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Until recently, the recommendations of infective endocarditis were based on expert opinions, due to its low incidence and the absence of controlled trials. The update in 2015 of the new guidelines of the European Society of Cardiology (compared with 2009) relates to the publication of a randomised study on the surgical treatment, the innovations in imaging procedures (especially functional imaging in nuclear medicine) and the new concept of «Team Endocarditis» (multidisciplinary approach). Their aim is to remind the limitations of antibiotic prophylaxis and to insist on hospital hygiene measures. Future challenges will be to obtain a better understanding of the mechanisms associated with the contamination of the valve and to optimize the adaptation of the current epidemiological prophylaxis. In this first part, we will describe the preventive and diagnostic approaches of infective endocarditis.

Acromegaly is a disease characterized by chronic growth hormone hypersecretion. Cardiovascular complications represent the main cause of death. We present here a rare case of dilated cardiomyopathy whose diagnosis revealed an acromegaly. This will provide the opportunity to review an uncommon disease and its recently reassessed prevalence.

Inadvertent insertion of a defibrillation lead in the left ventricle is a rare complication generally underdiagnosed after device implantation. Management is not strictly codified due to the small number of observed cases. We report the case of a 78 year-old man in whom the diagnosis has been performed lately during an echocardiography.

Documented ventricular tachyarrhythmias or related symptoms need meticulous cardiac investigations. The mechanism of ventricular arrhythmia must be defined. The prognosis is related to underlying cardiac electrical or structural disorders. In the absence of cardiovascular abnormalities, the prognosis is good. No disqualification to competitive activity is required in most cases. Assessment of the risk of sudden death remains a continuing challenge in athletes. This article reviews the diagnostic and therapeutic approaches of ventricular arrhythmias encountered in trained athletes.

Tachycardia-mediated cardiomyopathy is a form of dilated cardiomyopathy and heart failure induced by a persistent/chronic supraventricular or ventricular tachyarythmia. The incidence and the patho-physiology remain unspecified. Sometimes related to a previous cardiomyopathy, the diagnosis is always retrospective, but important because of the clinical and the significant haemodynamic improvement following the control of heart rate.

The congenital long QT syndrome (LQTS) is a hereditary cardiac disease characterized by a prolongation of the QT interval > 440 ms at rest ECG associated with a high risk of ventricular arrhythmias (torsade de pointe). Clinical manifestations are syncope and sudden cardiac death. The implicated genes encode cardiac ion channel subunits or proteins involved in modulating ionic currents. The diagnosis of LQTS can be complex in borderline cases. Etiology, pathogenesis, diagnosis and treatment are discussed.

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized clinical trials are particularly scarce. Two sets of guidelines exist: one in the USA and the other in Europe. However, they are not always consistent due to the lack of randomized data and it appears that, frequently, there is a gap between the existing guidelines and their effective application.

Adherence to the rules for antithrombotic ment in atrial fibrillation patients significantly reduces the risk of stroke. We review the criteria for the use of anti-vitamin K as well as its daily management in patients with atrial fibrillation.

Chronic heart failure is a growing public health problem with a bad prognosis. Despite the seriousness of this syndrome and the well defined therapeutic approach, adherence to guidelines remains poor. After briefly recalling the main points of these guidelines, we present statistical data regarding therapeutic care of these patients. We then present factors influencing prescription or non prescription of heart failure drugs and emphasize the importance of a team management programme and patients pathways.

Hypertrophic cardiomyopathy is of genetic origin, characterized by asymmetric left ventricular hypertrophy and variable clinical presentation. The physiopathology includes diastolic dysfunction and, in one third of the patients, dynamic left ventricular outflow tract obstruction. Patients are at increased risk of sudden death. Risk stratification in the individual patient is an essential component of management. This article describes the clinical presentation of a patient and his mother and summarizes essential features of the disease and the current recommendations for the prevention of sudden cardiac death.

Antiplatelet therapy is the leading therapy for the primary and secondary prevention for the atherosclerotic arterial disease. The practical question of withdraw alavoiding or continuation of oral antiplatelet agents accurs currently before any invasive procedure. It is important to compare the relative thrombotic vs hemorrhagic risk. For most interventions, it is recommended to continue antiplatelet therapy. It is particularly important in patients who benefited from drug-eluting stents where the thrombotic risk is major.

Patients after a myocardial infarction are at increased risk of adverse cardiovascular outcomes. They require aggressive secondary preventive measures to control cardiovascular risk factors, and prescription of some pharmacological agents. Compelling data derived from randomized controlled trials have shown the benefits of aspirin (or clopidogrel), statins, beta-blockers and angiotensin-converting enzyme inhibitors, in preventing recurrent events and improving survival. In some cases oral anticoagulants or fibrates may be necessary. Other agents as antioxidant vitamins, folate and B vitamins are disappointing. Lifestyle and dietary modifications can also have an important beneficial effect on mortality rates and should never be neglected.

Diabetic patients frequently develop heart failure and have a guarded prognosis because of the combination of diabetic cardiomyopathy, hypertension and ischaemic heart disease. The lack of patient awareness of the association between diabetes and cardiovascular disease contributes to the risk of heart failure in the diabetic population. Therefore, physicians should consider the risk of comorbidities and use appropriate screening tests to achieve early identification and initiate preventive strategies. There is evidence suggesting that adequate glycaemic control may improve cardiac metabolism and myocardial function in diabetics with heart failure. Improvement in cardiac function engendered by neurohumoral inhibition is associated with a decrease in mortality that is at least as great in the diabetic patients with heart failure as it is in the non diabetic patients. However, several therapeutic interventions have not yet been specifically validated in diabetic subjects. Thus, physicians should be encouraged to use therapies tested in the diabetic population, such as B-blockers and ACE inhibitors. Diabetic patients would benefit from more aggressive preventive programs aimed at reducing the incidence of cardiovascular morbidity and mortality.

The effect of calcium antagonist on clinical outcome is controversial. A recent study investigated the safety and efficacy of the calcium antagonist nifedipine GITS (gastro-intestinal therapeutic system) in patients with stable, but symptomatic coronary disease. ACTION randomised 7.665 patients to double-blind addition of nifedipine 60 mg once daily or placebo during a mean follow-up of 4.9 years. Most patients were already treated by a beta-blocker, a statine, or aspirine. The addition of nifedipine was well tolerated with a low incidence of side effects. With nifedipine, the development of heart failure was reduced by 29 %. There was also a reduction in the need for coronary angiography and bypass grafting (reduction of 18 and 21%, respectively). The primary efficacy and safety outcomes were not different between nifedipine GITS and placebo. The rate of total mortality and cardiovascular death were not significantly different. The addition of nifedipine GITS to convential treatment of stable angina is safe, has no effect on major cardiovascular event free survival, but reduces the need for coronary angiography and interventions.

Despite many studies, cardiac reinnervation after heart transplantation is not yet fully understood. This article reviews the physiology of the transplanted heart and briefly describes the imaging techniques and functional tests which allow demonstration of cardiac reinnervation. The data reported on this subject in the literature are summarized and the remainin uncertainties are underlined.

Paroxysmal supraventricular tachycardias are often encountered in young and otherwise healthy patients. They are rarely life threatening even though they may alter the quality of life. In this article, we review the acute treatment of an episod of tachycardia and the prevention of recurrences.

Paroxysmal atrial fibrillation is one of the most common disorders of cardiac rhythm. It is often a step toward permanent arhythmia, specially if associated with cardiac disease. The management objectives of intermittent arhythmia may be different, as maintenance of sinus rhythm. However, risks of stroke and thrombo-embolism are similar to those for sustained atrial fibrillation and must be carefully assessed. In this article we review the epidemiology, pathophysiology, clinical aspects and current guidelines for treatment and management of paroxysmal atrial fibrillation.

Tachycardias arise from an arrhythmogenic substrate triggered by a random factor (generally an extrasystole) and modulated by the autonomic nervous system. The three components are interactive, but their intensity and conjunction vary continuously. During the last decade, major achievements have been made to clarify definition and classification of data reported in the literature, helping our understanding of the mechanisms of ventricular arrhythmias. Nowadays, the pathophysiology of cardiac arrhythmias is well-known at the cellular and molecular ion channel activity. The progress of epidemiology and molecular genetics have allowed a better knowledge of the genotype-phenotype correlation in young patients presenting syncopes due to torsades de pointes or polymorphic ventricular tachychardia episodes which may degenerate into ventricular fibrillation and cause sudden death. The data of numerous large prospective randomised studies have led to more rational treatments with the progressive withdrawal of class I antiarrhythmics and their replacement by betablocking agents. The surgical approach of ventricular tachycardia has been overcome by the automatic implantable defibrillator and in some well-defined clinical situations, catheter ablation is used.

Cardiac transplantation is the treatment of choice for refractory heart failure. An immunosuppressive therapy must be given in the perioperative course to avoid graft rejection. In this article, we review the main classes of immunosuppressive agents (calcineurin inhibitors, anti-metabolities, corticoïds) and their side effects. The general preventive measures and the different kinds of rejection (hyperacute, acute vascular, acute cellular and chronical) are discussed. The current bacterial, protozoarian, mycotic and viral infections are described. We finish with the risk of cancer, mainly skin tumours and non-Hodgkinian lymphomas.

The aging of the cardiovascular system leads to an increased incidence of hypertension, coronary artery disease and ischemic stroke. Since cardiovascular disease is the leading cause of morbidity and mortality in patients > or = 70 years old, prevention seems crucial for improving quality of life and reducing medical costs. In this article we present some aspects of cardiovascular prevention in elderly patients.

Acute myocardial infarction (AMI) is a serious condition which requires rapid hospital management. In this article, we review the current recommendations concerning AMI treatment, as well as our therapeutic approach, which is based on the evidence provided by several large well controlled clinical trials. Mid and long term prognosis are mainly related to the development of left ventricular dysfunction which determines heart failure, the occurrence of severe ventricular arrhythmias and the persistence of residual myocardial ischemia. Several treatments (aspirin, beta-blockade, ACE inhibitors, statins) have shown their benefit in terms of secondary prevention.