The most common pathologies

The metabolic syndrome

The metabolic syndrome increases the risk of cardiovascular diseases.  It effects between 8% and 14% of the Swiss population.

The metabolic syndrome is characterised by the association of excess weight, an increase in sugar levels (diabetes) and cholesterol in the blood, and blood pressure that is too high. This association is particularly harmful.  When all the symptoms are present, the evolution of each component is worsened. In the presence of the metabolic syndrome, the mortality risk becomes up to five times higher.

An early diagnosis and care of the metabolic syndrome are a priority. Anyone showing signs of these components should benefit from specific research for other risk factors.  In the event of excess weight for example, it would be justified to take the blood pressure or the levels of cholesterol and sugar in the blood.

The diagnosis of the metabolic syndrome requires an evaluation of the arteries, and possibly the coronary arteries. The early detection of plates of arteriosclerosis makes it possible to undertake effective treatment promptly and thus prevent serious complications, such as cardiac insufficiency, coronary disease and coronary thrombosis, arterial insufficiency or stroke.

The necessity to treat each of the components of the metabolic syndrome explains the relative complexity of the care required. This demands the participation and interaction of several specialists – for diabetes, cardiology, and angelology, specialists in obesity and lipids. The metabolic syndromes is a chronic illness, which cannot be cured, the active participation of the patient is indispensable for defining the treatment. This is a long term solution and is most often associated with medical treatment and a change in lifestyle, - eating habits and/or physical activity.  The follow through and support for the patient is a priority so the support from a multidisciplinary team supplying medical, pharmacological and psychological assistance is particularly apt.

Dr Juan Ruiz, Endocrinology, Diabeteology, Metabolism Service

Aneurysm of the abdominal aorta

An aneurysm of the abdominal aorta corresponds to the dilation of the part of the aorta located in the abdomen and usually sitting between the renal arteries and the aortic junction, i.e. before the arteries of the pelvis (iliac arteries). In the majority of the cases, the aneurysm of the abdominal aorta is of atheromatic origin. This means that it is due to cholesterol plates that destroy the elastic elements of the aortic wall. The aneurysm of the abdominal aorta occurs especially with men in their sixties, hypertensive in 40% of cases and who have had a coronary heart attack (coronary arteries) obvious or latent in 50% of the cases

Diagnostic
Most often the discovery is made on an asymptomatic patient.  Palpitation of the stomach reveals a beating expansive mass at the level of the abdomen, usually inodorous, positioned centrally or slightly to the left.

Development
The natural development of the aneurysm of the abdominal aorta is essentially a tear or split in the aneurysm that is most often in the stomach (the peritoneum). The major pre-rupture sign is in the stomach (the peritoneum)  and pain felt at the level of the beating mass in the abdomen.

When this is observed, hospitalisation and vascular surgery is obligatory.

The risk of a rupture depends on the size of the aneurysm.  It is 15% in the case of 4 cm diameters, 75% if the diameter is 8cm.  The 6cm diameter constitutes a critical point in the evolution of the aneurysm.  The results call for rapid intervention in the case of an aneurysm of the abdominal aorta with a diameter of more than 5 cm.  All aneurysms of the abdominal aorta must be operated on.

Treatment
The classic treatment of the aneurysm is prosthesis after a review of the aneurysm and the extraction of the clots.  Another option is the endovascular technique, which is currently carried out if the characteristics of the aneural lesions permit.  This is not the replacement of the diseased aorta, but the introduction via the groin of an endoprothesis, which reinforces the aorta from the interior.

Based on these facts, an aneurysm of the abdominal aorta is currently pathology with a positive forecast

Dr Piergiorgio Tozzi, Cardiovascular surgery service

Development in the treatment of arrhythmia

The first recording of electric cardiac activity
At the end of the 19th century, Augustus Désiré Waller, Austrian, was the first person to record electric cardiac activity.  No one suspected its medical role.  He had trained his dog Jimmy to keep his paws in containers of salt water during the first recording of electrocardiogram me waves.  Travelling through Basel to give a demonstration, A. D. Waller met Willem Einthoven who would improve the technique.  At the beginning of the 20th century, Mr. Einthoven described the five waves of the ECG, P, Q, R, S and T.  Why begin with the letter P? Because the previous letters were already taken!

Treatment of arrhythmias by catheterisation
The first attempts of treatment of arrhythmias by catheter – a slender pipe that which is slid into the veins - took place in the 1980s. In its stammerings, an electric arc between two electrodes (flash) was put into contact with the myocardic tissue. This arc burned the surrounding tissue thus interrupting the circuits involved in the re-entries. Because of insufficient precision and too frequent complications, the technique was progressively replaced by radio waves emitted at the extremity of the catheters.  The success was worldwide.  The technique was popularised and the indications were widened, to allow us to treat nowadays by simple puncture of the arrhythmias something that required open heart surgery 15 years ago.

Although the approach by catheterisation spread, certain arrhythmias, where the auricular fibrillation required more precision and better comprehension of the relationship between cardiac anatomy, the genesis of the electric activity and the neurovegetative nervous system. required. Systems of three-dimensional navigation comparable with mini GPS were developed and implemented in daily practice. These brought the precision that the conventional approach by radioscopy did not offer.

Whereas these techniques offered virtual imagery of the heart, the advance of the catheter still required manual intervention. When the catheter is manually introduced it follows the hand movements and not those of the heart, similar to a 4-stroke engine.  This problem has recently been circumvented by the use of a magnetic support coupled to the navigation system in three dimensions. Two magnets which can turn on themselves, placed on both sides of the patient and are enough to hold up the catheter that also has the extremity magnetised.  The catheter is orientated in the direction required using the magnetic fields and their attraction and repulsion properties.  What is the advantage? The fields create a #direction# which the catheter follows once it is activated and when the cardiac wall is contacted the catheter follows its movements. The next steps can be envisaged … virtual navigation, manoeuvring by joystick, in the reconstructed cavities using IRM and a CT-SCAN, memorisation of relevant sites, semi-automatic treatment, etc.  The CHUV will be equipped with such a system in 2007.

Dr Etienne Pruvot, Rythmology unit of the cardiology service