The purpose of this study was to determine precisely which additional information on survival at 1 year and 4 years was provided by an ambulatory 24-hour ECG recording performed 3 weeks after myocardial infarction (MI), compared to clinical data. The study was conducted in 107 consecutive patients under 75 years of age who had had MI and were followed up for a mean period of 4 years and 9 months. The clinical variables most closely associated with mortality at both 1 year and 4 years were those which reflected the severity of myocardial damage and left ventricular dysfunction before or during hospitalization, viz.: a history of MI or heart failure (HF), HF in the acute phase, and digitalis-diuretic treatment on discharge. At 4 years a multivariate analysis yielded 3 separate clinical variables which enabled cardiac mortality to be predicted: history of MI (p less than 0.001), presence of HF in the acute phase (p less than 0.001) and history of hypertension (p less than 0.02). Ventricular arrhythmias also were closely associated with mortality, but only during the first year, the 2 most discriminant factors being a mean hourly frequency of ventricular ectopic beats (VEB) greater than 10, and the presence of successive VEB (doublet or burst of ventricular tachycardia). The positive predictive values (PPV) of clinical and ambulatory ECG recording variables taken separately for mortality at 1 year were fairly similar (about one-third) as regards HF in the acute phase, history of MI, successive VEB and mean VEB frequency greater than 10/h, the corresponding risk ratios being 23.9, 13.7, 11.6 and 9.4 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Q fever infectious endocarditis. 3 cases].

An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis. We report 3 cases of Q fever endocarditis. In 2 of these patients endocarditis developed on cardiac valve prosthesis. The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory. A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis. It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures.

Adult↗

PubMed1985

Mitral valve prolapse, Wolff-Parkinson-White syndrome, His bundle sclerosis and sudden death.

Explore the source record for details and available documents.

Adult↗

PubMed1985

[Eisenmenger's syndrome and pregnancy. Apropos of 2 spontaneous deliveries, one of which was fatal].

Two cases of spontaneous delivery at 27 weeks and 38 weeks are reported in two patients with Eisenmenger's syndrome. One case did not present any problems, while the other was followed by maternal death on the 6th day post-partum. The cause of death was similar to that of other cases reported in the literature. The pathophysiological explanation of the terminal clinical condition with refractory hypoxia remains unclear. In view of the maternal mortality of about 50 per cent, these patients should be prescribed effective contraception, free of thrombogenic and infectious risks. The therapeutic approach in patients who become pregnant is not well defined. However, a number of principles should be observed during delivery: oxygen therapy, rapid correction of haemorrhages, the timing and the modalities of anti-coagulation are controversial. The failure of the usual methods of resuscitation in the terminal stage raises the possibility of using fibrinolytics.

Adult↗

PubMed1983

[Paroxysmal atrioventricular block, cause of syncope in pulmonary embolism. 2 cases].

Two cases of pulmonary embolism accompanied by syncope in patients with pre-existing left bundle branch block are reported. Contrary to classical descriptions, the syncopes in these two patients could not be ascribed to cardiovascular collapse, but several arguments (such as the clinical features of the syncope and its coexistence in one case with ECG evidence of complete atrio-ventricular dissociation) were in favour of a paroxysmal disorder of conduction. Right bundle branch block is known to be common in pulmonary embolism and may even be more frequent in patients with left bundle branch block. In such cases, sudden and transient arrest of conduction in the right bundle would complete the left bundle branch block, thus accounting for a paroxysmal atrio-ventricular block.

Aged↗

PubMed1983

Comparison of short-term efficacy of diltiazem and propranolol in unstable angina at rest--a randomized trial in 70 patients.

The short-term efficacy of diltiazem (D) has been compared to that of propranolol (P), in a group of 70 patients hospitalized in the Coronary Care Unit for unstable angina, defined as recent (less than one month) appearance or aggravation of spontaneous chest pains. Among the 70 patients, 24 had angina only at rest. The patients have been divided into two groups according to ST-T changes during chest pain: 29 with ST elevation (group A) and 41 with other repolarization abnormalities (group B). Treatment was then randomized in each group. Treatment Treatment was considered successful only if spontaneous chest pains disappeared completely. Thirty-four patients were treated with D (282 +/- 102 mg/day) and 36 with P (158 +/- 81 mg/day). In the whole group and in groups A and B considered individually, responses to D and P did not differ. Among the 24 patients with angina exclusively at rest, nine successes and four failures were observed with D. There was no symptomatic relief among the 11 patients treated by P (P = 0.001). Moreover, the number of episodes of angina was decreased by D and unchanged by P, while eight out of the 11 failures with P were immediate successes when treatment was replaced with D. These results suggest that D is preferable to P for management of unstable angina in patients with angina which is exclusively spontaneous.

Adult↗

PubMed1979

Prenatal diagnosis of fetal lymphatic system abnormalities by ultrasound.

Antenatal ultrasound diagnoses of gross lymphatic system abnormalities were made in three fetuses. Although the diagnosis was made in only 1 fetus at a stage early enough in pregnancy to allow selective termination, knowledge of the abnormality in the remaining 2 fetuses proved to be valuable for subsequent management of those pregnancies. It is stressed that the extent of the abnormality must be carefully assessed because of the possibility of corrective surgery should the lesion be small and that the parents must be given detailed counseling before any definitive measures are taken.

Abortion, Therapeutic↗

PubMed1973