avec une maladie coronarienne. L’objectif de notre étude était d’explorer le lien entre l’incidence de cette maladie en été et divers paramètres météorologiques; température moyenne, nombre de canicules et nombre de jours au-dessus de 30 °C. 482 patients ayant présenté un syndrome coronarien aigu entre les étés 2012 et 2017 ont été analysés dans notre région (Valais, Suisse). Après application des critères d’éligibilité et d’exclusion, 15 avec un STK avéré ont été inclus dans l’étude. Les résultats montrent que l’incidence de STK était statistiquement plus élevée pendant les canicules (coefficient de corrélation: 0,77; p = 0,04), ce qui conforte l’hypothèse de l’influence des températures extrêmes sur l’incidence saisonnière de cette pathologie.

Background The SARS-CoV2 virus has been an emerging virus since December 2019 and is the cause of a global pandemic whose clinical manifestations extend far beyond respiratory disease. Case summary A patient with severe coronavirus disease 2019 respiratory infection, carrying a mechanical mitral valve and under anticoagulation, was admitted to our cardiology department because of a new atrial fibrillation, which turned out to be related to thrombosis of the mitral mechanical valve. Conclusion The pro-coagulant effect of the SARS-CoV2 virus does not spare patients at risk of thrombosis, even under effective anticoagulation. In patients with mechanical valves under vitamin K antagonist treatment, there is a high risk of thrombus formation. The treatment is based on thrombolysis by therapeutic anticoagulation, fibrinolysis, or surgery depending on the size, composition of thrombus, and clinical manifestation.

Percutaneous device closure of atrial septal defects (ASD) has proven to be safe and it is nowadays the standard treatment for ASDs. Immediate or late device embolization is a rare but potential complication of every attempted ASD device closure. We report a case of asymptomatic Amplatzer Septal Occluder into the left ventricular outflow tract (LVOT) detected by routine transthoracic echocardiography 3 months after successful implantation in a stable patient.

In daily practice, ischemia of embolic origin is frequent. The clinical spectrum can range from minor ischemia to stroke or myocardial infarction. This article summarizes the common etiologies of a cardioembolic event, such as atrial fibrillation or atrial flutter, presence of a patent foramen ovale or intracardiac masses (endocarditis, thrombi or tumors). This paper aims to serve as a short repository of information to guide every physician might need to initiate the diagnostic investigations and therapy according to recent recommendations.Dans son quotidien, le praticien sera couramment confronté à une ischémie d’origine embolique. L’éventail clinique va d’une ischémie mineure à un AVC ou un infarctus du myocarde. Cet article résume les étiologies courantes d’un événement cardioembolique, notamment la fibrillation ou le flutter auriculaire, la présence d’un foramen ovale perméable ou de masses intracardiaques (végétations, thrombi, tumeurs). Il vise à guider le praticien dans sa prise en charge diagnostique et thérapeutique selon les recommandations cliniques récentes. Cette prise en charge est très souvent multidisciplinaire.

Heart failure has become a real public health problem impacting both the hospital system and the outpatient sector. In constant evolution, the therapeutic armamentarium has been enriched with new molecules, making treatment more effective. Optimal management of patients suffering from heart failure are multileveled and require a multidisciplinary team. The team consists of the in-charge general physician, a cardiologist, a trained nurse in therapeutic education, and optimally a dietician and/or physiotherapist. A limiting step towards the efficiency of patient management is the communication skills of the network.À l’heure actuelle, l’insuffisance cardiaque est devenue un réel problème de santé publique qui impacte le système hospitalier comme le secteur ambulatoire. En constante évolution, le traitement médicamenteux s’est étoffé de nouvelles molécules, rendant la prise en charge plus efficace. Les défis pour une prise en charge optimale des patients souffrant d’insuffisance cardiaque sont multiples et requièrent une approche multidisciplinaire incluant bien évidemment le généraliste, le cardiologue mais aussi l’infirmière spécialisée en éducation thérapeutique, la diététicienne ou encore le physiothérapeute. L’augmentation du nombre d’intervenants nécessite une communication optimale et active entre les intervenants de l’hôpital et du cabinet.

Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.

Beta-blockers are very commonly drugs used in clinical practice, but whose mechanisms and clinical impacts are not always well understood, especially in certain specific clinical situations. This article proposes a review of some pharmacology notions over the different generations of β-blockers, as well as a review of indications and side effects in particular clinical situations, such as COPD, portal hypertension with esophageal varices and erectile dysfunction. Finally, an overview of response variability of these treatments is discussed from a genetic point of view.Les bêtabloquants sont des traitements médicamenteux couramment utilisés en pratique clinique mais dont les mécanismes et les impacts demeurent parfois méconnus, notamment dans certaines situations cliniques spécifiques. Cet article propose une revue de quelques notions pharmacologiques des différentes générations de bêtabloquants, ainsi que les indications et effets secondaires dans des situations cliniques particulières, comme la BPCO, l’hypertension portale avec varices œsophagiennes et la dysfonction érectile. Enfin, un survol de la variabilité de réponses à ces traitements est abordé notamment d’un point de vue génétique.

AIMS Elderly patients with sinus node dysfunction (SND) are at increased risk of falls with possible injuries. However, the incidence of these adverse events and its reduction after permanent pacemaker (PPM) implantation are not known. METHODS AND RESULTS Eighty-seven patients (mean [SD] age 75.4 [8.3] years, 51% women) with SND and an indication for cardiac pacing were included and were examined by a standardized interview targeting fall history. The incidence and total number of falls, falls with injury, falls requiring treatment, and falls resulting in a fracture were assessed for the time period of 12 months before (retrospectively) and after PPM implantation (prospectively). Furthermore, symptoms such as syncope, dizziness, and dyspnea were evaluated before and after PPM implantation. The implantation of a PPM was associated with a reduced proportion of patients experiencing at least one fall by 71% (from 53 to 15%, P < 0.001) and a reduction of the absolute number of falls by 90% (from 127 to 13, P < 0.001) during the 12 months before vs. after PPM implant. Falls with injury (28 vs. 10%, P = 0.005), falls requiring medical attention (31 vs. 8%, P < 0.001), and falls leading to fracture (8 vs. 0%, P = 0.013) were similarly reduced. Notably, fewer patients had syncope (4 vs. 45%, P < 0.001) and dizziness after PPM implantation (12 vs. 45%, P < 0.001). CONCLUSION Falls, fall-related injuries, and fall-related fractures are frequent in SND patients. Permanent pacemaker implantation is associated with a significantly reduced risk of these adverse events, although no causal relationship could be established due to the study design.

BACKGROUND: With the advent of second harmonic imaging in echocardiography, microbubbles have been observed during opening and closure of mechanical prosthetic valves. The single phenomenon of cavitation, an extremely short event described in the literature, cannot explain the persistence of microbubbles during several hundred milliseconds. Therefore, in vitro we reproduced two distinct phenomena created by a local depression occurring during the closure and/or opening of prosthetic valves: Cavitation and degassing. METHODS: We used a water circuit system enriched with CO(2) that passes through a Venturi tube in order to create variable pressure gradients. Three types of observations were performed: (1). the dimensions of the bubbles as a function of pressure, (2). calibration of the echocardiograph, and (3). comparison and illustrations of the difference between bubble formation by cavitation (vaporization) and degassing (liberation of CO(2)). RESULTS: According to the different pressures exerted, the dimensions of the bubbles only vary by several microns, not measurable in practice. Second, the calibration of the echocardiograph reveals that the dimensions of the bubbles measured by ultrasound are greater by a factor of 1.75. Finally, the observed cavitation is a short phenomenon (several milliseconds) and happens under a great local pressure gradient. The degassing produces microbubbles lasting up to as long as > 1 second under much lower pressure. CONCLUSION: This in vitro study suggests that microbubbles observed during several hundred milliseconds after the opening of prosthetic cardiac valves are the result of degassing of CO(2) in blood rather than a cavitation phenomenon as suggested in the literature.

After myocardial infarction (MI), international societies of cardiology recommend an optimal treatment associating four classes of drugs, known as BASI combination (beta-blocker, antiplatelets, statin and inhibitor of the angiotensin converting enzyme). This study shows that the implementation of locally adapted guidelines in a regional hospital (CHCVs, Sion) significantly improve the treatment quality after MI, with a 10% increase of the BASI combination at discharge. Detailed results are discussed. Finally, we provide a table summarizing the optimal treatment strategy with drug examples including doses, which will be helpful to both general practitioners and specialists.

In the light of the recommendations published in 2012 by the European Society of Cardiology, the present article provides a review of the assessment, diagnosis and drug therapy of frequent cardiac valvular disease in adults. Congenital valvular heart disease, as well as pathology of the pulmonary valve and tricuspid stenosis, which are less frequent, will not be discussed here.

Cardiovascular magnetic resonance (CMR) is a rapidly emerging non-invasive imaging technique free of X-Ray and offers higher spatial resolution than alternative forms of cardiac imaging for the assessment of left ventricular (LV) anatomy, function, and viability due to the unique capability of myocardial tissue characterization after gadolinium-chelates contrast administration. This imaging technique has clinical utility over a broad spectrum of heart diseases: ranging from ischaemic to non ischaemic aetiologies. Cardiomyopathies (CMP) are a heterogeneous group of diseases of the myocardium associated with architectural abnormalities and mechanical dysfunction. CMR can help excluding coronary artery disease and can provide positive diagnostic features for several CMP resulted in better diagnosis and management, Leading to improvements in mortality.

Percutaneous closure of patent foramen ovale (PFO) has been proposed as the treatment of choice for young high-risk patients who suffered cryptogenic stroke and/or peripheral paradoxical embolism. We sought to compare prospectively two different devices used for percutaneous PFO closure.Prospective data were collected on 40 high risk patients (females: 38%, mean age : 44 +/- 11 years, interatrial septal aneurysm10 mm: 68%) who underwent percutaneous PFO closure after cryptogenic stroke (n = 38) or peripheral paradoxical embolism (n = 2). Chronologically, 20 patients were first treated by a PFO-Star (Cardia, Burnsville, MI) device. Then, 20 other patients received a Starflex occluder (NMT, Boston, MA). The primary endpoint was complete PFO closure at 6 months as assessed by transthoracic contrast echocardiography. Secondary endpoints were major peri- or post procedural complications and clinical recurrence at 1 year follow-up.Baseline clinical and anatomical characteristics were comparable for both groups. Complete PFO closure was observed in 50% (PFO-Star) and 90% (Starflex) of patients (p=0.001) respectively. Major peri-procedural complications occurred in the PFO-star group only: right-sided device thrombus (1 patient) and aorto-right atrial fistula (1 patient). At 1 year follow-up, no clinical recurrence occurred.In conclusion, despite the absence of clinical recurrence in this high-risk population with presumed paradoxical embolism, complete PFO closure at 6 months follow-up was significantly related to the type of closure device used.

Placement of automated external defibrillators (AED) in public facilities and training of the lay persons in basic life support-defibrillation (BLS-D) was recommended by the American Heart Association for the treatment of out-of-hospital cardiac arrest (OHCA). Immediate use of AED result in increase of survival to hospital discharge. Many observation and much less randomized trials describe clinical efficacy of this approach. However, "negative" trials have also been published and some recent data suggest that public access defibrillation (PAD) will have a minimal impact on population survival. In this article various PAD strategies were briefly reviewed. In our opinion installation of AED in public places should be based on the long-term study of local OHCA demography and preceded by widespread BLS training of lay population.

Intracardiac echocardiography is a new technique based on the use of ultrasonic diagnostic catheter, which can be introduced through the femoral vein up of the right atrium. Intracardiac echocardiography provides bidimensional views, coupled to colour and pulsed Doppler. This review summarizes multiple applications of intracardiac echocardiography in the field of interventional cardiology, particularly during percutaneous closure of patent foramen ovale or atrial septal defect. A major advantage of intracardiac echocardiography is the possibility of avoiding general anaesthesia as well as providing equivalent information to the reference technique of transoesophageal echocardiography.