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Y Louvard

Publications and source records attributed to Y Louvard.

50 records · Page 3Linked to original sources
PubMed1992

[Early hospital discharge after uncomplicated myocardial infarction: strategies].

Considerable advances have been seen in recent years in the diagnostic and therapeutic management of myocardial infarction. Furthermore, approximately 50% of patients hospitalised for a myocardial infarction have shown no evidence of any complication by the 3rd day of the disease. With this in mind, the authors show that early discharge from hospital at the end of the first week is possible in perfect safety for the majority of these patients, most often treated by thrombolysis, based upon precise knowledge of the severity of arterial disease and of left ventricular function, and the detection of any residual ischemia or possible rhythm disturbances. Only patients with three vessel disease have a higher risk of residual angina and should theoretically be excluded from such programmes. Ambulatory rehabilitation is an essential adjuvant, contributing to a faster return to work and a decrease in health care costs.

Electrocardiography↗
PubMed1992

[Holter monitoring of ventricular arrhythmia during the 24 first hours of myocardial infarction treated with intravenous thrombolysis].

The aim of this study was to assess ventricular arrhythmias after intravenous thrombolysis for acute myocardial infarction and to determine their relationship with coronary artery patency. A 24 hour Holter recording was started 3.1 +/- 0.2 hours after the onset of pain in 40 patients (age 54 +/- 1.6 years, 42.5% anterior infarcts) treated by streptokinase (42.5%) or tissue plasminogen activator (57.5%) within 3.3 +/- 0.2 hours of the beginning of symptoms. The arrhythmias were analysed on a Marquette 8000 computer. Coronary angiography was systematic and was performed 26.7 +/- 2.5 hours (within 4 hours in 60% of patients) after the onset of pain to define coronary artery patency (TIMI 2 and 3: 72.5%) or occlusion (TIMI 0 or 1: 27.5%). Ventricular arrhythmias were common and generally well tolerated (one defibrillation for ventricular fibrillation). Accelerated idioventricular rhythms and ventricular tachycardias were equally prevalent in patients with patent arteries (90% and 83%) as with occluded arteries (82% and 73%). The prevalence of sustained ventricular tachycardias (> 15 complexes) and of early accelerated idioventricular rhythms (< or = 6 hours) was significantly higher in patients with patent coronary arteries: 38% versus 0% (p < 0.05) and 76% versus 18% (p < 0.01). These arrhythmias may be considered to be non-invasive markers of early coronary reperfusion, with a sensitivity of 38 and 76% and a specificity of 100 and 82%. Coronary patency was associated with higher numbers of ventricular extrasystoles, ventricular tachycardias and accelerated idioventricular rhythms by a factor of 14, 13 and 32 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Myocardial reperfusion syndrome].

Myocardial reperfusion is associated with a number of clinical, electrocardiographic (arrhythmias, conduction defects, ST segment changes), haemodynamic and biological events. The commonest arrhythmias are ventricular extra-systoles, rapid ventricular tachycardias, and accelerated idio-ventricular rhythms. Reperfusion bradycardias are less common. When the arrhythmia is related to ischaemia it usually regresses when perfusion is restored. Reperfusion of the inferior wall of the left ventricle is often associated with sinus bradycardia and hypotension. The ST segment changes may evolve in two different ways: progressive regression or accentuation of ST elevation. When the responsible artery is recanalized, there is an immediate rise in plasma enzyme and myoglobin concentrations. The peak CPK concentration is usually observed after the 12th hours. The diagnostic value of the reperfusion syndrome lies in the interpretation of rapid ventricular tachycardias, accelerated idio-ventricular rhythms, ST segment changes and immediate rise in plasma CPK levels. The clinical risks of the reperfusion syndrome are low, practically never rhythmic and only exceptionally haemodynamic.

Arrhythmias, Cardiac↗
PubMed1992

[Large thrombus in the left atrium and rheumatic mitral stenosis. Value of cardiac imaging].

Thromboses in the left atrium, which are a commonplace complication of mitral stenoses with major dilatation of the left atrium lead to a major risk of systemic embolism. It is important to discover them, because they constitute a contraindication to mitral valvuloplasty. The authors report the case of a large left intra-atrial thrombus complicating a pure, tight, mitral stenosis. They also highlight the value of new medical imaging techniques in cardiology: chest CT scan, nuclear magnetic resonance and cardiac scintigraphy. Subsequently, transesophageal cardiac ultrasound, not available in France at the time for this patient, has become the reference method for visualizing and detecting left intra-atrial thrombi.

Aged↗
PubMed1990

French multicenter trial of anistreplase versus heparin in acute myocardial infarction.

Eighty-four patients aged less than 71 years with less than 4-hour duration acute myocardial infarction (AMI) were randomized in a multicenter study to 30 U anistreplase or heparin (single injection of 6500 IU followed by 1000 IU/hr). Early reperfusion was assessed from ECG changes (50% of sum ST decrease 2 hours postdosing) and the CK release profile (CK peak less than 16 hours after onset of symptoms, CK slope greater than 10%/hr). Reperfusion rates in patients meeting at least two criteria of reperfusion were 62.5% on anistreplase versus 27.5% on heparin. On delayed angiogram (13.7 +/- 3.4 days), patency rates were 66% with anistreplase versus 47% (NS) with heparin in 76 patients. Global LVF was similar in both groups. With anistreplase, the mean lowest fibrinogen level was 0.43 +/- 0.55 g/l, plasminogen was 20 +/- 9%, and the highest F.D.P. was 1447 +/- 548 micrograms/ml. All values recovered by hour 48. In-hospital and 1-year follow-up mortality was 7.2% (three patients) with anistreplase versus 10.2% (four patients) with heparin. Bleeding occurred in 9.7% and 5.1% of the patients (NS), respectively. No intracranial hemorrhage occurred. Thus, with combined clinical criteria or reperfusion, anistreplase is twice as efficient as heparin, has a good tolerance, and is easy to use as a single injection.

Anistreplase↗
PubMed1989

[Prehospital thrombolysis. Evaluation of preliminary experiences at Val-de-Marne].

Benefits of thrombolysis have been shown to be greater when therapy is administered early, and this led us to consider the value of starting thrombolytic treatment in the patient's home. However, this implies the transfer of responsibility of patient management from the cardiologist to the physician in charge of the mobile emergency care team. A study was undertaken in the Val-de-Marne department to assess the benefits and risks of this therapeutic approach. The first phase was designed to evaluate the reliability of the emergency care team's diagnosis and the second phase of the study was a randomised double blind prehospital therapeutic trial of a thrombolytic agent, acylated streptokinase (intravenous bolus of 30 units in 4 minutes) against placebo. The nature of prehospital treatment was revealed on hospital admission and thrombolytic therapy was immediately given to those patients allocated to placebo at home providing the admitting cardiologist confirmed the indication. A total of 100 patients were included; 57 were allocated to thrombolytic therapy and 43 to placebo in the prehospital phase. The diagnosis of acute coronary insufficiency was confirmed in all cases and 97 p. 100 of patients had signs of acute myocardial infarction. No complications were attributable to prehospital administration of the thrombolytic. The average time gain in instituting treatment was 60 minutes. At control coronary angiography, 72 p. 100 of the coronary arteries thought to the responsible for the infarct were shown to be patent. The global left ventricular ejection fraction of patients treated with thrombolysis at home was 56.7 p. 100 compared with 53.4 p. 100 in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1988

[Early peak activity of creatine kinase in non-thrombolysed myocardial infarction: prognostic factor?].

The time elapsed between the onset of pain and serum creatine kinase (CK) peak activity is an indirect marker of reperfusion in the thrombolytic treatment of myocardial infarction, and some authors regard this time as a prognostic factor in infarctions not treated with thrombolysis. CK activity was measured in 90 consecutive patients (mean age 66.9 +/- 13.7 years) with acute myocardial infarction (anginal pain + ECG signs + CK greater than 160 3U/l, including 40 p. 100 of CK MB). Measurements began at the time of admission to the intensive care unit and were repeated 6-hourly until CK levels returned to normal. Mean time of CK peak activity was 19.30 +/- 7.15 h after the initial pain (8 to 55 hours prior to admission). This time was not influenced by age, sex, presence or absence of risk factors and history of coronary disease, nor by the anterior or transmural location of the infarct. In contrast, an early arrival at the intensive care unit was associated with an early CK peak: patients who reached the unit within 6 hours or less had a peak at 18.15 +/- 6 h, whereas those who arrived after 6 h had a peak at 22.30 +/- 9.30 h (p less than 0.01). In addition, cases of infarction without Q wave and with an initially elevated ST segment had an earlier peak than the others (16.30 +/- 5.30 h vs 19 +/- 6.45 h in transmural infarctions and vs 24.30 +/- 7.30 h in infarctions with initially depressed ST; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Prehospital administration of anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.

25 patients have been included in a randomised trial aimed to compare prehospital and hospital administration of anisoylated plasminogen streptokinase activator complex (AP-SAC). Patients were first seen, at home, by a noncardiologist doctor working in a mobile-care unit and were then evaluated for entry into the study. If they had evidence of myocardial infarction lasting for less than 3 hours and if there was no contraindication to thrombolytic therapy they were randomly allocated to APSAC 30U or placebo. They were next referred to an intensive coronary unit (ICU). On arrival in the ICU patients were reevaluated and received APSAC if they had previously received placebo. For 24 patients, diagnosis of myocardial infarction was confirmed. One patient died at home after having received placebo. There was 1 hospital death. At-home injection was made within a median of 124 minutes after the beginning of pain, whereas hospital administration was made after a median of 180 minutes. On a clinical basis reperfusion occurred in 16 out of 21 evaluable patients. Four patients had coronary artery bypass graft surgery and 9 had angioplasty. We conclude that prehospital administration of APSAC is feasible, well-tolerated and is a good way to shorten the delay of thrombolytic treatment in myocardial infarction.

Adult↗
PubMed1987

[Impact and significance of early rhythm disorders after fibrinolytic treatment of myocardial infarction].

The study concerns 31 cases of parenteral fibrinolysis performed at the acute stage of myocardial infarction in 30 patients (mean age: 51.9 years), treated less than 4 hours and 15 minutes after the onset of pain. The treatment with streptokinase (80.65%), BRL 26 921 (12.90%) and urokinase (6.45%) was undertaken within a mean time of 3 hours and 17 minutes +/- 53 min. Revascularization defined by the disappearing of pain, the sudden flattening of ST with presence of Q wave, was obtained in 71 p. cent of patients before the 6th hour. The study of the CK curve shows that the enzymatic peak is reached earlier in these patients (13 hours 23 vs 19 h 42). Severe arrhythmias are rare (VF: 0%, transient AVB III: 3.2%). VAIRs were only observed in patients revascularized at an early stage (p 0.02) and in 54.5 p. cent of them. It seems to concern the largest M.Is, treated and revascularized later, regardless of the artery concerned. The syndrome bradycardia-hypotension (Bezold-Jarisch reflex) is only found in patients revascularized at an early stage (22.7 p. cent). Late VES (RR' RR-200 ms or fusion) are more frequent in patients revascularized at an early stage. These three benign rhythm disorders which do not usually require treatment, seem to be good success criteria of fibrinolysis but cannot be considered as predictive indications of myocardial protection.

Adult↗
PubMed1985

[Value of the detection of myoglobin by immunoagglutination in myocardial infarction].

The abnormally elevated quantity of myoglobin present in the plasma of 11 patients suffering of myocardial infarction was demonstrated by a rapid immunoagglutination slide-test. The results of this qualitative test were compared to the myoglobin concentrations measured by radioimmunology. Although the immunoagglutination test is less sensitive than the myoglobin assay, it proved to be very specific. Its rapidity of use, its reliability shown on 121 plasma specimens collected during the myocardial infarction evolution in the patients under study, will enable the clinician to use advantageously the very rapid myoglobinemia taking place in the first hours of infarction. Indeed, we have shown in agreement with the literature that the rise of myoglobin during the first hours of infarction occurs at a much earlier stage than does the increase of creatine kinase activity which was equally assayed during this work.

Agglutination Tests↗
PubMed1984

[Should closed-heart mitral commissurotomies still be performed? Apropos of 168 operations, 108 open-heart and 60 closed-heart].

Mitral commissurotomy is known to give good results but the best surgical technique (open heart or closed heart) remains uncertain. Results of open heart commissurotomy (OC), 108 patients (Group I) and closed heart commissurotomy (CC), 60 patients (Group II) were compared. The population comprised 81% females and the average age was 39 +/- 12 years. Only cases of pure or very predominant mitral stenosis (MS) were included. The preoperative state of the patients in Group I was poorer than the one in Group II (repeat commissurotomy 8.3% compared to 1.7%, p less than 0.04; associated mitral regurgitation 41% compared to 27%, p less than 0.04; cardiothoracic ratio 0.54 +/- 0.07 compared to 0.51 +/- 0.06, p less than 0.01). A more complete surgical cure was possible in Group I. Both commissures were liberated in 99% of OC compared to 25% CC (p less than 0.001). Mitral valvuloplasty was associated in 87% of OC (63 cases on the papillary muscles, 21 cases on the chordae tendinae and 60 cases on the mitral annulus). Operative mortality was low and did not differ significantly between the two groups (zero in CC; 1.8% in OC). Overall survival rates were excellent (95% 5 year survival, 85% 7 year survival). The reoperation rate at 5 years was 7.4% and at 7 years, 23.9%, and did not differ with the surgical technique used. The functional result was good (patients in Class I or II of the NYHA classification 84% at 5 years; 75% at 7 years; identical for both groups). Significant late valvular "dysfunction" was rare after OC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Treatment of unstable angina: early invasive strategy].

Unstable angina is one of the main reasons for admission to a cardiology department and the risk of myocardial infarction is high. Non-Q wave myocardial infarction used to be assimilated to unstable angina. Myocardial infarction without prolonged ST segment elevation and with troponin increase is now the category used to describe this condition. CPK elevation, EKG and clinical parameters are involved in the acute prognosis of patients with unstable coronary syndrome. The FRISC II trial was the first study to demonstrate the superiority of systematic early angiography followed by a revascularization procedure selected according to the type of lesions to be treated, compared with conventional management. The use of stents combined with GPIIb/IIIa inhibitors has increased the safety of PTCA and seems to have a synergetic effect. The superiority of early invasive management using stents and GPIIb/IIIa inhibitors was confirmed by the TACTICS. The risks of bleeding complications associated with this therapeutic strategy are minimized by the TIMI classification. This classification no longer corresponds to the current norms of patient safety and comfort. Several methods can be used in order to decrease the risk of bleeding complications; the radial approach is undoubtedly the most efficient one.

Angina, Unstable↗