Biomedical subjects
Publications and source records attributed to E Aouizerate.
When facing a chronic hypotension, underlying chronic diseases must be ruled out. In most cases, it concerns a "constitutional" benign, low blood pressure, however ill-tolerated and associated with neurovegetative dystonia. In so far as it is not a disease, there is no specific treatment. The long-term prognosis is excellent since symptoms usually improve with years and a low blood pressure is a sign of longevity.
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The case presented here is a 27-year-old patient who was born with common atrium and left superior vena cava (LSVC). Construction of interatrial septum and intraatrial baffle with pericardium was performed 16 years ago. Radionuclide angiocardiography (RAC) showed that a substantial amount of blood flow from the LSVC was directed to the inferior vena cava through the hemiazygos vein (HAV). It also detected a baffle leak and a left to right shunt at the atrial level. Subsequent RAC after reoperation initially showed insignificant flow through the atrial baffle, major flow through the HAV, and no shunt. Repeat RAC one year after surgery showed increased flow through the baffle and diminished flow through the HAV, without a satisfying explanation. This case illustrates the value of RAC in detecting various types of cardiovascular abnormality and subtle hemodynamic changes.
Echocardiography seems to be the best non-invasive method for the detection of hypertensive heart disease: it shows early abnormalities of left ventricular compliance, frequently left ventricular hypertrophy and late abnormalities of myocardial contractility. These results are of paramount importance since recent epidemiological data have shown that left ventricular hypertrophy is a factor of severity and should be treated.
Ambulatory blood pressure monitorings for diagnosis purpose in non treated hypertensive patients are often performed only during day time for two reasons. First, target organ responses to hypertension, and mainly left ventricular hypertrophy, are more closely related to activity than to rest BP. Second, these automatic devices are frequently not well tolerated during sleep because of their noise during inflation of the cuff. However, 24 h BP monitoring seems of greater interest in treated hypertensive patients to control the efficiency of the treatment. As suggested by our work, incomplete lowering of BP during night may not be harmless. In a prospective study, we evaluated the relationship between BP recorded during 24 h (Spacelabs 5200) and M mode echocardiographic measurements of left ventricular mass index (LVMI) (Devereux's formula) both in non treated hypertensive patients (group A, n = 40) who had discontinued therapy at least 8 days prior to the study and in hypertensive patients treated with the same drugs for more than 3 months (group B, n = 24). More than half of these patients were receiving beta blocking agents. As previously stated day (8 h-22 h), systolic BP is better related with LVMI than clinical (C) and night (23 h-7 h) SBP in group A. In contrast, a higher correlation was found between night BP and LVMI in group B, which was significantly different from the correlation found in group A (Z test, p less than 0.05). (Table: see text). In conclusion, 24 h BP monitoring is useful in treated hypertensive patients. Inadequate lowering of BP during night time may partially account for persistent left ventricular hypertrophy in treated hypertensive patients.
Although rarely encountered, tumours of the heart are now more easily and frequently diagnosed owing to the availability of non-invasive imaging methods, notably echocardiography. With echocardiography the cardiac extension of the tumour is perfectly visualized, but its connections with the mediastinum are less readily accessible. The case presented here of a female patients with a malignant lymphoma involving the heart (right ventricle and atrium, pericardium) and the mediastinum illustrates the complementary nature of echocardiography, computerized tomography and magnetic resonance imaging.
UNLABELLED: In a prospective study the relation of left ventricular hypertrophy and exercise versus ambulatory blood pressure was analysed in 31 patients with essential hypertension (10 females, 21 males, mean age 44 +/- 14). Hypertension is borderline and has never been treated in 8 patients, mild to moderate in 24 patients who had discontinued therapy at least 8 days prior to the study. M mode echocardiogram, bicycle exercise testing and ambulatory blood pressure monitoring (spacelabs 5200) were performed within a 7 days period. Left ventricular wass (LVM) was calculated from M. mode echo data according to Devereux's formula and used to determine a LVM index (LVM/Body surface area). Correlations between LVM index and rest (R) SBP, end exercise (EE) SBP, the average of approximatively 60 SBP recordings from 7H to 22H (A-SBP) and the average of the 5 highest (5H) SBP recordings in the day are reported: (Formula: see text). There is no significative correlation with diastolic blood pressure. CONCLUSION: 24H A-SBP and EE-SBP appears to correlate better with severity of LVH than does the R-SBP. The selection of the 5 highest SBP in a day do not improve the correlation compared with R-SBP.
The object of this study was to identify vector-cardiographic parameters (VCG) dependant on the size of myocardial infarction and its consequences on segmental left ventricular wall motion. Forty-five patients were selected for study after a complete haemodynamic investigation including quantitative analysis of LV wall motion. They were divided into three groups: Group I, comprising 15 normal control subjects; Group II, comprising 16 patients with abnormal LV wall motion related to anterior wall infarction due to a solitary lesion of the left anterior descending artery; Group III, comprising 14 patients with abnormal LV wall motion related either to posterior wall infarction or inferior wall infarction due to a solitary lesion of the right coronary or left circumflex arteries. Segmental wall motion was analysed by a semi-automatic programme derived from the Standford method. This programme detects the number of pathological segments in a ventricle and their shortening, and also determines a coefficient of severity of the abnormal zone. The VCG was performed according to Frank's principle and exploited using the computerised Arnaud RUBEL system. The characteristics of the instantaneous vectors were determined every 10 ms up to 60 ms: X, Y and 2 coordinates, amplitude, azimuth and elevation. These coordinates were compared with the segmental wall motion in every patient. There was a close correlation between LV regional wall motion abnormalities and the deflection of the initial vectors (during the first 40 ms) in the horizontal and frontal planes. A ROC statistical analysis showed that VCG was an excellent method of detecting abnormal LV wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)
In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.
Poor effort tolerance is observed in a small percentage of cases of idiopathic mitral valve prolapse (IMVP). The aim of this study was to assess the possible left ventricular dysfunction in such cases, responsible for poor effort tolerance. Left ventricular function and segmental wall motion were studied retrospectively in a group of 17 patients with IMVP. The patients, average age 53 +/- 12 years, had poor effort tolerance (ST segment depression of 2 to 4 mm in 15 cases, drop in blood pressure in 6 cases) justifying catheter and angiographic studies. All patients had IMVP confirmed on RAO left ventriculography. There was no associated mitral regurgitation or coronary artery disease. Left ventricular function was studied by parameters of global function (systolic and diastolic parameters, volume measurements) and by a quantitative study of segmental wall contraction. The method used for studying regional wall motion was an application of the Stanford method in which segmental shortening is studied over all the endocavitary contour of the LV during an angiographic cycle filmed at 50 frames/second in the RAO projection. The time and velocity amplitudes of wall motion were measured during systole and diastole. The same methodology was applied to 21 normal control subjects. The results showed abnormal volumic compliance and wall motion in the IMVP group. Asynergy was mainly confined to the antero-lateral wall of the LV. The amplitude of contraction was generally normal but the contraction was slower and finished earlier. In the same zone, relaxation was abnormally early and lasted longer.(ABSTRACT TRUNCATED AT 250 WORDS)
Since arterial hypertension is one the main risk factors of coronary atherosclerosis, the association hypertension-coronary disease is a frequent one. Moreover, arterial hypertension aggravates the coronary disease and this association is therefore of very poor prognosis. However, this prognosis seems to improve with early and adapted treatment based largely at this time on beta-blockers and calcium inhibitors.