Prévalence et facteurs prédictifs du syndrome d’apnée obstructive du sommeil au décours de l’infarctus du myocarde

Background

Obstructive sleep apnea has been implicated in the pathogenesis and aggravation of coronary atherosclerosis. However, it remains underdiagnosed in cardiology practice.

Aim

The aim of this study was to determine the prevalence of obstructive sleep apnea and the predictors of severe sleep apnea in patients admitted for ST elevation myocardial infarction.

Methods

This was a prospective study which has included 120 patients hospitalized for ST elevation myocardial infarction, from April 2011 to March 2012. All patients have undergone an overnight sleep study using a portable polygraphy device, in the 15 days following the acute coronary syndrome. The diagnostic of obstructive sleep apnea was considered as apnea–hypopnea index of ≥ 5 events per hour, severe sleep apnea was defined as apnea –hypopnea index of ≥ 30. Subjective daytime sleepiness was assessed by the Epworth sleepiness scale. All patients have had an oxygen saturation monitoring in the coronary care unit using a pulse oxymeter, before undergoing the sleep study.

Results

The study population was made up of 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor found in 72% of all patients, diabetes and hypertension were represented in 40% and 44% of the population, respectively. Eighty-seven percent of patients were admitted in the first 24 hours of symptom onset. A primary percutaneous coronary intervention was performed in 60% of cases while fibrinolysis was done in 10% of patients. The prevalence of obstructive sleep apnea was 79%. Mean apnea–hypopnea index was 15.76 ± 14.93 and severe form was diagnosed in 16% of all patients. Multivariate analysis showed that Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe obstructive sleep apnea.

Conclusion

Prevalence of obstructive sleep apnea was very high in patients admitted for acute myocardial infarction. Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe form of sleep apnea.     

Dysfonction endothéliale : le rôle des bêtabloquants vasodilatateurs dans l’hypertension artérielle et l’insuffisance cardiaque chronique

The beneficial effects of beta blocking drugs in hypertension and heart failure are well known. However, this class of drugs is pharmacologically heterogeneous. In contrast to the non vasodilator betablockers like propranolol, atenolol or metoprolol which, in hypertension do not decrease intima media thinckness both in arterioles and large arteries, do not decrease arterial rigidity and can induce diabetes mellitus, the betablockers with vasodilating properties are beneficial on these parameters. Moreover, in heart failure, they more markedly decrease left ventricular workload than betablockers without any vascular relaxing effect and the results of SENIOR with nebivolol could suggest the beneficial role of NO on left ventricular dysfunction. Finally, the third generation betablockers, represented by celiprolol, carvedilol and nebivolol, have antioxidant properties which are probably implicated in their endothelial protective effects and in their absence of deleterious metabolic effects, effects which are probably of interest in term of protection of target organs during chronic treatment of hypertensive patients.     

Pratique médicale dans la prise en charge de l’hypertension artérielle comme facteur de risque rénal en pratique médicale générale,et en prévention primaire,chez l’enfant en milieu scolaire et la femme enceinte dans la région d’Annaba (Algérie)

Objective

To study medical practice in the management of hypertension as a factor in renal risk in general medical practice and primary prevention in children at school, and pregnant women under prenatal monitoring.

Method

The longitudinal study, observational over a year, focused on medical practice in schools, maternal health and medical practice among 100 physicians (general practitioner and specialist practitioner) in Annaba (Algeria).

Results

In children in schools, measurement of blood pressure is never done on the grounds because this gesture is considered unnecessary in 100% of cases. In pregnant women, the measurement of blood pressure is not performed in more than 26% of pregnant women because it is deemed unnecessary by the midwife in 89% of pregnant women and default material in 11% of they. In current medical practice, 69% of doctors routinely take blood pressure. For the rest, represented mainly by specialists, it is the patient who does not justify. Sixty-two percent of physicians, that is hypertension, above 140/90 mmHg, and 15% of physicians that is hypertension, above 145/95 mmHg. Among the physicians, 58.7% did not use urinary strip, either, because they think that this review should be done in a laboratory (64.8%), or because the urinary strip are not available at even consulting (35.2%).

Conclusion

Inadequacies in the coverage (care) of the HTA are real. Their effects on the progress of prevalence of the renal insufficiency chronic terminal treated are possibly important.     

Apport de l’IRM cardiaque dans l’évaluation initiale et le suivi des myocardites mimant un syndrome coronaire aigu : à propos d’une série de 43 patients

Aims

The diagnosis of acute myocarditis is complex, especially when the clinical presentation mimics an acute coronary syndrome. This condition may promote the progression to dilated cardiomyopathy and the occurrence of severe arrhythmias. A reassessment integrating a cardiac MRI at three months after the acute episode could help identify patients with a poor prognosis.

Patients and results

This prospective series of 43 consecutive patients hospitalised for acute myocarditis included 36 men and seven women, with a mean age of 32 years, with no indication of heart failure. All patients presented elevated levels of troponin I. Echocardiography showed moderate left ventricular dysfunction in six cases and segmental wall motion abnormalities in 22 cases. After gadolinium injection, a subepicardial late enhancement was observed in 39 cases. Three months after the acute episode, all patients were asymptomatic. The echocardiography and laboratory tests were normal. In 23 cases, the MRI showed persistence of the late enhancement without segmental wall motion abnormality. After a mean follow-up of three years, one patient was lost to follow-up and only one suffered a heart failure revealing a dilated cardiomyopathy complicated by ventricular arrhythmias.

Conclusion

On admission, the subepicardial localisation of late enhancement in the cardiac MRI is reliable criteria for the diagnosis of acute myocarditis, enabling to rule out an acute coronary syndrome. During follow-up, the persistence of late enhancement has no impact on prognosis. In this series, after a mean follow-up of three years, it was not associated with clinical or paraclinical abnormalities, except in one patient.     

Traitement chirurgical d’une insuffisance mitrale fonctionnelle aggravée par l’effort avec insuffisance cardiaque à fraction d’éjection préservée : une étude de cas

We here report the case of a 67-year-old woman with moderate mitral regurgitation without significant structural abnormalities that get worse during severe recurrent heart failures and preserved ejection fraction with concomitant paroxysmal atrial fibrillation. Atrial fibrillation became permanent and despite a well-controlled cardiac frequency, new heart failure episodes occurred. Exercise doppler echocardiography showed that the mechanism of this mitral regurgitation was a two leaflet mitral tenting. We discuss here the different mechanisms that could induce these kinds of mitral regurgitation with excessive tenting. We emphasize the interest of early detection by exercise doppler echocardiography even when a triggering factor like atrial fibrillation seems to be involved. We also discuss the interest of mitral valve replacement for these patients.     

Hypertension artérielle du sujet noir âgé de 50 ans et plus a Lomé : aspects épidémiologiques et évaluation du risque cardiovasculaire (Étude prospective et longitudinale de 1485 patients)

Introduction

High blood pressure is public health problems whose assumption of responsibility especially remains difficult at the old subject. Generally it is associated with the other cardiovascular risk factors. We assigned for objectives to determine the prevalence of High blood pressure in the old subject in specialized milieu and to evaluate the cardiovascular risk among these patients.

Methodology

It is about a longitudinal exploratory study undertaken on 1485 hypertensive of 50 years old and more, selected among 1999 patients received in three health professional trainings of the commune of Lomé, of June 1, 2004 to June 30, 2007. Information had been collected using a card of investigation. Classifications of high blood pressure were those of the JVCVII and the European Society of Cardiology. The data analysis had been made by computer tools.

Results

The prevalence high blood pressure was of 74.29%. We had noted a female prevalence (63.8%) with a sex ratio of 0,57 and one middle age of 62.08 ± 9.3 years. Dyspnea (45.9%), chest pains (16.2%) and palpitations (13.2%) were the principal found symptoms. The various listed risk factors were: the dyslipidemy (58.1%), obesity (36.12%), alcoholism (16.7%) and the diabetes (10.6%). The complications were of order cardiac (87.81%), eyepieces (79.8%), renal (19.86%), neurological (4.92%) and arterial (0.99%). The cardiovascular risk was very high at 58.05% of the patients. The rate of lethality was of 1.9%.

Conclusion

High blood pressure is the cardiovascular risk factor most frequent in our country as from 50 years. Its assumption of responsibility passes by information, the education of the population and requires the mobilization of all the social components.     

Infarctus du myocarde secondaire à l’occlusion aiguë simultanée des portions proximales de la circonflexe et de la coronaire droite : à propos d’un cas

Acute myocardial infarction due to simultaneous occlusion of two major coronary arteries is a rare phenomenon. We report a case of a 53-year-old man with many cardiovascular risk factors, who presented to the emergency with an acute coronary syndrome with ST segment elevation in anterior and inferior leads, complicated by atrioventricular block and cardiogenic shock. The coronary angiogram showed proximal occlusion of left circumflex artery and right coronary artery. Both arteries were treated successfully with thrombectomy followed by coronary stent implantation. Some similar cases have been reported, but the exact physiopathological mechanism is unknown. There is no clear strategy established for the therapeutic coverage, however, percutaneous revascularisation seems to be actually appropriated treatment.     

Aspects cliniques et étiologiques des uvéites : étude rétrospective de 121 patients adressés à un centre tertiaire d’ophtalmologie

Purpose

Uveitis consists of a large group of diseases characterized by intraocular inflammation involving the uveal tract. This heterogeneity makes the diagnosis and the treatment of uveitis frequently challenging. The purpose of this study was to describe the various clinical and etiologic aspects of uveitis, through the new standardized uveitis classification and the use of modern investigations for its diagnostic work-up.

Methods

The medical records of 121 new patients with uveitis referred to our tertiary ophthalmologic centre between January 2002 and December 2006 were retrospectively reviewed. Uveitis associated to human immunodeficience virus and secondary to exogenous endophthalmitis were excluded. All patients had a complete ophthalmological examination and appropriate clinical and paraclinical examination. The diagnosis was established according to the recent international criteria.

Results

One hundred and twenty-one patients were included. The four main etiologies were: toxoplasmosis (14%), sarcoidosis (11.6%), spondylarthritis or HLA B27-associated uveitis (13.2%) and Herpes virus infections (9.1%) that represented almost half of the uveitis causes (47.9%). Various diseases constituted the remaining causes of the uveitis (20.9%). Uveitis remained unexplained in the remaining 36 patients (29.7%). Overall, associated systemic diseases were diagnosed in 35.5% of our uveitis patients (34 patients), associated infectious conditions in 26.4% (32 patients) and specific ocular diseases in 8.3% (12 patients).

Conclusion

Despite a limited number of patients, our study showed an etiologic distribution similar to that of the main series reported in the literature. Nevertheless, we observed an elevated frequency of sarcoidosis and systemic diseases, which emphasizes a management that takes into account standardized clinical and paraclinical criteria and the usefulness of a collaboration with the internist.     

L’imagerie du nerf et du muscle dans les atteintes nerveuses périphériques associée à l’électroneuromyographie : le couple idéal ?

Electroneuromyography (ENMG) is the gold standard tool in evaluating peripheral neuropathies, and it is essential to the diagnosis and the location of the involvement, as well as the assessment of the severity and the prognosis of the lesion. However, it has also limitations. It is highly examiner dependant and because it is unpleasant, the assessment of some nerves and muscles is limited. The evaluation of proximal nerve and deep muscles is difficult to perform. Magnetic resonance imaging and echography represent a fast growing field in demyelinating and motor neuropathy assessment, while these imaging procedures are now well validated in myopathies. In this article, we discuss sensitivity, specificity and prognostic data brought up by these new imaging tools compared to ENMG and the significant future prospects they offer.