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R Haiat

Publications and source records attributed to R Haiat.

At least 19 recordsLinked to original sources
PubMed2003

[The value of repeated determinations of brain natriuretic peptide for the diagnosis of unstable angina].

The diagnosis of unstable angina (troponine undetectable) is often difficult in the absence of electrocardiographic changes after suggestive chest pains. The object of this study was to analyse the kinetics of Brain Natiuretic Peptide (BNP) during acute coronary syndromes (ACS) without ST elevation. Plasma BNP was measured every 6 hours for 48 hours in 65 patients admitted for suspicion of ACS without ST elevation and without clinical, radiological or echocardiographic signs of left ventricular dysfunction. The results of BNP measurements were masked until the final diagnosis was established on the usual investigations (ECG changes, troponine I values, myocardial scintigraphy, coronary angiography). These investigations identified 3 groups of patients: non-Q wave infarction (group A: 19 patients), unstable angina (group B: 21 patients) and non-coronary chest pain (group C: 25 patients). The peak BNP was significantly higher in groups A (210 +/- 172 pg/ml) and B (152 +/- 159 pg/ml) than in group C (16 +/- 14 pg/ml). However, the BNP was normal or only slightly increased (< 50 pg/ml) in 25% of cases of ACS. Analysis of the kinetics of BNP was much more discriminating: early increase after the pain, peak between the 14th and 24th hours (19th hour on average), followed by a progressive decrease. The kinetics were identical in Groups A and B, contrasting with the flat profile of the curve in group C. A change of > 20 pg/ml in BNP was a better criterion of ACS with a diagnostic accuracy > 90% than increased troponine (group A) or undetectable troponine (group B). The authors conclude that BNP kinetics is a new and reliable diagnostic marker of unstable angina when the usual criteria of ACS are not present (notably a normal ECG and undetectable troponine).

Aged↗
PubMed1997

[Kearns-Sayre syndrome. A rare indication for prophylactic cardiac pacing].

The authors report a case of Kearns-Sayre syndrome, a rare mitochondrial myopathy, diagnosed in a 19 year old man. Distal conduction defects are constant findings and are a dominant factor in the prognosis of this condition. Their early appearance and rapid progression pose the problem of prophylactic cardiac pacing despite the young age. In the case report, pacing was decided at the age of 23 in the absence of symptoms but with bifascicular block (right bundle branch block and left anterior hemiblock), without electrophysiological investigation. During follow-up, left bundle branch block was observed 3 years later and permanent complete atrioventricular block occurred 7 years after pacemaker implantation.

Adult↗
PubMed1992

[Negativity of the exercise thallium test despite tight stenosis of the common trunk of the left coronary artery].

The authors report a case of severe angina linked to subocclusive ostial stenosis of the common trunk of the left coronary, characterised by the contrast between a very positive stress test on the basis of clinical and electrocardiographic parameters and a negative Thallium stress test. The occasion is taken to review the sensitivity of Thallium stress testing in lesions of the common trunk.

Constriction, Pathologic↗
PubMed1991

[Unstable angina and infarction without Q wave treated with verapamil: value of the early exercise test].

Twenty patients aged 56.8 +/- 10 years, hospitalised for unstable angina (12 cases) or infarct without Q wave (8 cases) were treated with IV heparin, aspirin and oral verapamil. The clinical syndrome was controlled by verapamil in 16 cases out of 20 (80% of cases) at the dosage of 360 mg/d in 14 patients and of 480 mg/d in two. An exercise ECG, limited by symptoms, was obtained in 18 patients (90%) between the 8th and 12th day. Coronary arteriography was considered to be indicated in three sets of circumstances: recurrence of angina resistant to nitroglycerin, positive exercise ECG with verapamil, persisting despite triple therapy or strongly positive exercise ECG (total duration less than or equal to 6 minutes). An infarct complicated the early course in 4 patients (20%): twice following angioplasty, once following exercise ECG (spastic angina) and once during triple therapy (refractory angina). Hospital and mid-term (18 +/- 6 months) mortality was nil. With verapamil, the absence of recurrence of angina together with a negative exercise ECG enabled the identification of a large group of patients (40%) with a low risk of a subsequent major accident and in whom early and routine coronary arteriography is probably not indispensable.

Adult↗
PubMed1991

[Embolic retinitis in Haemophilus parainfluenzae endocarditis].

Infectious embolic retinopathy occurring secondary to a bacterial endocarditis is described in a 38-year-old woman with known aortic disease. The infectious organism was a haemophilus parainfluenzae confirmed by serial blood cultures and characterized by an embolic power equal to fungal infection. After four-weeks period of appropriate and intensive antibiotic therapy, blood cultures became negative but new emboli were observed in the fundus. This report describes ocular lesions rarely observed in endogenous bacterial retinitis. The delay between the bacterial endocarditis and the occurrence of the retinitis emphasizes the need for a long-term follow-up. Ophthalmologic examination can be acline for changing the heart valve.

Adult↗
PubMed1990

[What patients with cardiac insufficiency should know and why?].

The diagnosis of cardiac failure carries practical and psychological consequences which may require the patient to change his way of life. In addition to compliance to therapy which is the basis of clinical stability, the patient must understand a number of realities: violent physical exercise may be forbidden but regular daily physical exercise is to be recommended (with intermittent rest periods) as it increases the patient's comfort, although a beneficial effect on the prognosis has not yet been demonstrated. In addition, a reduced salt intake should be recommended although strict restrictions are no longer necessary with the ready availability of diuretics; the patient should also be taught to titrate his diuretic therapy with respect to alimentary intake and daily weight changes. Finally, instructions should be given about intercurrent conditions (infection, paroxysmal arrhythmias, hypertensive crises) which may decompensate stable patients and lead to a relapse of congestive heart failure. The patient and his family must know how and whom to contact immediately in case of an emergency.

Diet↗
PubMed1989

[Drug-induced major anomalies of ventricular repolarization masked by a left branch block].

The presence of a left bundle branch block (LBBB) may hamper the electrocardiographic diagnosis of diseases that involve the QRS complexes. That it may conceal, or even completely erase, major abnormalities of ventricular repolarization induced by certain drugs is not so well known. In this paper, two highly demonstrative examples of such abnormalities observed with bepridil (case 1) or with the amiodarone-aprindine combination (case 2) are reported. In both cases, the intermittent character of the LBBB revealed the phenomenon which deserves to be known as it is not without practical consequences: in patients under treatments likely to modify repolarization and induce severe dysrhythmias (notably torsades de pointes) the presence of a LBBB indicates that the QT and/or QU intervals must be very carefully measured. In case of phase 3 LBBB compression of the carotid sinus or intravenous ATP injection helps the diagnosis since in the presence of even moderately prolonged ventricular cycles such manoeuvres create a refinement of QRS complexes which then demonstrate the major alteration of the underlying repolarization.

Aged↗
PubMed1988

The influence of molsidomine on infarct size: an acute post-infarction pilot study with 303 patients.

In a multicenter, randomized and double-blind study, the efficiency of molsidomine on infarct size has been examined in 303 patients suffering from a first myocardial infarction and compared with a placebo. According to previous enzyme studies, and in order to detect a 20% reduction infarct size with conventional levels of risk, alpha = 0.05 and beta = 0.20, the recommended sample size was 264 patients. Thirty-three patients initially selected were excluded for protocol violation and, among the 270 patients definitively included, 133 were allocated to molsidomine and 137 to placebo, without any difference concerning age, delay of treatment, infarct location, and initial blood pressure. Test drugs were both initiated within the 6 first hours and administered orally at decreasing doses for 10 days: 16 mg on the first day, 12 mg on the second day, and 6 mg daily from the third to the tenth days. There was not a significant difference between the molsidomine and placebo groups regarding the enzyme evaluation of infarct size, neither for CK dosage (101.72 +/- 74.76 gram equivalents vs. 92.71 +/- 65.91 gram equivalents, NS) nor for its MB fraction (67.34 +/- 50.07 gram equivalents vs. 63.50 +/- 43.01 gram equivalents, NS). Moreover, changes in the Q- or R-wave sum during the 10 days of follow-up were strictly identical. However, in-hospital mortality was lower in the molsidomine group than in the placebo group (4.5% vs. 8.0%), but this reduction was not statistically significant. During the study, there were few side effects, mainly headaches, without withdrawal of the treatment.

Acute Disease↗
PubMed1987

Torsade de pointes during loading with amiodarone.

Torsade de pointes represents a potential complication of chronic amiodarone therapy. Several reports have emphasized the need for a loading dose in order to achieve therapeutic blood levels rapidly. We report a case of torsade de pointes following a single oral dose of amiodarone (1400 mg or 30 mg kg-1) administered after short intravenous loading for prevention of paroxysmal atrial flutter. Torsades de pointes were preceded and associated with marked QT prolongation and bradycardia. This report suggests that careful monitoring of patients undergoing oral amiodarone loading is necessary.

Administration, Oral↗
PubMed1987

[Auricular fibrillation: a cause of reversible myocardiopathy].

A chronic supraventricular tachycardia may alone be responsible for a picture of severe congestive cardiac insufficiency, which is totally reversible after return to a sinus rhythm. The two cases reported here emphasize this particular fact, the physiopathology of which still remains unknown. There is also a prognostic advantage to such cases: in the presence of a congestive cardiopathy with atrial fibrillation, apparently idiopathic, it is important to try to obtain a sinus rhythm and to study from a distance the left ventricular performance indexes which may return to normal after regularization of the rhythm.

Atrial Fibrillation↗
PubMed1986

[Left coronaro-ventricular microfistulas. Apropos of 25 cases].

A retrospective study of 25 patients with left coronaroventricular microfistulae, investigated in the same vascular radiologic exploration unit, and data in the international literature were used to analyze these lesions in greater detail. Their frequency appears to have been underestimated since they represented 1.33% of coronarographies performed in adults in this series. Distribution into two groups as a function of presence or absence of significant coronary lesions, vascular disease or myocardial insufficiency showed that the group with isolated microfistulae was composed solely of women of about 50 years of age (16 cases). These patients presented typical angina with a simple course (absence of infarction), but a sometimes severe disability due to the symptomatology. The myocardial ischemia could result from a "coronary steal" phenomenon but other hypotheses have been evoked. Their congenital origin is widely accepted but their relation to atherosclerosis has not been established (cause, consequence or fortuitous association). They present specific images on routine coronarography. Treatment is symptomatic but surgical in exceptional cases with refractory, very disabling angina. Finally, detection of left coronaroventricular microfistulae should, when combined with metabolic studies, allow classification of the difficult problem of "angina with angiographically normal coronary arteries".

Aged↗
PubMed1985

[Intravenous cibenzoline in the treatment of ventricular and supraventricular arrhythmias].

The efficacy of intravenous cibenzoline in the treatment of supraventricular and ventricular arrhythmias was demonstrated in a French trial of 212 patients including 40 in the acute phase of myocardial infarction. The minimal therapeutic plasma concentration was about 0.3 microgram/ml: this was obtained by a loading dose of 1 mg/kg relayed by a perfusion of 8 mg/kg/24 hours. The clinical tolerance was satisfactory in 96.2% of cases when the contra-indications were respected (severe cardiac failure, intraventricular conduction defects and non-paced 2nd and 3rd degree atrioventricular block). Local tolerance was excellent in all cases.

Anti-Arrhythmia Agents↗
PubMed1985

[Splenic abscess disclosing endocarditis].

A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.

Abscess↗
PubMed1985

[Transmural myocardial infarction. An impossible electrocardiographic diagnosis].

The anatomical and experimental data clearly show that transmural myocardial infarction does not always produce a pathological Q wave on the ECG, but may sometimes only cause abnormalities of the ST segment and the T wave. Conversely, a sub-endocardial myocardial infarction may present with pathological Q waves. Schematically, the histology of transmural myocardial infarction usually reveals so-called coagulation necrosis, while sub-endocardial myocardial infarction generally corresponds to myofibrillary degeneration (contraction band necrosis), which promotes a reperfusion process. Very often, however, the histological appearance is not so clear-cut and the features tend to overlap. Consequently, in practice, it does not seem justified to use the electrocardiogram as a basis to distinguish between transmural and sub-endocardial infarctions, in terms of prognosis, or to select possible candidates for coronary angiography following a first myocardial infarction.

Diagnosis, Differential↗
PubMed1984

Silent pericardial effusion in late pregnancy: a new entity.

Of 123 healthy pregnant women examined systematically by M-mode and two-dimensional echocardiography at various stages of gestation, 46 were in their late pregnancy (32nd-38th week) of whom 19 (41.3%) showed unexpected signs of pericardial effusion on the echocardiogram. Following Horowitz's criteria, the effusion was large in 2, moderate in 4, and small in 13 cases; in all women the condition was clinically silent. Clinical examination was normal in all but 3 women, in whom high blood pressure returned to normal after delivery. The ECG was usually normal (16 of 19 cases) or showed nonspecific ST-T changes. The entity appeared in late pregnancy (not before the 32nd week), was transient, and no longer could be seen within a month after delivery of a normal child. Cause of the effusion was attributed to excessive water and salt retention in those women with an abnormal echocardiogram who at this late stage of gestation had a mean weight gain significantly higher (P less than 0.03) than in others (13.60 +/- 4.28 vs 10.96 +/- 3.7 kg) - an observation not reported before in normal pregnancy. Since pericardial effusion cannot be detected by clinical examination or ECG, echocardiography affords a safe and reliable diagnostic approach.

Adult↗
PubMed1983

[Long-term prognosis of resuscitation after cardiocirculatory arrest in coronary disease patients].

In France alone, coronary diseases are responsible for about 30 000 sudden deaths each year. In 60 to 90% of the cases cardiac arrest (CA) is due to ventricular fibrillation. The overall survival rate after CA is 66-92% at 1 year and 67-87% at 2 years. The long-term prognosis is more favourable when CA occurs during a recent infarction. Frequent, polymorphous, paired or consecutive ventricular extrasystoles, three-vessel coronary lesions, an ejection fraction lower than 0.30 and repetitive ventricular response to electrophysiological stimulation indicate severe myocardial damage and suggest that CA might recur. The preventive treatment of recurrent CA has not yet been fully established. Beta-blockers should probably be used widely, but the protective effect of other anti-arrhythmic agents is more questionable. Coronary artery bypass reduces mortality in patients who survive CA but has not been proven to lower the recurrence rate.

Coronary Disease↗