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Context In the context of hospitalization for acute heart failure (AHF), patients’ characteristics and outcome depending on the department of management (cardiologic or cardiogeriatric) are unknown. The aims of this study were to determine the profile and the outcome (rehospitalizations at 90 days) of patients hospitalized for HF in the Val de Marne area, a district in the suburbs of Paris, depending on whether they were hospitalized in cardiology or in a specific cardiogeriatric centre; and to analyze the modes and the precipitating factors triggering rehospitalizations in the two type of centre. Methods We conducted the ICREX-94 observatory within seven French cardiologic departments and three specific cardiogeriatric departments in the Val de Marne district, France. Results 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 3 months following discharge, 52 (17%) patients were rehospitalized for AHF. Compared with patients hospitalized in cardiogeriatric centre, patients from cardiologic department were younger (P Conclusion Compared to cardiogeriatric centres, AHF patients discharged from cardiologic centers had clinical differences, but we found that they had the same prognosis regarding AHF rehospitalization at 90 days.

Implantable cardioverter defibrillator (ICD) is well-recognized therapy to prevent sudden cardiac death. Classic ICD need the use of permanent endocavitary leads, which may cause serious troubles (lead dislodgement, ventricular perforation, lead infections, etc.). The subcutaneous implantable cardioverter defibrillator (S-ICD) is a new device provided by only a subcutaneous lead. It has been developed for the last five years and it is becoming at present a real alternative to classic ICD. We report a clinical case of a 34 y.o. woman who presented a sudden cardiac death and who benefited the implantation of this new technology. This paper deals with the potential indications, usefulness benefits, and problems of the S-ICD.

International audience; Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.

Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.

Resume A l’occasion d’une embolie pulmonaire septique, une endocardite tricuspidienne a Staphyloccocus aureus et Serratia marcescens est decouverte chez un ancien toxicomane. Malgreune antibiotherapie systemique adaptee, la persistance d’une vegetation supracentrimetrique et l’aggravation de complications immunologiques renales font pratiquer une chirurgie conservatrice de l’orifice tricuspidien. L’evolution est rapidement favorable et permet la reprise des activites habituelles.

Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.

Implantable cardioverter defibrillator (ICD) is well-recognized therapy to prevent sudden cardiac death. Classic ICD need the use of permanent endocavitary leads, which may cause serious troubles (lead dislodgement, ventricular perforation, lead infections, etc.). The subcutaneous implantable cardioverter defibrillator (S-ICD) is a new device provided by only a subcutaneous lead. It has been developed for the last five years and it is becoming at present a real alternative to classic ICD. We report a clinical case of a 34 y.o. woman who presented a sudden cardiac death and who benefited the implantation of this new technology. This paper deals with the potential indications, usefulness benefits, and problems of the S-ICD.

The association of vasoplegic shock and myocardial infarction in a patient under iloprost treatment for critical ischemia of the lower limbs has not previously been reported.A 56 year-old man suffering from type 2 diabetes, hypertension and dyslipidemia developed critical ischemia of the right leg and was treated with iloprost. On the 19th day of infusion, he developed a vasoplegic shock with myocardial infarction. The shock resolved and he recovered from the infarction.This case report indicates the need for reinforced blood pressure and electrocardiographic monitoring in diabetes patients treated with iloprost.

Cardiovascular disease is the main cause of mortality in chronic alcoholics. There is a clear association between excessive alcohol consumption and the risk of sudden cardiac death. The pro-arrhythmogenic effect of ethanol could be responsible for some of these cases of arrhythmia and sudden death in subjects with an alcoholic cardiomyopathy and also in those with an apparently normal heart. In any case of supraventricular or ventricular arrhythmia in a chronic alcoholic or in an occasional heavy drinker, the potential role of alcohol consumption in the initiation of these disorders should be considered. In all cases, patient management consists of detoxification and abstaining from alcohol consumption, but the withdrawal period is particularly critical as regards the risk of ventricular arrhythmias.

In the light of a new case revealed by a stroke, the authors confirm the importance of transesophagal echocardiography (TEE), and show that multislide computered tomography can be used as a new efficient tool for the diagnosis of cardiac papillary fibroelastoma (CPF). These benign tumours of endocardium are rare and case reports have been published sporadically. Stroke is an usual clinical complication and the most frequent symptom associated with CPF. Transesophageal echocardiography is the reference for diagnosis of CPF when transthoracic echocardiography is normal. When TEE is contraindicated or technically impossible, multislide computered tomography appears as an interesting alternate solution for diagnosis because of its fast acquisition and high spatial resolution. Symptomatology may be connected to either tumoral embolisation or cruoric emboli. Surgery is required for any symptomatic tumour.

Resume Introduction L’association d’un choc vasoplegique et d’un infarctus du myocarde chez un patient traite par iloprost pour ischemie critique des membres inferieurs n’a pas ete rapportee jusqu’alors. Observation Chez un patient âge de 56 ans, diabetique de type 2, hypertendu et dyslipidemique, une ischemie critique du membre inferieur droit a ete traitee par iloprost. Au 19th jour de perfusion, est survenu un etat de choc avec infarctus du myocarde, d’evolution secondairement favorable. Commentaires Cette observation implique un renforcement de la surveillance de la pression arterielle ainsi que de l’electrocardiogramme chez des patients diabetiques traites par iloprost.