PubMed Health⌕ Search

Biomedical subjects

R Haïat

Publications and source records attributed to R Haïat.

At least 37 records · Page 2Linked 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↗
PubMed1992

[Evaluation of treatments with beta-blockaders after myocardial infarction].

Beta-blockers have been used after myocardial infarction since 1965: however, it was not until the beginning of the 80s that the large multicentre clinical trials published results showing clearly their beneficial effects and leading to their widespread usage: betablockers significantly reduce the medium term (1 to 3 years) risk of death (-22 to -24%), especially sudden death (-32%) and the frequency of recurrent infarction (-27%). The cardio-protection so obtained is multifactorial, essentially related to their antiarrhythmic, antiischemic and antihypertensive effects. It has been established that beta-blockade should be instituted as soon as possible in the hours following the infarct (intravenous relayed by oral administration) and may be useful associated with aspirin. Although the large scale clinical trials did not determine the optimal dosage or the duration for which treatment should be administered, they did show that the groups of high risk patients were those to benefit the most from this therapy. Beta-blockers are usually well tolerated. However, it must be pointed out that 18% of patients were excluded from the two principal trials (only 25 to 30% of infarct patients were included) because of contraindications to beta-blockers and that 25 to 30% of the patients initially included had to interrupt the treatment because of side effects.

Adrenergic beta-Antagonists↗
PubMed1992

[Electrocardiogram during the initial period of myocardial infarction: a tool of therapeutic decision].

The electrocardiogram (ECG) remains the basic investigation for the diagnosis of acute myocardial infarction. The decision to institute intravenous thrombolytic therapy, which has revolutionised the treatment of myocardial infarction in recent years, requires the presence of ST segment elevation and a suggestive clinical history. Early Q waves and reciprocal ST changes may be helpful. The value of thrombolytic therapy has not been demonstrated in patients without ST elevation, especially considering the usually favourable prognosis of infarcts with normal ECGs or with only non-specific repolarisation changes. The initial ECG provides information about infarct size which is an essential prognostic factor. This evaluation is based on the topography (anterior or inferior), the amplitude of ST elevation and the number of leads in which these changes are observed. The initial analysis has two objectives: to evaluate the risk/benefit ratio of treatment in cases of relative contraindications to thrombolysis or with a doubtful diagnosis; to select high risk patients (extensive infarcts) who may benefit from "salvage angioplasty" in the event of failure of thrombolysis: coronary angiography should be programmed from the onset as the ECG outcome does not allow prediction of the results of thrombolysis for the majority of these patients.

Decision Support Techniques↗
PubMed1991

[Heparin in the treatment and secondary prevention of myocardial infarction. A critical review of the main trials].

The aim of this article is to assess the therapeutic value of standard heparin in the acute phase and secondary prevention of myocardial infarction. Only clinical trials with an adequate methodology have been analysed. In patients having undergone thrombolytic therapy associated with aspirin, heparin slightly reduces the mortality but only during the period of its administration. In a metaanalysis of approximately twenty clinical trials of patients not receiving thrombolytic or aspirin therapy, heparin was associated with a significant reduction of deep vein thrombosis, pulmonary embolism, recurrent myocardial infarction and cerebrovascular accidents. In the context of secondary prevention of myocardial infarction, the administration of a moderate dose of subcutaneous heparin resulted in a beneficial effect on morbidity and mortality in one published trial. The use of low molecular weight heparins for the prevention of coronary thrombosis merits attention because of the pharmacological and pharmacokinetic properties of these products.

Cerebrovascular Disorders↗
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↗
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↗
PubMed1984

[Electrocardiographic study of left ventricular performance in normal pregnancy].

This study was undertaken to determine the changes of left ventricular function during normal pregnancy. Fifteen women aged 23 to 36 years old were studied by M mode and 2D echocardiography at 3, 6 and 9 months and during the post partum period (30 days). The M mode recordings were analysed on an ID.01 computer. The principal parameters rose significantly from the 3rd to the 9th month, and then fell during the post partum period: heart rate, 73 +/- 5 to 80 +/- 9 and then to 70 +/- 8 beats/min: LV end diastolic parameter 46 +/- 2 to 49 +/- 3 mm: LV end diastolic volume 102 +/- 16 to 120 +/- 30 and then 102 +/- 22 cm3; stroke volume: 72 +/- 15 to 87 +/- 25 and then to 70 +/- 16 ml; cardiac output: 5.6 +/- 1.2 to 7.1 +/- 2.3 and then to 5.0 +/- 1.4 l/min; cardiac index: 3.5 +/- 0.7 to 4.1 +/- 1.3 and then to 3.0 +/- 0.8 l/min/m2; LV mass: 69 +/- 14 to 91 +/- 39 and then to 82 +/- 27 g; the ratio of mass/volume also increased from 0.97 +/- 0.14 to 1.10 +/- 0.5. On the other hand, the following parameters did not change significantly: LV end systolic diameter: 30 +/- 3 to 31 +/- 3 and then to 30 +/- 4 mm; ejection fraction: 0.70 +/- 0.72 and then to 0.68; LV fractional shortening: 34 +/- 5 to 36 +/- 5 and then 33 +/- 6; velocity of circumferential fibre shortening: 1.2 +/- 0.2 to 1.2 +/- 0.1 and then 1.1 +/- 0.2 circ/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Asymptomatic severe stenosis of the left main coronary artery].

Severe stenosis (greater than 70%) of the main stem of the left coronary artery may rarely be asymptomatic. This particular clinical presentation, which has recently been highlighted, is probably commoner than had previously been thought. Though usually a chance finding, its presence should be suspected when exercise stress tests are strongly positive at low work loads; confirmed at coronary angiography, asymptomatic stenosis of the left main coronary artery is no different from symptomatic stenoses with regard to the extent and severity of the coronary lesions; they do differ, however, in that left ventricular function is preserved and may remain normal over a long period. This has therapeutic implications in that systematic surgery of first intention may not be mandatory in these cases.

Angiography↗
PubMed1983

[Echocardiographic detection of asymptomatic pericardial effusion during normal pregnancy].

A series of 123 healthy pregnant women (average age: 28 years) was studied by M mode and 2D echocardiography to evaluate the hemodynamic changes due to pregnancy. Latent and asymptomatic pericardial effusion was detected in 19 of the 46 patients in the last stages of pregnancy (32nd to 38th week). The effusion was slight in 13 cases, moderate in 4 cases and voluminous in 2 cases. This was a transient finding, occurring at the end of pregnancy (never before the 32nd week) and regressing totally in the two months post partum. The pregnancy ran its natural course in all 19 patients. None had any specific past medical history or clinical signs of toxemia. Cardiovascular examination was normal in all cases with no signs of pericardial friction rub or of heart failure. However, the blood pressure was raised in 3 of the 19 patients. The ECG was normal in 16 of the 19 cases; non-specific ST-T wave changes were observed in 3 cases. Pericardial effusion was probably related to salt and water retention which often occurs at the end of pregnancy: at this stage the average weight gain was significantly higher (p less than 0,03) in the 19 patients with pericardial effusion than in the 27 patients without (13,6 +/- 4,3 kg compared to 10,9 +/- 3,7 kg). Therefore, pericardial effusion of variable volume but always asymptomatic and latent was observed in 40,1 p. 100 of patients at the end of pregnancy on echocardiographic examination. This previously undocumented finding requires further study to determine the underlying physiopathological mechanism and its exact significance.

Adult↗
PubMed1983

[Septal rupture in elderly patients. Apropos of 2 cases treated surgically in the acute phase of myocardial infarction].

Two cases of interventricular septal rupture (VSR) in elderly patients (71 and 74 years) occurring at the 5th and 12th day of primary postero-inferior myocardial infarction, were reported. The diagnosis was made at 2D echocardiography and confirmed at catheterisation with coronary angiography. Good surgical results were obtained after operation 72 and 12 hours after VSR (9th and 12th infarct days, respectively): the first patient had a good outcome with a 2 year follow-up, but the second patient died in the 55th postoperative day, of renal failure. The authors underline the value of 2D echo in the management of acute myocardial infarction and in the detection of VSR. In addition, the advances in intensive care and surgical techniques allow early and complete cure of cardiac lesions with a low hospital mortality and significant functional improvement, even in the elderly patient.

Aged↗
PubMed1982

[Evaluation of the cardiovascular risk associated with atherosclerosis: HDL-cholesterol or apoproteins? (author's transl)].

The antiatherogenic role of HDL-cholesterol is now well established and for some years plasma HDL-cholesterol measurements have been used in the biochemical evaluation of atherosclerosis. A positive correlation has been found between low HDL-cholesterol plasma levels and high risk of cardiovascular complications. More recently, studies of the proteinic component of lipoproteins, particularly apoprotein A 1 of HDL lipoproteins and apoprotein B of LDL and VLDL lipoproteins, have shown that measurement of apoproteins is of greater help to differentiate between normal subjects and patients with coronary artery disease, irrespective of age.

Apolipoprotein A-I↗