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Abstract
RÉSUMÉ
Introduction. L’insuffisance cardiaque se définit par l’incapacité du cœur à assurer un débit suffisant pour répondre aux besoins métaboliques des organes. Le but est d’étudier le mode d’utilisation des inotropes positifs dans le traitement de l’insuffisance cardiaque aigu en état de choc. Matériels et Méthode. L’étude s’est déroulée dans le service de cardiologie du CHU-ME, sur une période allant du 1er janvier 2019 au 30 juin 2021. Il s’est agi d’une étude transversale, descriptive et prospective, portant sur les patients admis dans le service pour insuffisance cardiaque en état de choc, traités par inotropes positifs. Résultats.: Nous avons inclus 80 patients. L’âge moyen a été de 61,19±16,76. Le sex-ratio était de 1,22. La sédentarité et l’HTA ont été les facteurs de risque les plus retrouvées avec respectivement : 86,25% et 61.25%. La dyspnée stade III-IV suivie de la douleur thoracique ont été les motifs de consultation dans respectivement 86,25% et 82.5% des cas. L’insuffisance cardiaque globale a été retenue dans 85% des cas. La dobutamine a été administrée dans 98,75% des cas, la dopamine dans 25% des cas et la digoxine dans 59% des cas. Dans 56,25% des cas, la symptomatologie a régressé et 32,5% de cas de décès ont été enregistrés. Conclusion. Le syndrome d’insuffisance cardiaque aiguë avec débit cardiaque abaissé est greffé d’une forte mortalité et l’utilisation des inotropes positifs permet de subjuguer cet état à court terme. Une prise en charge précoce et adaptée permet de réduire la mortalité imputable à ce syndrome.
ABSTRACT
Introduction. Heart failure is the inability of the heart to provide sufficient flow to meet the metabolic needs of organs. The aim is to study the use of positive inotropes in the treatment of acute heart failure in shock. Materials and Method. The study took place in the cardiology department of the CHU-ME, over a period from January 1, 2019 to June 30, 2021. It was a cross-sectional, descriptive and prospective study of patients admitted to the ward for cardiac failure in shock, treated with positive inotropes. Results. Sedentary lifestyle and hypertension were the most common risk factors with respectively: 86.25% and 61.25%. Dyspnea stage III-IV followed by chest pain were the reasons for consultation in respectively 86.25% and 82.5% of cases. Overall heart failure was retained in 85% of cases. Dobutamine was administered in 98.75% of cases, dopamine in 25% of cases and digoxin in 59% of cases. In 56.25% of cases, symptomatology decreased and 32.5% of cases of death were recorded. Conclusion. Acute heart failure syndrome with lowered cardiac output is associated with high mortality, and the use of positives inotropics makes it possible to subjugate this condition in the short term. Early and appropriate treatment can reduce mortality from this syndrome.
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References
- Saudubray T, Saudubray C, Viboud C. Prévalence et prise en charge de l’insuffisance cardiaque en France : enquête nationale des médecins généralistes du réseau Sentinelle, Rev Med Interne 2005 :845-50.
- Diallo B, Sanogo K, Diakite S, Diarra MB, Toure MK. L’insuffisance Cardiaque au service de cardiologie du CHU du Point G. Bamako: Mali Médical 2004 ; 19(2) :15-17.
- Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ, for the ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure. Classification and regression tree analysis JAMA 2005;293:572-80.
- Zannad F, Mebazaa A, Jullière Y et al. For the EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA Study. Eur J Heart Fail 2006.
- Swan HJ, Forrester JS, Diamond G, et al. Hemodynamic spectrum of myocardial infarction and cardiogenic shock. A conceptual model. Circulation 1972;45: 1097-110.
- Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med 1999;131:47-59.
- Hochman JS, Sleeper LA, White HD, et al. One year survival following early revascularization for cardiogenic shock. JAMA 2001;285:190-2.
- Pirracchio R, Parenica J, Resche Rigon M, Chevret S, Spinar J, Jarkovsky J, et al. The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis. PLoS One 2013;8(8):1—10.
- Nieminem MS, Bohm M, Couvie MR et al.Task Force on acute heart failure of the European Society of Cardiology. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J 2005;26: 384-416.
- Touré K. Insuffisance cardiaque aigue au service de cardiologie du CHU-PG. Memo Cardio FMOS 2016; 57 : 87.
- Diallo B, Sanogo K, Diakité S, Diarra M.B, Touré M.K. L’insuffisance cardiaque à l’hôpital du Point-G. Mali Méd 2004; 19 (2) : 17.
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- Damasceno A, Bongani M. The causes, treatment, and outcome of acute heart failure in 1006 africans from 9 countries. Arch intern med 2012 ; 172 (18) : 1386-1394.
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- Prasart A, Kriengkrai H , Rungsrit K. Thai acute decompensated heart failure registry (Thai ADHERE) ; CVD prevention and control 2010 ; 5 : 89– 95.
- Simon Stewart, David Wilkinson et all. Predominance of heart failure in the feart of soweto study cohort emerging challenges for urban african communities. Circulation 2008; 118 : 2360-2367.
- Adams Jr KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005 ;149 :209–16.
- B. Sountoura. Aspects épidémio-clinique, thérapeutique et évolutif de l’insuffisance cardiaque aigue au service de cardiologie du CHU Pr Bocar Sidy SALL de Kati. 2019. p72.
- Bristow, M.R., et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004 ; 350 (21) : 2140-2150.
- Chaib K, Hocini N, Boutadara M. L’insuffisance cardiaque (Etude épidémiologique) République Algérienne Démocratique et Populaire, Departement de médecine. Université Abou Bekr Belkaîd Faculté de Medecine 2015; 112 (12463) : 70.
References
Saudubray T, Saudubray C, Viboud C. Prévalence et prise en charge de l’insuffisance cardiaque en France : enquête nationale des médecins généralistes du réseau Sentinelle, Rev Med Interne 2005 :845-50.
Diallo B, Sanogo K, Diakite S, Diarra MB, Toure MK. L’insuffisance Cardiaque au service de cardiologie du CHU du Point G. Bamako: Mali Médical 2004 ; 19(2) :15-17.
Fonarow GC, Adams KF, Abraham WT, Yancy CW, Boscardin WJ, for the ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure. Classification and regression tree analysis JAMA 2005;293:572-80.
Zannad F, Mebazaa A, Jullière Y et al. For the EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA Study. Eur J Heart Fail 2006.
Swan HJ, Forrester JS, Diamond G, et al. Hemodynamic spectrum of myocardial infarction and cardiogenic shock. A conceptual model. Circulation 1972;45: 1097-110.
Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med 1999;131:47-59.
Hochman JS, Sleeper LA, White HD, et al. One year survival following early revascularization for cardiogenic shock. JAMA 2001;285:190-2.
Pirracchio R, Parenica J, Resche Rigon M, Chevret S, Spinar J, Jarkovsky J, et al. The effectiveness of inodilators in reducing short term mortality among patient with severe cardiogenic shock: a propensity-based analysis. PLoS One 2013;8(8):1—10.
Nieminem MS, Bohm M, Couvie MR et al.Task Force on acute heart failure of the European Society of Cardiology. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J 2005;26: 384-416.
Touré K. Insuffisance cardiaque aigue au service de cardiologie du CHU-PG. Memo Cardio FMOS 2016; 57 : 87.
Diallo B, Sanogo K, Diakité S, Diarra M.B, Touré M.K. L’insuffisance cardiaque à l’hôpital du Point-G. Mali Méd 2004; 19 (2) : 17.
Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. Euro heart survey investigators; heart failure association, European society of cardiology. Euro heart failure survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur heart J 2006 ; 27 : 2725–2736.
Damasceno A, Bongani M. The causes, treatment, and outcome of acute heart failure in 1006 africans from 9 countries. Arch intern med 2012 ; 172 (18) : 1386-1394.
Adams Jr KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005 ;149 :209–16.
Prasart A, Kriengkrai H , Rungsrit K. Thai acute decompensated heart failure registry (Thai ADHERE) ; CVD prevention and control 2010 ; 5 : 89– 95.
Simon Stewart, David Wilkinson et all. Predominance of heart failure in the feart of soweto study cohort emerging challenges for urban african communities. Circulation 2008; 118 : 2360-2367.
Adams Jr KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005 ;149 :209–16.
B. Sountoura. Aspects épidémio-clinique, thérapeutique et évolutif de l’insuffisance cardiaque aigue au service de cardiologie du CHU Pr Bocar Sidy SALL de Kati. 2019. p72.
Bristow, M.R., et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004 ; 350 (21) : 2140-2150.
Chaib K, Hocini N, Boutadara M. L’insuffisance cardiaque (Etude épidémiologique) République Algérienne Démocratique et Populaire, Departement de médecine. Université Abou Bekr Belkaîd Faculté de Medecine 2015; 112 (12463) : 70.