[Diagnostic and therapeutic progress. Venous thromboembolism, cardiac insufficiency and radio contrast agents].
MODALITIES FOR THE DIAGNOSIS OF VENOUS THROMBOEMBOLISM: Currently rely on the confrontation of the initial clinical data and the results of D-dimer measurements, a venous Doppler, although reliable, is not a first-line exploration. REGARDING TREATMENT: Indications for thrombolysis are currently limited to massive pulmonary oedema with shock. Alteplase added to heparin improves the progression of severe embolism; it spares the patients from heavy interventions of resuscitation but the mortality remains the same. Concerning anticoagulant treatments, prolonged antivitamin K at classical doses is more effective than low doses and for limited duration if phlebitis is an idiopathic one. FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION: Treatment of these heart failures, formerly know as 'diastolic' is similar to that of the acute phase of systolic heart failure. However, care should be taken with vasodilatators. CONCERNING HEART FAILURE IN GENERAL: The brain natriuretic peptide (BNP) represents a remarkable progress for the aetiological diagnosis of dyspnoea (inferior to 80 pg/ml in the case of pulmonary origin, superior to 300 pg/ml in the case of cardiac origin or severe pulmonary embolism). Regarding treatment, for acute heart failure, it is still the association of nitrates and diuretics, with oxygen therapy and eventually inotropics. Beta-blockers, which have revolutionized the treatment of chronic heart failure, must be maintained whenever possible in the case of the onset of acute pulmonary oedema. Multisite pacing is increasingly used in refractory chronic heart failure. Implantable defibrillation has become common practice. Non-invasive ventilation (Bi or C-PAP) is interesting in acute cardiogenic pulmonary oedema. THE PREVENTIVE ROLE OF N ACETYL-CYSTEINE: N acetyl cysteine reduces the incidence of nephropathies induced by the radio contrast products in patients with chronic kidney failure. Combined with hydratation, it must be proposed the day before and on the day of the procedure in any patient with diabetes or kidney failure.
Genest
Marc
M
Service de cardiologie, CH Provins, Provins. marc.genest@wanadoo.fr
Pochmalicki
Gilbert
G
D000111:Acetylcysteine / Q000627:therapeutic use; D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D015908:Counterpulsation / Q000379:methods / Q000639:trends; D003971:Diastole; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000379:methods / Q000639:trends; D004554:Electric Countershock / Q000379:methods / Q000639:trends; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005440:Fluid Therapy / Q000379:methods / Q000639:trends; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods / Q000639:trends; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010102:Oxygen Inhalation Therapy; D011654:Pulmonary Edema / Q000209:etiology; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D004232:Diuretics; D005338:Fibrin Fibrinogen Degradation Products; D014665:Vasodilator Agents; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain; D006493:Heparin; D010959:Tissue Plasminogen Activator; D000111:Acetylcysteine