EMC - Cardiologie-Angéiologie最新文献

{"title":"Cardiomyopathie hypertrophique","authors":"P. Charron (Maître de conférences des Universités, praticien hospitalier),&nbsp;M. Komajda (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcaa.2005.01.003","DOIUrl":"https://doi.org/10.1016/j.emcaa.2005.01.003","url":null,"abstract":"<div><p>Hypertrophic cardiomyopathy is characterized by an asymmetric hypertrophy of the left ventricle, especially in the interventricular septum. An outflow gradient in the left ventricle is present in twenty-five percent of cases. The disease is usually hereditary and genes responsible for the disease encode for the sarcomere proteins. The natural course is generally favourable but sometimes complications may occur, such as sudden death or congestive heart failure. Treatment remains difficult. If symptoms are not controlled by beta-blockers or verapamil, and if a pressure gradient is present, surgery with myotomy-myectomy may be proposed. Other treatments in such case are dual-chamber pacing or non-surgical septum reduction (alcohol injection). In patients with high-risk of sudden death, amiodarone or implantable cardioverter-defibrillator can be proposed.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2005.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72113137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hémorrhéologie et cardiologie. Concept, physiopathologie, applications aux affections cardiologiques","authors":"M.-R. Boisseau (Professeur)","doi":"10.1016/j.emcaa.2004.12.001","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.12.001","url":null,"abstract":"<div><p>The discovery that the blood and the vessel wall constitute a single organ, i.e., that the content definitely influences the container - which is the main object of the haemorrheology - is attributable to A.L. Copley (1910-1992). Due to driving forces, blood flow organizes itself as concentric layers (laminar flow) shearing over each other. Such a shear stress is stronger at the wall level than in the middle of the vessel, where layers are less distinct. Red cells deform and take the shape of layers, allowing blood to become fluid (low viscosity). In vascular areas with decreased pressure, thus lower shear stress, blood becomes more viscous due to the presence of huge red cell aggregates, in relation to fibrinogen level (thyxotropy, red cell aggregation), changing and decreasing the shearing at the wall level. Such a two-phase behaviour of the shear stress characterizes the blood flow reactivity toward the wall. As viscosity measurement consists of plasma and blood viscosity, time and threshold of erythrocyte aggregation appear more accurate determinants. The shear stress mechanotransduction involves endothelial membrane receptors (caveoli, ion channels, integrins), then MAP-kinases systems, and finally transcription factors able to bind specific areas in gene promoters. Over 10 000 shear-sensitive genes have been identified to date. In arteries the shear stress induces NO, which is vasoactive and inhibits platelets. The shearing power at the wall level or at branching zones is often poor, due to pulsations and picks, where subsequently NO production is low and shear-down-regulated functions can occur, mainly leukocyte adhesion and migration. In veins changes in shear are more frequent, particularly in valvulae. Microcirculation is implemented as functional units, exhibiting a vasoactive precapillary side, capillaries with diameters lower than those of red cells and a post-capillary venous side with low output and much decreased shear stress. Endothelial cells are here very active for leukocyte adhesion, inflammation and haemostasis as well. Atherosclerosis stems from zones where monocytes-macrophages are able to enter the wall, bearing large amounts of lipoproteins, the main plaque constituent. As risk factors increase fibrinogen, high red cell aggregates change the wall shear stress and then LDL-receptors can be activated allowing plaques to grow up and extend along the arterial trunks. The atherosclerosis plaque is submitted to high shear upwardly, that activates platelets, but exhibits a stagnant zone downward, where leucocytes adhere and migrate. Myocardial infarct is due to the rupture of a coronary plaque, but its size is related to the rheological factors (fibrinogen, viscosity). Occlusive arterial disease largely exhibits such rheological disorders, with subsequent actions on ischemia. Hemodilution is proposed during acute events, mainly in stroke. Flow restoration (bypass), prevention of risk factors, venous contention and venoa","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72074866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Troubles cardiovasculaires d'origine thyroïdienne","authors":"Y. Lorcy (Praticien hospitalier) ,&nbsp;M. Klein (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcaa.2005.01.001","DOIUrl":"https://doi.org/10.1016/j.emcaa.2005.01.001","url":null,"abstract":"<div><p>Thyroid hormone directly affects the heart and the peripheral vascular system. It increases myocardial inotropy and heart rate and dilate peripheral arteries to increase cardiac output. Triiodothyronine (T₃) enters the cardiac monocytes, and binds to nuclear T₃ receptors. The complex then binds to thyroid hormone response elements of the genes for several cell constituents and regulates transcription of these genes, including those for Ca ²⁺ -ATPase and phospholamban in the sarcoplasmic reticulum, myosin, β-adrenergic receptors, adenylyl cyclase, guanine-nucleotide– binding proteins, Na⁺/Ca²⁺ exchanger, Na⁺/K⁺ – ATPase, and voltage-gated potassium channels. Non nuclear T₃ actions on ion channels for sodium (Na⁺), potassium (K⁺), and calcium (Ca²⁺) ions represent an alternative way of action for thyroid hormone. Many electrocardiographic abnormalities have been described in hyperthyroidism including sinus tachycardia, atrial and ventricular extrasystoles, atrial fibrillation (AF), atrioventricular block and ventricular repolarisation abnormalities. AF is common in patients with hyperthyroidism, which predisposes to embolic events. Subclinical hyperthyroidism is associated with increased heart rate atrial arrhythmias, increased left ventricular mass impaired ventricular relaxation and reduced exercise performance. Overt hypothyroidism increases of coronary disease, pericardial effusion, systolic hypertension, myocardiopathy and congestive heart failure. Subclinical hypothyroidism is associated with impaired left ventricular diastolic dysfunction at rest, with systolic dysfunction in case of stress; the risk for atherosclerosis and myocardial infarction is increased.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2005.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72113139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communications interventriculaires","authors":"A. Chantepie (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcaa.2005.03.001","DOIUrl":"https://doi.org/10.1016/j.emcaa.2005.03.001","url":null,"abstract":"<div><p>Isolated ventricular septal defect (VSD) is the most common congenital cardiac malformation. VSD is also the most frequent defect associated to others congenital cardiovascular malformations. The numerous anatomic varieties of VSD explain the great variability of the clinical features and the differences in the natural history. With echocardiography and colour Doppler, the diagnosis of VSD is easier and more accurate than previously; so, pre-operative catheterization is no longer needed in most of the cases. The course of VSDs, depending on their size and location, may be early predicted in analysing their anatomic aspect by repeated echocardiography Doppler during the first months of life. Most of them become proportionally smaller with time and, finally, close spontaneously during infancy, childhood or adolescence. Few VSDs need early surgical closure to avoid complications of a large left-to-right shunt, such as cardiac failure and pulmonary hypertension secondary to a severe damage of pulmonary arteries. This management prevents Eisenmenger's syndrome, an irreversible situation corresponding to an inversion of the shunt in relation to high pulmonary vascular resistance. When VSD persists in adults, others complications such as infective endocarditis and aortic regurgitation may occur; therefore, strict surveillance and antibiotic prophylaxis are recommended in concerned patients. Owing to the improvement of cardiac surgery in low weight infants, the surgical closure of large VSD in infancy gives currently excellent results. Apical muscular VSD and multiple muscular VSD still present a particular surgical challenge: today, their closure may be achieved using a ventricular septal device during surgery or interventional catheterization. In this article, only isolated VSDs will be considered. Indeed, VSDs that constitute an integral part of a more complex malformation, such as the “tetralogie de Fallot” or complete atrio-ventricular defect, have a different presentation and require a specific treatment. Persistent VSD after correction of another cardiac malformation (aortic coarctation, transposition of great arteries, etc .) may be assimilated to isolated VSDs because they have usually similar clinical features and outcome.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2005.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72074828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chirurgie des cardiopathies congénitales à l’âge adulte","authors":"E. Belli, R. Roussin, C. Planché, A. Serraf","doi":"10.1016/J.EMCAA.2004.12.002","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2004.12.002","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81010315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artériopathies iatrogènes et toxiques","authors":"P. Cacoub, N. Limal, J. Piette","doi":"10.1016/J.EMCAA.2005.01.002","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2005.01.002","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82989497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hémorrhéologie et cardiologie. Concept, physiopathologie, applications aux affections cardiologiques","authors":"M. Boisseau","doi":"10.1016/J.EMCAA.2004.12.001","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2004.12.001","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81178589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chirurgie des cardiopathies congénitales à l’âge adulte","authors":"E. Belli,&nbsp;R. Roussin,&nbsp;C. Planché,&nbsp;A. Serraf","doi":"10.1016/j.emcaa.2004.12.002","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.12.002","url":null,"abstract":"<div><p>The surgical management of congenital heart diseases in adult patients is characterized by the diversity of the anatomo-clinical situations and the difficulty of the specific surgical techniques. The pre-surgery evaluation is of great importance. The cardiac lesions encountered are often suitable for biventricular repair; however, there are also previously repaired hearts that require new surgical intervention due to the deterioration of the initial result. Encouraging results of surgery are observed, in terms of mortality and quality of life as well.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.12.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72074829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traitement non pharmacologique de l'hypertension artérielle","authors":"J. Blacher, S. Czernichow, P. Iaria, J. Bureau, O. Roux, T. Kondo, B. Tournier, M. Cocaul, I. Moreau, J. Detienne, M. Safar","doi":"10.1016/J.EMCAA.2005.03.002","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2005.03.002","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87976942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traitement non pharmacologique de l'hypertension artérielle","authors":"J. Blacher,&nbsp;S. Czernichow,&nbsp;P. Iaria,&nbsp;J.-M. Bureau,&nbsp;O. Roux,&nbsp;T. Kondo,&nbsp;B. Tournier,&nbsp;M. Cocaul,&nbsp;I. Moreau,&nbsp;J.-P. Detienne,&nbsp;M. Safar","doi":"10.1016/j.emcaa.2005.03.002","DOIUrl":"https://doi.org/10.1016/j.emcaa.2005.03.002","url":null,"abstract":"<div><p>All guidelines on the management of arterial hypertension stress on the lifestyle measures have demonstrated their efficacy on blood pressure reduction. Although their effect on the cardiovascular risk remains hypothetical, they are, or should be, instituted in every hypertensive or pre-hypertensive subject. The five lifestyle measures that are widely agreed as lowering blood pressure are: 1) weight reduction, 2) reduction of excessive alcohol intake, 3) physical exercise, 4) reduction of salt intake and 5) augmentation of fruit and vegetable intakes and reduction of saturated and total fat intakes. It is reasonable to consider that these lifestyle modifications are, at best, additive to pharmacological treatment. As such modifications are difficult to institute and maintain in individuals, health education and public health campaigns should help practitioners in better controlling blood pressure in the general population.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2005.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72074864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}