Cardiac erethism is a state of hyperexcitability of the heart. It results in hyperpulsatility, which is characterized by an ample pulse, an accentuation of heart sounds on auscultation, and an exaggeration of heart movements on echocardiography. While it can be very troublesome, cardiac erethism has no pathological significance. However, care must be taken to exclude any underlying cardiac or extracardiac pathology before confirming the diagnosis. No treatment is usually considered except to reassure the patient and avoid contributing factors. Beta-blockers are effective and should be prescribed on a case-by-case basis.

The aim of this study was to describe the effects of a 64.2 km ultra-trail on the biomarkers of muscle damage, inflammation and oxidative stress, and compare the results observed with an ECG and an echocardiogram, both performed before and after the race. Thirty-three ultra-trail volunteers (45.8 +/- 8.7 years old) were enrolled in our study. Three blood tests were drawn from each runner, one just before (TPRE), one just after (TPOST) and the last 3 h after the end of the race (TPOST3h). All the markers increased. The maximum concentrations observed were at TPOST3h and were significant (p < 0.001) for creatine kinase, creatine kinase isoform MB, high-sensitivity C-reactive protein, uric acid and for the ratio of reduced glutathione to oxidised glutathione. However, in the case of myoglobin, high-sensitive troponin T, N-terminal pro-brain natriuretic peptide, oxidised glutathione, myeloperoxidase, cystatin C and creatinine, the most significant increases were at TPOST (p < 0.001). Modifications were observed in the medical imaging using echocardiography such as reduction of left ventricule end-sytolic and diastolic volumes and left ventricular global longitudinal strain. ECG showed electrical criteria for left ventricular hypertrophy and incomplete right bundle branch block after the race. Endurance races cause significant physiological stress to the body that can be measured by the increase of different biomarkers. From a laboratory perspective, it is important to take into account the possible exercise performed previous to the testing to avoid a misinterpretation of the results. From a training perspective, due to these increases in biomarkers, it is recommended that runners wait at least 72 h after an ultra-trail before subsequent training. In addition a transient impairment of ventricular function due to dehydration were observed.

This paper, “Reconstruction d'images spatiales a haute resolution temporelle, was presented as part of International Conference on Space Optics—ICSO 1997, held in Toulouse, France.

IntroductionCardiopathies are the world's leading cause of mortality and morbidity. Although rare, cardiovascular accidents can occur during intense and infrequent sporting activity, particularly among those who are unaware of their heart condition. The development of cardiospecific biochemical markers has led to a reconsideration of the role of biology in the diagnosis of cardiovascular illnesses. The aim of this study therefore was, through the use of cardiac biomarker assays, to highlight the impact of sustained physical effort in the form of intense and prolonged concentric isokinetic exercise and to research potential cardiovascular risks.Materials and methodsEighteen subjects participated in a maximal concentric isokinetic exercise involving 30 knee flexion-extensions for each leg. Five blood tests were taken to study the kinetics of the cardiac biomarkers. Haemodynamic parameters were measured continuously using a Portapres, and respiratory parameters were measured using a Sensormedics Vmax 29C.ResultsThe results showed significant increases in the creatine kinase, myoglobin, homocysteine and haemoglobin cardiac markers. Evolutionary trends were also observed for the following biomarkers: NT-proBNP, myeloperoxydase and C-reactive protein. All the physiological parameters measured presented statistically significant changes.ConclusionIsokinetic effort leads to the release of cardiac markers in the blood, but these do not exceed the reference values in healthy subjects. Maximal concentric isokinetic exercise does not, therefore, lead to an increased risk of cardiovascular pathologies.

Background Heart-type fatty acid-binding protein (H-FABP) is a low molecular weight protein involved in the intracellular uptake and buffering of long chain fatty in the myocardium. Troponin T is a component of the contractile apparatus of the striated musculature. Both are early markers for acute coronary syndrome. Objective The aim of our study was to compare the results obtained with the H-FABP and the highly sensitive cardiac troponins (hsTnT) and to test their cardiospecificity in healthy runners. Design Prospective, cohort study. Setting Amateur marathon runners. Patients 23 runners (marathon) were enrolled. Interventions We drowned blood samples at three times: just before (T0), just after (T1), and three hours after the end of the race (T3). Main outcome measurements H-FABP and hs-TnT were performed according to the manufacturer's instructions. A linear regression was calculated to observe if there is any correlation between the two biomarkers. Values above the 95th percentile for H-FABP (2.5 ng/mL) and the 99th percentile for hsTnT (14 ng/L) were considered as positive. Results At T0, none of the subjects were positive for hsTnT but 35% were positive for H-FABP; at T1, 83% for hsTnT and 100% for H-FABP; at T3, 83% for hsTnT and 96% for H-FABP. At T0, the regression equation was H-FABP T0=3.9454–0.1001×hsTnT T0; at T1: H-FABP T1=51.838–1.7026×hsTnT T1; at T3: H-FABP T3=47.977–1.6193×hsTnT T3. No correlation was observed between the 2 biomarkers. Conclusion We observed a significant increase of H-FABP and hsTnT in runners. These markers are independent to each other. These values could biologically correspond to a heart ischemia. These biomarkers could be helpful for the screening of cardiac risk among runners.

BackgroundCardiac troponins (cTn) are considered as the best biomarkers for detection of myocardial cell injury and NT-proBNP as the best for the cardiac insufficiency.ObjectiveOur aim was to compare cTnT and NT-proBNP levels before and after the stress tests, in sportive subjects.DesignProspective, cohort study.SettingAmateur marathon runners and ultrarunners.Patients28 subjects (26 men, 42.5±11 yrs) were enrolled.InterventionsSubjects ran the Maasmarathon (42.195 kilometers) and 33 subjects (33 men, 45.7±9.3 yrs) ran the Ultratour of Liège (Belgium; 67 km). All subjects gave their informed consent. We took blood sample before (T0), just after (T1) and 3 hours after the race (T3).Main outcome measurementscTnT concentrations were measured by high sensitive methods (hsTnT, Roche Diagnostics) on heparin plasma. The NT-proBNP was also determined with the kit Roche on heparin plasma. All statistical analyses were performed using Medcalc version 8.1 for Windows. P-value <.01 was regarded as statistically significant.ResultsA significant difference between hsTnT concentrations at T0 and T1 (P<.001), and between T0 and T3 (P<.001) for NT-proBNP have been observed, but not between T1 and T3. This observation appeared only after a strenuous exercise. However, up to now this type of exercise is not reproducible easily in a laboratory. Moreover, nobody knows if these observations would have cardiac consequences at long terms.ConclusionMeasurement of cardiac troponins by high sensitive methods allows detecting significant release of biomarkers from the heart during exercise. The value of NT-proBNP are also significant but less than TnThs. We think that the TnThs could be an interesting tool in the future to help sport medicine to detect risk of developing a cardiac problem in the future or a sudden death.

Sudden cardiac death is the leading cause of death in athletes. Pre-competition screening including 12-lead electrocardiogram is recommended by the European Society of Cardiology. This attitude contributes to significantly decrease the risk of sudden cardiac death. We review the electrocardiographic criteria of Seattle that increase the specificity of screening in athletes.

Materials and Methods: Four populations were compared a control group of 16 participants “sedentary” (37 ± 4,39 years old) a group of 24 semi-marathon runners (41 years ± 8,76 years old) a group of 28 marathon runners (44,1 ± 8,37 years old) a group of 33 ultra-trail runners (45,8 ± 8,7 years old) Three blood tests were drowned one just before one just after  the last three hours after the end of the race Different oxidative and stress and cardiac biomarkers were measured: Myeloperoxydase Reduced Glutathion Oxydized Glutathion Lipid peroxyde Creatine kinase isoform MB C-reactive protein Highly Sensitive Troponin T Natriuretic peptide (NT-proBNP) All automated assays were performed according to the manufacter’s specifications. The ultra-trail runners will be subject to an echocardiography and an ECG preand post-race. For statistical analysis, STATISTICA 10 software was used. We performed a non-parametric test of KruskalWallis for independent sample and a Friedman ANOVA for paired samples. Results and discussion: We observe an increase of troponin T and natriuretic peptide but with a different kinetic than the kinetic obtained for a myocardial infarction (Fig 1 and 2). Also, we note an increase of creatine kinase isoform MB (Fig 3) and C-reactive protein (Fig 4) during the race. There is a decrease in lipidic peroxidation during exercise (Fig 5).

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease.

Rev Med Liège 2013; 68 : 10 : 497-503 Résumé : Cas d’un patient âgé de 64 ans présentant une insuffisance cardiaque dans le cadre d’une amyloïdose cardiaque primitive. Ce cas clinique offre l’opportunité de parcourir la littérature sur l’atteinte cardiaque liée à cette affection ainsi que les diagnostics différentiels des cardiopathies restrictives. mots-clés : Cardiomyopathie restrictive Décompensation cardiaque Imagerie par résonance magnétique Echocardiographie caRdiac amyloidosis, about an atypical case Summary : A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease. KeywoRds : Restrictive cardiomyopathy Heart failure Echocardiography Magnetic resonance imaging B. Falque (1), l. Davin (2), P. Mélon (3), S. RoBinet (4), P.J. BRuyèRe (5), l. PieRaRD (6) LE CAS CLINIQUE DU MOIS Amyloïdose cardiaque, à propos d’un cas atypique

Materials and Methods: Four populations were compared a control group of 16 participants “sedentary” (37 ± 4,39 years old) a group of 24 semi-marathon runners (41 years ± 8,76 years old) a group of 28 marathon runners (44,1 ± 8,37 years old) a group of 33 ultra-trail runners (45,8 ± 8,7 years old) Three blood tests were drowned one just before one just after  the last three hours after the end of the race Different oxidative and stress and cardiac biomarkers were measured: Myeloperoxydase Reduced Glutathion Oxydized Glutathion Lipid peroxyde Creatine kinase isoform MB C-reactive protein Highly Sensitive Troponin T Natriuretic peptide (NT-proBNP) All automated assays were performed according to the manufacter’s specifications. The ultra-trail runners will be subject to an echocardiography and an ECG preand post-race. For statistical analysis, STATISTICA 10 software was used. We performed a non-parametric test of Kruskal-Wallis for independent sample and a Friedman ANOVA for paired samples.

Transient impairment of consciousness frequently prompts the patient to consult a neurologist or a cardiologist. Detailed medical history and physical examination allow to distinguish fainting from epileptic seizure, metabolic or psychogenic events. We report the history of an 83-year-old woman who presented a transient loss of consciousness.The vascular, investigation demonstrated a subocclusive stenosis of one of the internal carotid arteries. We shall consider the differential diagnosis of transient impairment of consciousness and discuss the relationship between fainting and carotid artery disease.

Inadvertent insertion of a defibrillation lead in the left ventricle is a rare complication generally underdiagnosed after device implantation. Management is not strictly codified due to the small number of observed cases. We report the case of a 78 year-old man in whom the diagnosis has been performed lately during an echocardiography.