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La mort subite d’origine cardiaque est une pathologie à l’origine 50 000 décès soudains annuels en France. Elle atteint aussi bien les sujets âgés porteurs d’une coronaropathie que les sujets jeunes porteurs de cardiopathie structurelle ou non structurelle. Nous rapportons l’observation de deux jeunes patients, porteurs de canalopathies (syndrome de repolarisation précoce et syndrome du QT long), ayant bénéficié de l’implantation d’un défibrillateur sous-cutané en prévention secondaire après une mort subite récupérée.

Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.

Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.

Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

Resume Background La prise en charge du syndrome coronaire aigu avec sus-decalage du segment ST n’a pas ete recemment evaluee. L’objectif de l’etude est d’evaluer leur prise en charge en France en 2014 et de la comparer aux recommandations actuelles. Methodes Cette etude multicentrique s’appuie sur un questionnaire envoye par mail aux angioplasticiens francais. Il evalue les donnees demographiques des coronarographistes, la prise en charge interventionnelle et medicamenteuse et le devenir des patients. Resultats Cent soixante-seize reponses ont ete analysees. La majorite des centres realisaient plus de 600 angioplasties annuelles. En moyenne, 209 infarctus ont ete admis par centre en 2014, plus frequemment en centre hospitalo-universitaire qu’en centre regional ou prive (respectivement 51, 32 et 17 % des infarctus). La thromboaspiration – dont nous discutons l’apport – et les anti-GPIIbIIIa (34 % des cas) n’etaient pas systematiques mais adaptes a chaque patient, conformement aux recommandations. L’abord radial (85 % des cas) et les stents actifs (62 % des cas) etaient privilegies. L’heparine non fractionnee et l’enoxaparine representaient plus de 80 % des traitements anticoagulants. Les taux d’utilisation du clopidogrel, du prasugrel et du ticagrelor etaient comparables. La readaptation cardiovasculaire etait insuffisamment proposee a 50 % des patients. Conclusion Malgre une heterogeneite de prise en charge du syndrome coronaire aigu avec sus-decalage du segment ST, l’ensemble des pratiques s’integre dans les recommandations actuelles. Des efforts pourraient etre faits sur l’utilisation des nouveaux inhibiteurs P2Y12.

Resume But de l’etude Malgre les progres therapeutiques et diagnostiques, l’incidence et la mortalite de l’endocardite infectieuse (EI) n’ont pas diminue au cours des dernieres annees. L’objectif de l’etude est de decrire les caracteristiques epidemiologiques et le pronostic des EI dans un centre non universitaire en les comparant aux donnees actuelles et a celles d’une etude menee dans le meme centre 10 ans auparavant. Patients et methode Une etude retrospective incluant les EI confirmees selon les criteres de Duke modifies entre 2004 et 2014 a ete menee dans un centre non universitaire francais. Resultats Les resultats – notamment le taux de deces intrahospitalier de 16 % – sont superposables aux donnees francaises et internationales. En 10 ans, on constate une augmentation (non significative) des endocardites a Staphylococcus et sur pacemaker . Les EI liees aux soins sont en expansion. En analyse univariee, les facteurs predictifs du deces intrahospitalier sont l’insuffisance renale, l’âge superieur a 77 ans et le Staphylococcus aureus . En analyse multivariee, seules l’insuffisance renale et l’absence de prise en charge chirurgicale sont associees a la mortalite. On note une surmortalite non significative lors des endocardites a S. aureus ou en cas d’insuffisance cardiaque. Conclusion L’EI reste une maladie severe et le Staphylococcus est de plus en plus souvent implique. Cette pathologie semble pouvoir etre prise en charge de maniere sure en centre peripherique s’il existe un partenariat avec un centre de reference.

Interactions between heart and thyroid are strong. Main cardiac complications of Graves' disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement.A 40-year-old man with history of refractory Graves' disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves' disease.Acute myocarditis is an exceptional complication of Graves' disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.

Doping is the use of a substance that artificially increases an individual's physical ability for competition purpose. Products and methods used in doping are not without risk, especially at cardiovascular level. Here we review the most common doping substances in sport and their cardiovascular consequences.

Cardiac allograft vasculopathy is the major determinant of long-term survival in patients after heart transplantation. Clinical presentations are congestive heart failure, ventricular arrhythmias and sudden cardiac death. Acute coronary syndrome is a rare presentation of cardiac allograft vasculopathy due to myocardial denervation. We present the case of a 31-year-old patient, who had undergone heart transplantation 6 months earlier and who developed a painless anterior myocardial infarction revealed by syncope. He was successfully treated by percutaneous coronary intervention with drug eluting stent implantation.

Carbon monoxide poisoning is the leading cause of death by poisoning in France. Neuropsychological symptoms are most common. We report on a patient with acute coronary syndrome and transient left ventricular dysfunction in carbon monoxide poisoning. Patient improved under hyperbaric oxygen therapy. Coronary angiography shows no significant lesion leading to myocardial stunning diagnose. Patients exposed to carbon monoxide must have systematic cardiac evaluation with electrocardiogram and dosage of biomarkers.

Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection.

Real life management of myocardial infarction has not recently been evaluated in France.To describe ST-elevation myocardial infarction management in France in 2014 and to compare it with current guidelines.A multicentre study was performed. An e-mail questionnaire was sent to French interventional cardiologists. Demographic data of interventional cardiologists, procedural aspects of percutaneous coronary intervention, antithrombotic treatments and patient rehabilitation have been investigated.One hundred and seventy-six answers were analysed. Most of centres realized more than 600 annual angioplasties. An average of 209 myocardial infarctions were managed per centre in 2014, more often in academic than in general or private centres (respectively 51, 32 and 17% of infarctions). Anti-GPIIbIIIa (34% of the cases) and thromboaspiration were not systematic but depend on patient's characteristics, according to guidelines. Radial access was favoured in 85% of the cases and increased for the last decade. Drug eluting stents were used in 62% of cases. Unfractionated heparin and enoxaparine accounted for more than 80% of anticoagulants treatments. Overall, use of clopidogrel was as high as that of prasugrel or ticagrelor although clopidogrel is recommended in second-line. Cardiovascular rehabilitation was proposed to more than 50% of patients.In spite of heterogeneity of ST-elevation myocardial infarction management in 2014, real-life practices generally comply with current guidelines.

We report on a patient hospitalized in cardiology department to explore dyspnea and right ventricular failure evoking constrictive pericarditis. This case is of great interest to review conventional and new imaging features used for the diagnosis of constrictive pericarditis versus restrictive cardiomyopathy.

Trichinellosis is a cosmopolitan nematodosis which is rare in the developed countries. Myocarditis represents the most frequent form of cardiac complications, sometimes lethal. The authors report the observation of a 36-years-old patient admitted for trichinellosis, who presented asymptomatic electrocardiographic modifications and a rise in the troponine I. The magnetic resonance imaging (MRI) after gadolinium injection, highlighted an underepicardic late raising rendering the diagnosis of myocarditis highly probable. The paraclinic anomalies were corrected gradually under antiparasitarian treatment. Besides the EKG, the MRI is a non-invasive and repetitive method allowing as well the positive diagnosis as the follow-up of those patients.

Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a severe disease. The aim of the study was to describe clinical features and prognosis of patients with IE in a non-teaching hospital and compare them with current data and a similar study conducted 10 years earlier in the same center.We performed a single institution retrospective study including all patients with Duke-Li definite IE between 2004 and 2014.Ninety-four patients were included. Results are consistent with current French and international data, including in-hospital death rate of 16%. In accordance with literature, we report on an increase in Staphylococcus and health care-associated IE and endocarditis on pacemaker leads, but without significant difference compared to our previous study. In univariate analyses, renal failure, age over 77 years and Staphylococcus aureus IE were associated with in-hospital mortality. In multivariate analyses, predictors of in-hospital death were renal failure and lack of surgery. There was a non-significant trend of excess mortality in Staphylococcus endocarditis and in patients with heart failure.IE remains a severe disease and S. aureus is more often involved. IE seems to be safely managed in a peripheral hospital provided that there is a partnership with a reference hospital.

Cardiac allograft vasculopathy is the major determinant of long-term survival in patients after heart transplantation. Clinical presentations are congestive heart failure, ventricular arrhythmias and sudden cardiac death. Acute coronary syndrome is a rare presentation of cardiac allograft vasculopathy due to myocardial denervation. We present the case of a 31-year-old patient, who had undergone heart transplantation 6 months earlier and who developed a painless anterior myocardial infarction revealed by syncope. He was successfully treated by percutaneous coronary intervention with drug eluting stent implantation.

Resume Nous rapportons, a l'occasion d'une hypothermie profonde, la constatation d'une anomalie de la repolarisation sur l'electrocardiogramme de surface, denommee « onde J », et decrite de facon exhaustive par Osborn, qui y a rattache son nom. Elle correspond au crochetage de la branche terminale du QRS, avec surelevation en dome, le point J est alors sureleve par rapport a la ligne de base. Elle peut egalement se retrouver chez des patients normothermiques dans des circonstances physiologiques ou pathologiques. Son mecanisme physiopathologique est desormais mieux compris, l' « onde J » resultant de la difference de potentiel d'action entre l'epicarde et l'endocarde durant les phases 1 et 2 de la repolarisation ventriculaire. Ce gradient est lie au courant Ito, egalement incrimine dans les « canalopathies », dont le syndrome de Brugada.

We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung's adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high.

Carbon monoxide poisoning is the leading cause of death by poisoning in France. Neuropsychological symptoms are most common. We report on a patient with acute coronary syndrome and transient left ventricular dysfunction in carbon monoxide poisoning. Patient improved under hyperbaric oxygen therapy. Coronary angiography shows no significant lesion leading to myocardial stunning diagnose. Patients exposed to carbon monoxide must have systematic cardiac evaluation with electrocardiogram and dosage of biomarkers.

Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic.We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy.Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence.

We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung's adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high.

We report the case of a 63-year old patient presenting five infective endocarditis (IE) in a 13-years period, with different types of streptococcus. No entrance way had been found until the last relapse occurring on mitro-aortic bioprosthesis. This recurrence leads to the diagnosis of caecal adenocarcinoma by coloscopy, preceded and guided by PET scanner. It seems to be the initial entrance way which had been unrecognized because of its small size and its particular location, that is very difficult to observe by coloscopy. Recurrent streptococcus IE are rare and severe. When a gut or colic tumor is suspected, PET scan seems to be helpful in etiological survey.

We report a 75-year-old woman with a severe and symptomatic valvular tricuspid dysfunction, revealing a carcinoid syndrome, confirmed by an octreotid scan and liver biopsy. Carcinoid heart disease is a common complication of carcinoid syndrome associated with poor prognosis. Despite new pharmacological treatment, valve replacement surgery is the only curative treatment. Early diagnosis and multidisciplinary management could improve prognosis and quality of life of these patients.

Coronary artery (CA) dissection following blunt chest trauma is a life-threatening and rare event. Its occurrence in the setting of a contact sport like rugby is even less common. We report on two cases of young adult presenting with segment elevation myocardial infarction related to CA dissection following rugby game. Both were successfully treated with stent implantation. We discuss the mechanism, diagnosis, and optimal management of blunt chest trauma-induced CA dissection.