{"title":"Pathologie athéroscléreuse des troncs supra-aortiques","authors":"C. Laurian, V. Marteau, C. Saliou","doi":"10.1016/J.EMCAA.2005.09.010","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2005.09.010","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"34 1","pages":"426-436"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81806825","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":"Place du dosage des troponines","authors":"J. Bertinchant, A. Polge","doi":"10.1016/J.EMCAA.2004.07.001","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2004.07.001","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"96 1","pages":"317-322"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82420675","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}
Dany-Michel Marcadet (Cardiologue, Attaché en premier des Hôpitaux de Paris, Membre de la Société française de cardiologie, lauréat de la faculté de médecine de Paris, consultant de la fédération française de tennis)
{"title":"Électrocardiogramme d'effort","authors":"Dany-Michel Marcadet (Cardiologue, Attaché en premier des Hôpitaux de Paris, Membre de la Société française de cardiologie, lauréat de la faculté de médecine de Paris, consultant de la fédération française de tennis)","doi":"10.1016/j.emcaa.2004.08.001","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.08.001","url":null,"abstract":"<div><p>Exercise testing is an important diagnostic and prognostic tool in coronary artery disease. After prediction equations and scores have been established, its predictive value has reached those of techniques more sophisticated and far more expensive. Such inexpensive, easy to perform and widely used investigation technique has now many well established indications such as the evaluation of valvular disease, heart failure and arrhythmias. The present article is an update on its utilisation, interpretation, and current indications.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"1 4","pages":"Pages 281-309"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72068684","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":"Hémorhéologie clinique. Concept, physiopathologie et applications aux maladies vasculaires","authors":"M.-R. Boisseau","doi":"10.1016/j.emcaa.2004.08.005","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.08.005","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 hoemorheology - 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 <em>arteries</em> 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 <em>veins</em> changes in shear are more frequent, particularly in valvulae. <em>Microcirculation</em> 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 very decreased shear stress. Endothelial cells are here very active for leukocyte adhesion, inflammation and haemostasis as well. <em>Atherosclerosis</em> 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 <em>occlusive arterial disease</em> largely exhibits such rheological disorders, with subsequent actions on ischemia. The same is observed in <em>diabete</em>s, along with the addition of hyperglycemia picks, viscous HbA1c et glycation of red cells, adding worsened effect on retinopathy. Ischemic <em>cerebral vascular accidents</em> also exhibit high red cell aggregation making prognostic worse, mainly in elderly. Patients with lacunar CVA of Binswanger use to show a strong hyperviscosity. Haemorrhoeological disorder","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"1 4","pages":"Pages 364-381"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72068704","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}
M. Perrin (Chirurgien vasculaire, ancien interne, ancien chef de clinique des Universités, ancien assistant des hôpitaux de Lyon)
{"title":"Insuffisance valvulaire non post-thrombotique du système veineux profond des membres inférieurs","authors":"M. Perrin (Chirurgien vasculaire, ancien interne, ancien chef de clinique des Universités, ancien assistant des hôpitaux de Lyon)","doi":"10.1016/j.emcaa.2004.07.004","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.07.004","url":null,"abstract":"<div><p>Although deep non post-thrombotic venous reflux in the lower limbs has been identified for several decades, it remains poorly recognized as a pathophysiological mechanism responsible for chronic venous disease. Primary deep venous insufficiency which is the most frequently observed type is combined with primary superficial venous insufficiency in about 15% of varicosities, and may be responsible for recurrences after their treatment. In severe cases, in case of conservative treatment failure, surgery, mainly valvuloplasty, must be considered after full investigations including duplex scan, ambulatory venous pressure measurement and phlebography.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"1 4","pages":"Pages 323-330"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72068697","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 de la dépendance tabagique","authors":"G. Lagrue (Professeur honoraire des Universités)","doi":"10.1016/j.emcaa.2004.08.004","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.08.004","url":null,"abstract":"<div><p>Tobacco consumption is one of the major causes of cardiovascular events. Together with hypercholesterolemia and arterial hypertension, smoking is responsible for large artery atherosclerosis, whatever the lesion localization. Therefore, smoking cessation is mandatory in case of any vascular event. In primary and secondary prevention as well, immediate benefit is observed. Despite the existence of such risk and awareness of its seriousness, over 50% of the smokers keep smoking; the reason for such paradox is known: smoking is a behaviour reinforced by an addiction due to the psychoactive properties of nicotine. Addiction is an explanation for all hindrances encountered when fighting tobacco consumption, both at the individual and the general level. For smokers having experienced vascular events, difficulties are important and due to paradoxically insufficient motivation for cessation, to the severity of addiction, and to the frequency of associate anxiousness and depressive disorders. Assistance for smoking cessation is a multiple step procedure that includes: the evaluation and the reinforcement of the basic smoker’s motivation; the implementation of smoking stoppage with prior assessment of the addiction, screening for other psychoactive substances consumption, and detection of anxious and depressive comorbidities; the prevention of relapses, known to be frequent but avoidable with adequate strategies. Only three types of treatment have demonstrated an efficient action: nicotine replacement therapy (patches, chewing gums, …); behavious and cognitive therapies; psychotropic drugs that exert a general activity on the withdrawal syndrome (bupropion), or a specific activity such as the antidepressive agents, particularly the serotonin recapture inhibitors that are utilized in case of anxious and depressive disorders.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"1 4","pages":"Pages 443-455"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.08.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72068678","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":"Échographie de stress et SPECT","authors":"F. Bauer, A. Manrique †","doi":"10.1016/j.emcaa.2004.07.002","DOIUrl":"https://doi.org/10.1016/j.emcaa.2004.07.002","url":null,"abstract":"<div><p>Both stress test echocardiography and myocardial perfusion SPECT are influential in the management of coronary artery disease. Beyond evidence of ischemia, they provide information on reversibility of left ventricular dysfunction due to significant coronary artery stenosis. The stratification of coronary artery disease directly relies on these factors in an ultimate goal to decrease cardiovascular morbidity and mortality in modern countries.</p></div>","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"1 4","pages":"Pages 310-316"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcaa.2004.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72068686","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":"Syncopes chez l’enfant et l’adolescent","authors":"G. Vaksmann, D. Lacroix","doi":"10.1016/J.EMCAA.2004.08.006","DOIUrl":"https://doi.org/10.1016/J.EMCAA.2004.08.006","url":null,"abstract":"","PeriodicalId":100413,"journal":{"name":"EMC - Cardiologie-Angéiologie","volume":"28 1","pages":"358-363"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83617649","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}
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