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Biomedical subjects

H Douard

Publications and source records attributed to H Douard.

At least 19 recordsLinked to original sources
PubMed2006

[Exercise test in athletes].

The particularities of exercise tests in athletes concern mainly the exertion protocols adapted to their increased physical capacities and the interpretation of ECG tracing which can sometimes be very special at rest and also misleading during exercise. In the great majority of cases, the test used is both cardiac and pulmonary, in order to assess the aerobic capacities, the maximal aerobic power, and the determination of ventilation thresholds (programming and follow-up of training...). More infrequently, the test is used to detect cardiovascular diseases, especially during a longitudinal follow-up of high-level athletes, or to exclude it in case of cardiovascular symptoms, atypical resting ECG or even in case of suspicion of disease (arrhythmia, cardiac chamber hypertrophy or dilation at echocardiography). In more aged sportsmen (athletes masters), exercise tests performed are usually required for screening coronary heart disease. In this case the test protocols should be more adapted for screening than for the assessment of sportive capacities.

Electrocardiography↗
PubMed2005

[Survey of cardiovascular risk assessment and the behaviour of a sporting population].

In order to better understand the risk factors and behaviour of a general sports population, a questionnaire was handed to 603 consecutive sportsmen of various disciplines during a specific sports medicine consultation and a half-marathon. Among the discovered risk factors, smoking was the most common (19.3% for the entire study population), predominantly in the youngest group (26%). A resting ECG had been performed very frequently within the previous year in those over 40 years (86.5%), but less often in the younger sportsmen (44.8%). An exercise test had also very often been performed in those aged over 40 years (69.2 vs 10.6%). Behaviour associated with cardiovascular risk was common. Undertaking physical activity while febrile (58%) and smoking just before or after exertion (13.1%) were widespread behaviours. This population appeared casual in its approach to possibly suspicious cardiac symptoms of exercise, particularly the females and paradoxically the subjects doing the most sport. Lastly, only a minority of sportsmen knew the telephone number for the emergency medical service (45%) or claimed to be competent at first aid (32%). This survey underlines a practice relatively in accordance with the recommendations for detecting cardiovascular pathology, but shows a failure of preventive education.

Adult↗
PubMed2003

[Unusual cause of myocardial infarction].

The authors report the case of a woman with an acute myocardial infarction in whom coronary angiography performed a few hours earlier was completely normal. Transoesophageal echocardiography showed two thrombi in the left atrial appendage confirming the thromboembolic mechanism of this infarct.

Aged↗
PubMed2002

[Bi-ventricular synchronous pacing and heart failure].

After initial trials of conventional DDD pacing in dilated cardiomyopathies, the concept of multisite stimulation was introduced in 1994. This new indication of heart failure treatment is based on the correction of myocardial contraction and relaxation asynchronies. European pilot studies including few patients were followed by two multicenters randomized trials (MUSTIC and MIRACLE) that confirmed a significant improvement of functional capacity, quality of life and hemodynamic status. Intraventricular delay and QRS duration shortening seems to be the best predictor of clinical success. Patients with more depressed functional and hemodynamic status seems to benefit most from this therapeutic approach. Two studies (CARE HF and COMPANION) are still conducted which will provide further insight into the effectiveness in terms of prognosis of cardiac resynchronisation therapy in this patient population.

Heart Failure↗
PubMed2001

[Exercise tolerance tests in athletes, then what?].

Exercise tolerance tests in athletes are usually performed to evaluate aerobic exertion capacity and to plan training. They are based on simultaneous measurement of expired gases (determination of ventilation threshold and of VO2max). They can also be used to seek a possible cardiovascular anomaly, particularly in case of clinical symptoms or anomalies on auscultation; findings based on electrocardiography (rhythm, repolarisation, etc.) and on blood pressure readings, however, can lead to suspicion of an early anomaly and direct complementary investigation.

Blood Gas Analysis↗
PubMed2001

[Prognosis and risk evaluation of postoperative coronary patients (PERISCOP). Methodology and study population characteristics].

The aim of the PERISCOP study was to evaluate the predictive value of cardiological investigations performed after recent coronary bypass surgery with regards to cardiac event and mortality at one year. The treatment of lipid abnormalities was also analysed. This first article describes the methodology and patient characteristics at inclusion. This prospective national multicenter trial included 2065 patients (86% men) with an average age of 63.1 +/- 9.9 years. The number of diseased vessels was 2.6 +/- 0.6. Preoperative left ventricular function was normal (ejection fraction 60 +/- 13%). Revascularisation was complete in 73% of cases (22% of arterial grafts). The cardiological investigations were performed at Day 20 +/- 10 after surgery. The duration of exercise on stress testing was 429 +/- 170 seconds. It was positive or doubtful in 9% of cases. Ventricular arrhythmias were observed in 6.5% of cases. The blood pressure response was abnormal in 6% of cases. Holter monitoring showed a median number of ventricular extrasystoles over 24 hours of 44. Three per cent of patients had one episode of ventricular tachycardia and 7% had ischaemic episodes. The echocardiographic index of segmental contractility was on average 1.75 (ejection fraction: 52.6%). The lipid analysis performed at one month, under lipid therapy in 34% of cases, showed a total cholesterol level at 1.91 +/- 0.10 g/l, an LDL-cholesterol of 1.27 +/- 0.08 g/l. The therapeutic target (LDL-cholesterol < 1 g/l) was attained in 46% of cases with treatment and in 18% of cases without treatment.

Aged↗
PubMed2000

Comparative effects of bisoprolol and nitrendipine on exercise capacity in hypertensive patients with regular physical activity.

The aim of this study was to evaluate the long-term effects of administering bisoprolol compared with nitrendipine on the duration of the exercise tolerated by male and female patients, aged 18-65 years, having mild to moderate hypertension and taking regular exercise. In this double-blind, randomized prospective study, 96 patients (85 men and 11 women, 48+/-10 years) formed two groups: 49 in the bisoprolol group, and 47 in the nitrendipine group. After a washout period of 14 days, either 10 mg of bisoprolol or 20 mg of nitrendipine was given daily over a treatment period of 12 weeks. During the treatment period, the stability of the physical training was monitored weekly by using a questionnaire. The results of two maximal triangular exercise tolerance tests (ETTs) on an ergometric bicycle performed at D0 under placebo and at D84 under active treatment were compared. No statistical difference was observed between both groups, concerning age, gender, morphologic characteristics, resting cardiovascular parameters, or physical training. Both groups maintained the same training level throughout the study. No significant differences between the groups were noted for duration of ETT [D0 892+/-284 s, D84, 919+/-267 s (NS) vs. D0 929+/-290 s, D84 904+/-324 s (NS)], or maximal work load [D0 190+/-49 W, D84 197+/-48 W (NS) vs. D0 198+/-49 W, D84 196+/-55 W (NS)]. On the other hand, both groups differed in maximal systolic blood pressure [D0 239+/-24 mm Hg, D84 215+/-22 mm Hg (p<0.001) vs. D0 237+/-24 mm Hg, D84 222+/-27 mm Hg (p<0.05)] (p = 0.05), and maximal pulse rate during exercise [141+/-18 vs. 163+/-17] (p<0.001), albeit not in maximal diastolic blood pressure [D0 113+/-13 mm Hg, D84 106+/-17 mm Hg (p<0.05) vs. D0 112+/-13 mm Hg, D84 104+/-15 mm Hg (p<0.05)]. The patient's own perception of the maximal effort (Borg scale) was not significantly different in either of the groups (placebo vs. treatment). Overall, in a population of hypertensive patients taking regular exercise, long-term treatment with bisoprolol produced no significant changes in the duration of peak effort, maximal workload, or the effort perceived by the patients themselves. The effects of regular exercise were comparable in both groups (bisoprolol or nitrendipine). Because previous studies have shown that dihydropyridines do not modify exercise performance in hypertensive patients, it may be concluded that the antihypertensive therapy with bisoprolol is well tolerated in a population of active hypertensive patients during dynamic exercise.

Adolescent↗
PubMed2000

[Prognostic evaluation of silent ischemia during exercise in patient with recent infarction. Italian multicenter study. SMISS Group].

AIM: The aim of the Multicenter Silent Ischemia Study (SMISS), co-ordinated by the Italian Working Group on Cardiac Rehabilitation, was to evaluate prospectively, the prognostic significance of silent myocardial ischemia during exercise testing in patients with proven ischemic cardiac disease. METHODS: Over a period of six months 4389 consecutive patients performing a maximal symptom-limited exercise testing, after drug withdrawal, were enrolled in the 73 ergometric laboratories. All patients were followed up after 12 months, at which time electrocardiogram, examination and clinical history were reassessed. Here we report the results of 1111 patients group with the recent myocardial infarction (inferior 3 months). The follow-up was completed in 1031 (93%) patients. RESULTS: The results of exercise testing were normal in 666 (64.6%) patients; angina alone in 33 (3.2%) patients; silent ischemia in 234 (22.7%) patients; symptomatic ischemia in 98 (9.5%) patients. In 270 patients (26.1%) new events occurred: angina (19.7%); myocardial infarction (3.1%; PTCA (4%); CABG (6%); cardiac death (1.4%). The total events were more common in the patients with exercise induced angina (48.5%) and in those who had exercise induced-symptomatic ischemia (48%), in respect of patients with silent ischemia (29.5%) and of those who had normal testing (20.7%) (p = 0.0001). Myocardial infarction rate was higher in patients with symptomatic ischemia (7.1%) that for those of all other groups (silent ischemia: 1.3%, angina: 3%, normal 3.2%) (p = 0.05). Moreover, the patients with symptomatic ischemia had higher incidence of CABG (p = 0.0001). The mortality rate was low among all patients and did not show differences among the groups. Only among the 31 patients (3%) with blood pressure fall was mortality higher that in patients with a normal blood pressure increase. By multivariate logistic analysis the angina induced by exercise maintained its prognostic significance for all the events, but also other variables were significant: poor exercise tolerance and, between clinical variables angina before myocardial infarction. CONCLUSION: The results showed, in patients who underwent to exercise testing after drug withdrawal, a low incidence of cardiac death and of myocardial infarction on 12 month follow-up; the patients with induced-exercise symptomatic schema had a greater risk for all cardiac events, except for death.

Aged↗
PubMed1999

Irregular ventricular stimulation in the DDI mode of a dual chamber pacemaker with atrial-based lower rate timing.

This report describes two patients with atrial fibrillation in whom an implanted CHORUS DDD pacemaker programmed to the DDI mode produced an irregular ventricular stimulation rate. The lower rate timing of these devices is atrial-based only when an atrial event opens an AV interval shorter than the programmed AV delay. In the DDI mode, if Api represents the time when an atrial paced event (Ap) would have occurred if it had not been inhibited by a previous atrial sensed event (As), then Api-Vp constitutes the implied AV interval where Vp is a paced ventricular event. Although the As-Vp interval (As-Api + Api-Vp) generates an atrial refractory period during its entire duration, the pacemaker can sense an atrial event (AR) during the implied AV interval. AR cannot start another AV delay, but it can initiate the atrial-based lower rate interval. This timing mechanism can cause irregular prolongation of Vp-Vp intervals to a value longer than the programmed lower interval with a maximal extension equal to the programmed AV delay. Such behavior of the CHORUS pacemaker should not be interpreted as malfunction.

Atrial Fibrillation↗
PubMed1999

[Third degree atrio-ventricular block induced by interferon alpha. Report of a case].

Iatrogenic third degree atrioventricular block due to alpha interferon is rare. The authors present a case which occurred with low dosage, regressed when treatment was withdrawn and reappeared when treatment was reintroduced. The physiopathological mechanism of disease of the conduction pathways and its general cardiotoxicity is not yet understood. The secondary effects of this increasingly widely used anti-tumoral and anti-infectious drug should be recognised in order to prevent them. Initial cardiological investigation and follow-up are indicated to ensure this prevention.

Cardiomyopathies↗
PubMed1999

[Significance of exercise induced ST elevation in patient without a history of previous myocardial infarct].

UNLABELLED: Between 1980 and 1995, we observed twenty-five patients (22 males, 3 females) at the mean age of 50.6 +/- 13 years, without previous myocardial infarction who presented exercise induced ST elevation on a bicycle stress test. METHODS: Significant ST elevation was defined as a > or = 1 mm change present in > or = 1 lead measured 0.08 sec after the J point and in 3 consecutive beats. All patients have undergone coronary angiography in the days following the exercise test. RESULTS: Most of patients (56%) presented a history of typical angina that was either purely exertional (8 pts) or also occurred at rest (6 pts). Others (36%) had non typical angina or no angina (8%); 78% of pts were smokers. Sixteen patients (group I) had ST elevation during exercise (exercise duration: 7.6 +/- 4 min; peak heart rate: 135.5 +/- 29 batt/min; ST = 3.5 +/- 1.5 mm) and nine (group II) during the recovery phase (exercise duration 16.3 +/- 1.6 min; p < 0.05; peak heart rate 168 +/- 22 batt/min; p < 0.05; ST: 5.8 +/- 3 mm; p < 0.05). In group I, 1 patient had no vessel disease, 12 had one vessel disease, 3 had multivessel disease with 6 cases of hypersevere coronary stenose (> 90%). In group II, 4 patients had normal coronary arteries, there was one vessel coronary artery disease in 4 patients and multivessel in one subject, without hypersevere coronary stenosis. Correlation between anatomic location of stenosis and electrocardiographic ST elevation was excellent, particularly in case of single vessel disease (100%). All patients underwent one or more new exercise tests after therapeutic intervention (surgery n = 3; angioplasty n = 7; medical treatment n = 15), only 2 patients had persistent exercise induced ST elevation. During follow-up (5 +/- 3 years), 3 patients died (2 cardiac deaths) and 3 had recurrent angina controlled by new treatment. CONCLUSION: Exercise-induced ST elevation is a rare phenomenon in patients without prior myocardial infarction. When occurring purely during exercise, coronary lesions are frequent and often servere, in the other hand ST elevation of the recovery phase is frequently associate with normal arteries or less severe lesions. In most cases, revascularisation or medical therapy can abolish clinical and electrocardiographic abnormalities.

Adult↗
PubMed1999

[The heart and sexual activity].

There has been considerable media attention surrounding the commercialisation of Sildenafil. The advice of cardiologists is often solicited before its prescription because of its potential side effects; the cardiovascular stress due to sexual activity is generally modest, both in normal subjects and coronary patients with, however, important individual variations, the "legitimate" nature of the intercourse seeming to be one of the principal factors. Recent coronary events, poorly controlled hypertension and uncompensated cardiac failure are the main contra-indications; the prescription should be based on the results of maximal exercise stress testing in patients at risk.

Adolescent↗
PubMed1998

Endocardial biventricular pacing.

Simultaneous right and left ventricular pacing was performed in a 73-year-old man with coronary artery disease end-stage congestive heart failure and a DDD pacemaker implanted for sick sinus syndrome. An endocardial LV lead was introduced transseptally after unsuccessful attempts to enter the coronary sinus. This new approach for multisite pacing offers an alternative to epicardial LV from the coronary sinus or by thoracotomy.

Aged↗
PubMed1998

[Study of the cardiorespiratory response and chronotropic function after correction of tetralogy of Fallot. Important role of residual pulmonary regurgitation].

Effort tolerance is reduced after correction of Tetralogy of Fallot. This prospective study investigated the cardiorespiratory response and the chronotropic function (mean follow-up 11.1 years) of 70 patients (43 boys and 27 girls) with an average age of 14.9 +/- 7.2 years (group 1) compared with 65 normal, sedentary subjects paired red for age and gender (group 2). All underwent exercise testing (Bruce protocol) with measurement of respiratory gases. Quantification of pulmonary regurgitation was performed by Doppler echocardiography. The chronotropic response to exercise was assessed by calculating the mean of slopes established by chronotropic metabolic relationship of Wilkoff. The cardiorespiratory response to exercise was abnormal in group 1: the duration of exercise (11.3 vs 13.6 min; p = 0.005), peak VO2 (35.5 vs 46 ml/min/kg; p < 0.001) and anareobic threshold (8.3 vs 9.2 min; p = 0.001) were decreased. Maximal heart rate (172 vs 190bpm; p < 0.001) and the mean of the metabolic-chronotropic slopes (0.68 vs 0.83; p < 0.001) were decreased in the patient group, showing abnormal chronotropic response to exercise. The latter seemed to be related to the severity of pulmonary regurgitation. The duration of exercise (10.6 vs 11.5 min; p = 0.001), peak VO2 (33 vs 37 ml/min/kg; p < 0.001), maximal heart rate (161 vs 177 bpm; p = 0.002) and the mean of the slopes of the metabolic-chronotropic relationship (0.59 vs 0.72; p < 0.001) were decreased in patients with moderate to severe pulmonary regurgitation. This study shows that significant pulmonary regurgitation is responsible for a poor cardiorespiratory response to exercise and for an abnormal chronotropic response which seems to be multifactorial but probably related to an adaptation favouring left ventricular filling during exercise.

Adolescent↗