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Biomedical subjects

C Halphen

Publications and source records attributed to C Halphen.

At least 19 recordsLinked to original sources
PubMed1992

[False aneurysm of the left ventricle during the acute phase of myocardial infarction: diagnosis by transesophageal echocardiography].

The authors report a case of myocardial infarction complicated by a false aneurysm of the posterior wall of the left ventricle, the diagnosis of which was confirmed, for the first time, by transesophageal echocardiography (TEE) which provided better definition of the anatomical features of the lesion: visualisation of the particularly wide neck (5 cm) and the site of rupture of the myocardium; demonstration of the presence in the false aneurysm with a thin pericardial wall of a large thrombus of different acoustic density, itself overlain by swirling whorls. Colour Doppler combined with TEE clearly showed the acceleration of flow at the neck and its slowing in the newly formed cavity. Once the diagnosis was made, the patient rapidly underwent surgery with a successful outcome. The quality of the images obtained without risk by TEE suggests the important role which this investigation could play in the future in the diagnosis of certain mechanical complications of myocardial infarction.

Diagnosis, Differential↗
PubMed1991

[Unstable angina and infarction without Q wave treated with verapamil: value of the early exercise test].

Twenty patients aged 56.8 +/- 10 years, hospitalised for unstable angina (12 cases) or infarct without Q wave (8 cases) were treated with IV heparin, aspirin and oral verapamil. The clinical syndrome was controlled by verapamil in 16 cases out of 20 (80% of cases) at the dosage of 360 mg/d in 14 patients and of 480 mg/d in two. An exercise ECG, limited by symptoms, was obtained in 18 patients (90%) between the 8th and 12th day. Coronary arteriography was considered to be indicated in three sets of circumstances: recurrence of angina resistant to nitroglycerin, positive exercise ECG with verapamil, persisting despite triple therapy or strongly positive exercise ECG (total duration less than or equal to 6 minutes). An infarct complicated the early course in 4 patients (20%): twice following angioplasty, once following exercise ECG (spastic angina) and once during triple therapy (refractory angina). Hospital and mid-term (18 +/- 6 months) mortality was nil. With verapamil, the absence of recurrence of angina together with a negative exercise ECG enabled the identification of a large group of patients (40%) with a low risk of a subsequent major accident and in whom early and routine coronary arteriography is probably not indispensable.

Adult↗
PubMed1990

[Relations between intelligence and perversion. Small essay on ethics].

Excepted vegetarians, everybody let kill and may kill for self-defence. The killed-one suffers and dies. Perversity is to kill or to let suffer without personnal life's saving's necessity--for the treasure of the "perverse subject". We think that such subjects must not be considered as non responsible, excepted when they present a mental retardation. The sexual perversions are probably not the most dangerous: the most are subjects using a personnal high level of intelligence to domination and destruction, including in the sexual behaviours.

Adult↗
PubMed1988

[Angina at rest without significant changes in the per-critical ECG in coronary insufficiency].

In coronary patients angina pectoris at rest is usually attended by clear changes in repolarization, and in the absence of such changes clinicians are justifiably reluctant to assert that the constrictive chest pain is due to ischaemia. However, a number of concordant data indicates that in some cases myocardial ischaemia--whether spontaneous or induced by the ergonovine test or by coronary angioplasty--may cause an anginal pain that proceeds without significant alterations in repolarization and indeed, without any changes in ECG tracings. Prior to making a firm diagnosis of this type of angina, several causes of error must be excluded, the main one being that repolarization disorders are labile and may have disappeared whilst the anginal pain persists. But above all, the ischaemic episode that accompanies angina must be documented by haemodynamic, angiographic, scintigraphic or echocardiographic data. The pathogenesis of angina at rest occurring in coronary patients and without changes in per-critical ECG is still imperfectly known and probably complex. The authors review several possible mechanisms: the pain perception threshold may be lowered, the collateral circulation may be highly developed, and the ischaemic episode may be so discreet and/or controlled by treatment, or so evenly distributed between two opposite territories that no electric gradient is generated.

Angina Pectoris↗
PubMed1988

[Anomalies of the T waves induced by flecainide].

Flecainide is a class I antiarrhythmic agent which depresses depolarization and conduction velocities in myocardial and Purkinje's fibres, thereby extending their refractory period. As the drug belongs to the IC group, it may increase--moderately as a rule--the duration of QRS, but it does not alter the action potential duration and therefore does not increase the JT interval. In 3 patients treated with flecainide we observed a peculiar alteration in the shape of T waves, the peak of which was flattened and notched, forming a double hump. This abnormality, most clearly visible on precordial leads, remained isolated with no changes in other electrocardiographic parameters. It appeared independently of any circumstance likely to modify repolarization. It remained stable throughout treatment with flecainide and vanished when the drug was discontinued. It was regularly observed with the recommended therapeutic doses (200-300 mg/day) and was unaccompanied by signs of toxicity. To our knowledge, these T wave abnormalities have not yet been reported. Yet they deserve to be known and correctly interpreted, since they reflect impregnation of the myocardium by the antiarrhythmic agent which should not be withdrawn on this account.

Adult↗
PubMed1988

[Aneurysm of the interauricular septum].

In reference to three personal cases of interatrial septum aneurysm discovered on ultrasonography performed for the diagnosis of a cerebral embolism, the authors describe the positive diagnosis criteria, in mono- and bi-dimensional mode, of this abnormality, as well as related data obtained from catheterization, angiocardiography, and phonocardiography. This malformation, the frequency and pathogenesis of which still remain, today, difficult to evaluate, may be at the origin of complications, especially embolic migrations, systemic and also pulmonary, supraventricular rhythm disorders, interatrial shunt, reduced ventricular filling. Once established, the diagnosis is the subject of many controversies: if plain monitoring appears logical in asymptomatic forms, the occurrence of a systemic embolism makes it difficult to choose between surgical treatment and long-term anticoagulant therapy.

Aged↗
PubMed1987

[Auricular fibrillation: a cause of reversible myocardiopathy].

A chronic supraventricular tachycardia may alone be responsible for a picture of severe congestive cardiac insufficiency, which is totally reversible after return to a sinus rhythm. The two cases reported here emphasize this particular fact, the physiopathology of which still remains unknown. There is also a prognostic advantage to such cases: in the presence of a congestive cardiopathy with atrial fibrillation, apparently idiopathic, it is important to try to obtain a sinus rhythm and to study from a distance the left ventricular performance indexes which may return to normal after regularization of the rhythm.

Atrial Fibrillation↗
PubMed1986

[Value of echocardiography in the study of the embolic origin of a cerebral ischemic accident].

One hundred consecutive patients aged from 35 to 82 years (mean : 74 years) admitted to a Neurology unit for cerebral ischaemic accident of suspected embolic origin were examined by two-dimensional echocardiography, then divided into two groups. Group I patients (n = 24) had a cardiopathy detectable by ultrasound, such as valve disease (n = 5), ischaemic cardiopathy (n = 10), myocardial dilatation (n = 4) or hypertrophic obstructive cardiomyopathy (n = 1). Group II patients (n = 74) had no cardiopathy detectable by ultrasound. Among group I patients, a thrombus was detected in 3 cases (12.5%), and 16 patients (66.7%) had echographic signs of potentially emboligenic cardiopathy without thrombus, including mitral or aortic valve stenosis (5 cases), parietal ectasia (6 cases), severe abnormality in left ventricular contractility (4 cases) and left atrial dilatation (4 cases). No thrombus was visualized in group II patients, but 10 (13.2%) had signs of potentially emboligenic cardiopathy, including mitral valve prolapse in 6 and left atrial dilatation in 4 cases. Altogether, therefore, a potentially emboligenic cardiopathy was detected by echocardiography in 29% of these 100 patients, but it had already been diagnosed prior to this examination in 24%. A thrombus could be visualized in only 3% of the cases. It is concluded that echocardiography need not be systematically performed in all patients with cerebral ischaemic accident, but only in young patients in search of a cause amenable to curative or actively prophylactic treatment.

Adult↗
PubMed1985

[Splenic abscess disclosing endocarditis].

A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.

Abscess↗
PubMed1979

Prognostic value of exercise testing soon after myocardial infarction.

The prognostic value of a limited treadmill exercises test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no over heart failure and had been free of chest pain for at least four days. No complications occurred. During a one-year follow-up period 28 of 43 patients (65 per cent) who had chest pain during the test reported angina, as compared with 60 of 167 (36 per cent) who had no chest pain during test (P less than 0.001). The one-year mortality rates were 2.1 per cent (three of 146) in patients without changes in the S-T segment during exercise and 27 per cent (17 of 64) in those with depression of the S-T segment (P less than 0.001). Sudden death occurred in one of 146 (0.7 per cent) patients who showed no change in the S-T segment and in 10 of 64 (16 per cent) with depression of the segment (P less than 0.001). Thus, a limited treadmill exercise test performed before hospital discharge after acute myocardial infarction is safe and can predict mortality in the subsequent year.

Adult↗
PubMed1979

[Aortocoronary bypass for the threatened spread of acute myocardial infarction].

21 patients with unstable angina in the acute myocardial infarction period were treated by early surgery, on average on the 3th day after infarction. Resistance to medical therapy given in the coronary care unit, associating modern pharmacological agents and circulatory assistance, on the one hand, and the presence of lesions on the coronary arteries accessible to surgery on the other, were the surgical indications. The absence of operative mortality and of electrical changes after operation seem to be related to the many advances made in the various stages of the medico-surgical management. These results suggest that revascularisation surgery with an acceptable risk may be proposed to patients with unstable angina after a recent myocardial infarction.

Acute Disease↗
PubMed1978

Coronary artery disease in young women: clinical and angiographic features and correlation with risk factors.

Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P less than 0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P less than 0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.

Adult↗
PubMed1976

[Pitfalls of the normal electrocardiogram].

The authors report the cases of 7 patients with a normal basal electrocardiogram, whereas they were all affected with a high risk cardiovascular condition: coronary insufficiency in 3 cases, paroxysmal arrhythmia in 4 cases. They recall the limits of the conventional ECG and emphasise interest of dynamic recordings, with effort tests, and/on continuous ECG recording in the identification of certain transient heart manifestations.

Adams-Stokes Syndrome↗