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Biomedical subjects

J C Quiret

Publications and source records attributed to J C Quiret.

At least 19 recordsLinked to original sources
PubMed1991

[Myocardial infarction caused by closed thoracic injury: pathogenic and angiocoronarographic aspects. Apropos of 4 cases and review of the literature].

The 4 cases of transmural myocardial infarction by closed chest trauma reported by the authors bring the number of angiographically documented and published cases to 52. This group serves as a basis for a detailed review of coronary and myocardial anatomical lesions and their pathophysiological mechanism is suggested. Long controversial, direct traumatic coronary damage has been confirmed by coronary angiography and is the essential mechanism of transmural infarctions. Myocardial contusion, much commoner, is responsible for non transmural lesions which remain difficult to diagnose. The authors stress the twin value of coronary arteriography: pathophysiological with its medicolegal consequences, and also therapeutic since a revascularisation procedure may be particularly beneficial in situations where thrombolysis is generally contraindicated.

Adolescent↗
PubMed1991

[Postoperative iatrogenic left coronaroventricular fistula. Demonstration by color two-dimensional Doppler].

The authors report the case of an asymptomatic 67 year old patient, in whom, 6 years after aortic valve replacement, Doppler color flow mapping showed the presence of a coronary artery--left ventricular fistula. The normality of preoperative coronary angiography suggested that this fistula was created during peroperative left ventricular purging: the implantation of a needle through the right ventricle and interventricular septum. A iatrogenic lesion of a septal branch probably caused the communication between the left anterior descending artery and the left ventricle. Postoperative normalisation of the left ventricular end diastolic dimension, the absence of dilatation of the left main coronary on 2D echocardiography, the narrowness of the Doppler color jet and the absence of a significant end diastolic Doppler signal in the aortic isthmus indicated a fistula of small size and simple Doppler echocardiographic follow-up was decided upon.

Aged↗
PubMed1991

[Free-wall rupture during the acute phase of myocardial infarction. Apropos of 2 cases surgically treated with success].

The authors report two cases of cardiac rupture during acute myocardial infarction successfully treated surgically. In the first case, rupture occurred 7 days after hospital admission for anteroseptal myocardial infarction. The patient developed sudden cardiogenic shock with signs of venous hypertension without left ventricular failure. The second patient was admitted for syncopal chest pain with transient hypotension which regressed after volume repletion and pressor amine therapy. On admission, the patient had signs of cardiac tamponade. The ECG showed recent inferolaterobasal myocardial infarction. In both cases the diagnosis was made by 2D echocardiography which showed voluminous circumferential pericardial effusions probably due to haemorrage, with an image very suggestive of a blood clot in the effusion of the second patient. The two patients underwent emergency cardiac surgery and both survived with a 4 and 1.5 month follow-up respectively. These two cases confirm the value of 2D echocardiography as an emergency bedside procedure for the diagnosis of cardiac rupture, especially when images of intrapericardial thrombosis are observed, as in our second patient. In addition, the first case raises once again the question of the role of late thrombolysis as a predisposing factor of cardiac rupture at a time when this technique is proposed up to 24 hours after the onset of symptoms.

Aged↗
PubMed1990

[Thrombolysis and intravenous beta-blockaders in the acute phase of myocardial infarction].

Since proof exists of the individual efficacy of thrombolytics and intravenous beta-blockers in the acute phase of myocardial infarction (MI), it seemed to us logical and interesting to combine them. The aim of this retrospective study was to evaluate the safety and potential benefit of this drug combination for left ventricular function. We compared 40 patients (group I) of mean age 53.9 +/- 8.5 years admitted for MI in the six hours following the onset of symptoms treated by thrombolysis and intravenous beta-blockers (metoprolol or atenolol), with 27 patients (group II) of mean age 57.1 +/- 9.4 years treated within the same time lapse by thrombolysis alone. All patients underwent coronary arteriography and only two in group I were not examined by ventriculography. The two groups were comparable in terms of age, coronary history, localization of MI, clinical status at the outset, and time lapse before administration of the thrombolytic. Only heart rate differed at the outset (lower in group II; p = 0.05). A significant reduction in heart rate of 18% was seen in group I. When administration of the two drugs was simultaneous (less than or equal to 30-min lapse between each drug) this reduction was greater (22%) than when they were given separately (13%). In group II, the drop in heart rate was not significant (63%). In contrast, the decrease in systolic pressure in both groups was significant and comparable (group I: 16.6%; group II: 14.5%) even in the case of simultaneous administration (22%). There was no between-group difference in left ventricular ejection fraction (LVEF).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1990

[Iatrogenic coronary stenosis after angioplasty].

Restenosis is the usual mechanism of recurrent myocardial ischaemia in the months following successful percutaneous transluminal coronary angioplasty (PTCA). Control coronary arteriography may occasionally show another cause: the constitution of a new stenosis near the dilated segment or in the left main coronary stem after angioplasty in a branch of this artery. The authors report 4 cases of patients who developed new coronary stenoses within a few weeks of PTCA, interpreted as traumatic complications of the initial procedure due to a lesion of the intima with a secondary fibrotic reaction and luminal narrowing. The guiding catheter was probably responsible for the trauma to the left main coronary stem whereas the tips of either the balloon catheter or the guide wire were thought to have been responsible for the endothelial effraction of the dilated vessels.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Doppler echocardiographic study of hemodynamic changes of double stimulation mode and atrial detection in patients with dual chamber pacemaker. Value of hysteresis of the atrioventricular delay].

This Doppler echocardiographic study of patients with a dual chamber pacemaker was undertaken to assess the changes in mitral and aortic flow induced by passing from the double stimulation to the atrial detection mode. Thirteen patients totally dependent on ventricular pacing were examined and mitral and aortic blood flow recorded by pulsed wave Doppler. The chronology of left atrial contraction as assessed by the Doppler mitral A wave was measured with respect to the ventricular stimulation. The A wave was recorded on average 177 ms after the right atrial stimulation artefact. For an average AV delay of 168.8 ms and an identical pacing frequency, the passage from the double stimulation to the atrial detection mode led to left atrial contraction occurring on average 70 ms earlier with respect to ventricular stimulation, reflecting prolongation of the programmed AV delay related to the delay in detection of the sinus atrial wave. This earlier atrial systole shortened the total duration of mitral flow from 363 to 317 ms, decreased the early diastolic mitral flow and increased the atrial end diastolic flow; the stroke volume and cardiac output calculated from the aortic velocity time integral decreased significantly from 73 +/- 11 ml to 67 +/- 10 ml and 5.4 +/- 1.11/mn to 4.9 +/- 1.01/mn respectively. The initial parameters were restored (average 74 +/- 9 ml and 5.5 +/- 1.11/mn respectively) when the AV delay in the atrial detection mode was reduced by a value close to that of the calculated increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[EPIM. Survey of myocardial infarction in Picardie].

The aim of this prospective study carried out in picardy (Aisne, Oise and Somme Departments) between October 1st 1985 and September 30th 1986, was to determine the incidence and outcome of recent myocardial infarction (less than 1 month) hospitalised in the region, to assess the time delay before hospital admission, the mode of management, treatment in the acute phase and at discharge, and the attitudes to exercise stress testing and coronary angiography. All public and private hospitals of the 3 departments who admitted patients with acute myocardial infarction accepted to fill out the questionnaire. A total of 1260 infarcts in patients with an average age of 66.7 +/- 12.6 years were collected. Nearly 3 out of 4 patients were male, and the men generally 10 years younger (64 +/- 12.6 years) than the women (73.4 +/- 10 years). The time delay to hospital admission was very long: 16.6 +/- 47.5 hours. Two thirds of patients were transferred by non medicalised transport; 82 per cent of patients were directed to the casualty department which redirected 71 per cent to the cardiology department. Myocardial infarction was inaugural in 46.5 per cent of cases. The incidence of anterior and inferior infarction was almost identical (44 ans 45.5 per cent respectively). Treatment in the acute phase included Heparin (94 per cent), nitrate derivatives (93.7 per cent) and calcium inhibitors (78 per cent). Thrombolytic and betablocker therapy was only prescribed in 8.3 and 23.5 per cent of cases respectively. During the hospital period, average 17 +/- 9 days, the mortality rate was 22.3 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Demonstration by Doppler echocardiography of multiple valvular involvement in carcinoid cardiopathy].

We report a case of carcinoid heart disease which was remarkable on three scores: --the value of echocardiography which enabled us to diagnose the disease; --the usefulness of cardiac doppler examination which provided non-invasive haemodynamic evaluation of lesions of the four valves; --the presence of moderate involvement of the right heart, which is classical from the point of view of anatomopathology but is often missed clinically and was ascertained in that case by doppler-echocardiography.

Carcinoid Heart Disease↗
PubMed1988

[Asymptomatic and transitory electrocardiographic changes in the 24 hours following coronary transluminal angioplasty].

Fifty patients underwent a 24-hour Holter system recording immediately after successful coronary angioplasty. Only those patients who had been "successfully" dilated and who, during the following 2 days, had remained totally symptomless and without changes in standard ECG were selected. Arrhythmias occurred in 18 patients: 12 had supraventricular arrhythmia, including 3 prolonged attacks of tachyarrhythmia due to atrial fibrillation; 6 had ventricular arrhythmia, with numerous extrasystoles in 5 cases and bursts of ventricular tachycardia in 1 case. Changes in ventricular repolarization were recorded as: (1) isolated T-wave modification (11 patients), and (2) ST-segment depression (11 patients) reaching or exceeding 2 mn in 5 cases and lasting from 4 to 33 minutes. These silent and transient electrical abnormalities were observed mostly during the 12 hours which followed transluminal angioplasty, and particularly after dilatation of the right coronary artery. The physiopathological mechanisms of these changes are uncertain, but their occurrence has no influence on mid-term results, i.e. the follow-up coronary arteriography at 6 months.

Adult↗
PubMed1979

[Severe pulmonary embolism and recurrent thrombophlebitis caused by hereditary antithrombin III deficiency].

Severe pulmonary embolism with thrombosis of the inferior vena cava was observed in a 16 year old girl with no risk factors and treated successfully by fibrinolytic therapy. Secondarily, despite heparino-therapy, upper limb venous thrombosis occurred. Investigation of the clotting factors in the patient and her family revealed a hereditary deficit of antithrombin III. The features of the haemotological diagnosis of this rare condition and the therapeutic implications are discussed.

Adolescent↗
PubMed1979

[Artefacts during continuous electrocardiography by the Holter method].

Continuous ECG by the Holter method provides valuable information on the electrical activity of the heart but the interpretation of the playback may be made difficult by the presence of artefacts. The principal artefacts which may mimic arrhythmias or blocks, disturb QRS detection or deform the ventricular depolarisation are described. The majority are caused by incomplete preparation of the patient or the electrodes, but others may arise from a mechanical or electrical fault. Artefacts interfere with the automatic analysis of the tape, which is one reason for knowing the limitations of these systems of automatic analysis, and therefore control visual reinterpretation is necessary in cases where there is the slightest doubt. The presence of these artefacts is a limitation of the Holter method, the practice of which demands a certain amount of experience to avoid incorrect diagnoses which could lead to inappropriate or injustified therapy.

Diagnosis, Differential↗
PubMed1978

[Hyperventilation test in coronary disease: a comparison with a bicycle ergometer exercise test. Report of 100 cases].

A hundred cases have been studied and divided into three categories:--60 normal subjects;--30 coronary subjects with a positive exercise test;--10 subjects with defective nervous control of the circulation; using the exercise test, we studied the effects of hyperventilation on repolarisation of the ventricle. In the normal subjects there was no ischaemic depression of the ST segment, but there were minor changes in repolarisation which affected the T wave in 73% of subjects and were essentially posterior in distribution. In the coronary subjects, we found three with ischaemic depression of the ST segment and one with ST elevation of 2.5 mm (6.7% of the coronary subjects). This last finding is evidence against the commonly held hypothesis that reproduction of ST depression by hyperventilation during the exercise test indicates a false positive test. In the patients with defective nervous control of the circulation, 9 had an ischaemic type of ST depression, either as a new feature or as a more severe one compared with that found at rest. The mechanism by which these depressions are produced has not been totally explained:--in the cases with defective nervous control of the circulation, it appears that latent increased sympathetic activity is increased by the hyperventilation;--in the coronary subjects, it may be caused by true ischaemia or by an associated defect in nervous control of the circulation.

Adult↗
PubMed1978

[Comparison of echocardiography and phonomecanography in adult aortic valve stenosis. 55 cases].

The results of echocardiography and phonomecanography were compared in 55 cases of adult valvular aortic stenosis. Although the most reliable echocardiographic sign of the severity of stenosis is the systolic separation of the aortic valve echos, it should be amphasised that: -- this cannot be measured in 25 % cases; --in 10 % cases the values obtained vary with the angle of the transducer. In these cases, the finding of a left ventricular posterior wall thickness greater than or equal to 15 mm is specific for severe aortic stenosis. On the other hand, the left atrial, left ventricular and aortic internal dimensions and the morphology of the mitral leaflets do not help in the estimation of the severity of adult aortic stenosis. The best correlations between echo and phonocardiography are the values of aortic valve opening and : --hemi-ascension time (r = 0.67); --left ventricular ejectiontime (r = 0.93) when patients in cardiac failure are excluded. The complementary nature of these two investigations is notable, and should, in pure aortic stenosis without angina, spare patients who are often elderly and fragile from heamodynamic investigation.

Aged↗
PubMed1977

[Changes in left ventricular function with effort in the coronary patient. l].

The altered haemodynamics of the coronary patient have been investigated in 30 patients both at rest and under conditions of maximal effort as carried out on the bicycle ergometer under the usual conditions for an exercise electrocardiogram. Patients with angina of effort but no previous infarction have normal left ventricular function at rest; under the ischaemia induced by exercise there is acute dysfunction of the left ventricle as witnessed by a reduction in maximal cardiac output, a raised end-diastolic pressure, and changes in compliance which are more marked than those in contractility. Patients with a healed infarct but without sequelae have a rigid left ventricle, but it is not failing; they show normal changes in dP/dt max and in the indices of left ventricular work, but a pathological form of negative peak of dP/dt, of end-diastolic pressure, and of deltaP/deltaV (which reflects myocardial compliance). Patients who have had an infarction with sequelae such as angina or attacks of left ventricular failure have filling pressures which are already elevated at rest, and cardiac failure, which becomes evident on exercise.

Angina Pectoris↗
PubMed1977

[Left ventricular function with effort in the coronary patient. Study of the correlations with the data on echocardiography, effort ECG, and the teleheart. 2].

Correlations were established, for 30 coronary patients, between the haemodynamic findings and those adduced from non-invasive techniques - electrocardiography, both at rest and on exercise, telethorax, and echocardiography. Left ventricular function in the coronary patient can be assessed, even before catheterisation, by means of: 1. The clinical findings: angina of effort, an uncomplicated infarct, and an infarct with sequelae each has its own peculiar haemodynamic pattern at rest and on exercise; 2. The ECG finding of an extensive anterior infarct implies a haemodynamic picture vastly different from that with a limited posterior infarction; 3. The appearance of an ischaemic shift in the ST segment on exercise implies an acute malfunctioning of the left ventricle; 4. On the echocardiogram, an end-diastolic volume greater than 150 ml/m2, an ejection fraction less than 0.50 and VCF greater than 0.8 c/s are always accompanied by disturbances in the haemodynamics. By contrast, the cardio-thoracic ratio, except in post-infarct cases complicated by left ventricular failure, gives no predictive indication of cardiac function. These various examinations should therefore be applied to the coronary patient as an index of cardiac function.

Angina Pectoris↗