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Biomedical subjects

M Komajda

Publications and source records attributed to M Komajda.

177 records · Page 10Linked to original sources
PubMed1980

Intracardiac conduction defects in dystrophia myotonica. Electrophysiological study of 12 cases.

Twelve patients with dystrophia myotonica had cardiac electrphysiological study for conduction disturbances (five cases) or for syncope (seven cases). Conduction disturbances were found in each case, being intranodal in two cases, intra-Hisian in three cases, or diffuse in seven cases. These findings are in agreement with those previously reported, and may be related to the high incidence of sudden death in these patients. Pacemakers are advocated in symptomatic patients, and in some asymptomatic patients with severe and diffuse lesions.

Adolescent↗
PubMed1979

[Immunological study of primary non-obstructive myocardiopathies. A report on 37 cases (author's transl)].

The pathogenicity of primary non-obstructive myocardiopathies remains unknown at the present time. Immunological disturbances have been demonstrated but their role is open to discussion. A comparison between 37 such patients and 37 control subjects with cardiac insufficiency, similar according to age and sex, gave the following results: circulating immune complexes levels, anti-organ or anti-tissue antibody levels, and the levels of serum complement and its fractions were the same in both groups. Serum IgA levels were significantly higher in the "patient" group, and this appears to be partly related to alcoholism. Finally, an antimyocardial cellular immunity exists. These results would appear to demonstrate that conventional immunological techniques are of limited value in primary cardiac insufficiency.

Adult↗
PubMedDate not supplied

Management of heart failure in the elderly: recommendations from the French Society of Cardiology (SFC) and the French Society of Gerontology and Geriatrics (SFGG).

Heart failure, a frequent disease in the elderly, has a pejorative prognosis. Clinical diagnosis is complicated by atypical or difficult-to-interpret symptoms and by the concomitant presence of other diseases, particularly cognitive impairment, neurological disorders and diseases of the musculoskeletal system. Among the additional investigations, echocardiography remains underused. Impairment of diastolic left ventricular function is frequent. The usual laboratory tests must include calculation of the creatinine clearance, which is indispensable for dosage adjustment of certain drugs (ACE inhibitors, digoxin, spironolactone). The value of plasma natriuretic peptide assays as diagnostic tools has not been determined in elderly or very elderly populations and the plasma B-type natriuretic peptide increases with age. Comprehensive geriatric assessment is essential in order to screen for concomitant diseases and determine the patient's degree of dependence. The general objectives of treatment remain applicable to the elderly subject: improvement in the quality of life, reduction of mortality and the number and duration of hospitalisations, and slowing disease progression. In the frail elderly subject, symptom alleviation is to be the primary objective. In the absence of specific studies on elderly or very elderly subjects, most of the recommendations have been extrapolated from the data based on the evidence generated in younger populations. The dietary rules are to be more flexible than those used for younger subjects, particularly in order to prevent the risk of denutrition induced by strict salt-free diets. Special precautions for the use of heart failure drugs are due to comorbidities and the pharmacokinetic and pharmacodynamic changes related to aging. Drugs dosage increase is to be cautious and carefully monitored for adverse reactions. The therapeutic programmes in which multidisciplinary teams are involved reduce the number and duration of hospitalisations and the costs generated by the disease.

Aged↗
PubMedDate not supplied

[Early postoperative thrombosis of an aortic Saint-Jude prosthesis. Success of fibrinolytic treatment].

We are reporting the case of a 63 year-old woman presenting an early thrombosis of a mechanical aortic Saint-Jude prosthesis, on the 21st post-operative day, following an insufficient anti-coagulant treatment and discovered by the presence of a well tolerated murmur of aortic insufficiency. The treatment consisted in fibrinolysis using urokinase, administered intravenously at a dose of 4,400 IU/kg/hour, for 12 hours. The clinical, ultrasound and radiocinematographic control performed on the 75th day, were normal; the patient, at that time being treated with anti-vitamin K and platelets anti-aggregates. No complication was observed. This case demonstrates the advantages of fibrinolytic treatments in early thrombosis following insertion of a valvular prosthesis.

Aortic Valve↗
PubMedDate not supplied

[Holter monitoring in patients with focal cerebral ischaemic attacks (author's transl)].

One hundred patients with focal cerebral ischaemic attacks of suspected embolic origin were investigated by Holter monitoring to determine whether paroxysmal arrhythmia may have been responsible for the episodes. There were 57 men and 43 women aged from 16 to 79 years (mean 50 years). Ninety-seven had residual focal neurological deficits and 3 had transient ischaemic attacks. The neurological lesions were verified by cerebral angiography in 68. Twenty-one had arterial hypertension and 9 had old myocardial infarction or angina. Nine had a history of palpitations. None had cardiac valve disease. All patients were in sinus rhythm, 4 had ventricular extrasystoles on routine ECG, and 4 had supraventricular extrasystoles. None of the patients were receiving anti-arrythmic drugs at the time of investigation. Holter monitoring was performed for 18 hours in 91 cases and for 24-54 hours in the remaining ones. The interval between the cerebral ischaemic attack and the monitoring was less than one month (mean 20 days) for 50 patients and longer for the others. Cardiac arrythmias were found in 36 patients. Sixteen had more than 10 supraventricular extrasystoles per hour, 13 had runs of 3 to 8 beats of supraventricular tachycardia, 1 had an episode of atrial fibrillation. Eighteen subjects had more than 5 ventricular extrasystoles per hour, 1 had accelerated ventricular rhythm, 2 had runs of 4 to 7 beats of ventricular tachycardia. Two patients had second degree A.V. block. None had palpitations during monitoring. Arrythmias were increasingly frequent with age. Our findings are similar to those obtained with monitoring in ambulatory asympatomatic subjects of the same age without apparent heart diseases reported by other authors. On the other hand, the frequency of arrythmia was unrelated to the time elapsed between the ischaemic attack and Holter monitoring. In conclusion, Holter monitoring performed several weeks after suspected cerebral embolism failed to reveal arrythmias likely to be responsible for a focal cerebral ischaemic attack.

Adolescent↗