Introduction Atrial fibrillation (AF) is a cardiac arrhythmia. It is the most common arrhythmia and it has implications for patients and anaesthetists alike. The anaesthetist must take into consideration the physiological and pharmacological implications of this common arrhythmia. In a healthy individual receiving a general anaesthetic, the anaesthetist must be aware of the causes and treatment of acute onset AF, both intra-operatively and peri-operatively. Patients with AF often develop a decline in left ventricular performance and other hemodynamic instabilities including reduced diastolic filling and tachycardia mediated cardiomyopathy1, all of which can reduce cardiac output and pose difficulties for the anaesthetist. One of the characteristics of the common disorder, and perhaps the most worrisome for the patients affected, is decreased blood flow in the atria, which is associated with and allows thrombi to form. Embolism from the atria can cause cerebrovascular accidents, which can be devastating to the affected individuals and their families. Even over the short course of my clinical experience thus far, various consultants have asked my colleagues and I about the pathophysiology of AF, the causes of AF and most have been asked to describe the rhythm of the pulse of AF. Hospital doctors do not have to look far to find a patient with the often symptom less disorder, and quiz medical students on it. A study conducted in Trinity College, Dublin by Finucane et al (2011) reported that 10.8% of Irish men over the age of 80 are living with AF2. They also reported prevalence across all age groups of 3.2%. AF is highly prevalent in Ireland today, and is set to become more prevalent in the country, in keeping with our agei... ... middle of paper ... ...k Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010 Oct; 12:1360-420 (13) Pazirandeh S. Overview of vitamin K. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed 27th April 2014) (14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51. (15)Patel M, Mahaffey K, Garg J, Pan G, Singer D, Hacke W, Breithardt G, Halperin J, Hankey G, Piccini J, Becker R, Nessel C, Paolini J, Berkowitz S, Fox K.. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.. New England Journal Of Medicine. 365 (10), 883-91.
Fibrillations are caused by rapid, irregular contractions and may be useless for pumping blood. A defective in the SA node may result in ectopic focus causes abnormal pacemaker takes over. If the AV node takes over the junctional rhythm the heart will run at a pace of 40 to 60 beats per minute. If a defective AV node occurs, it may result in partial or total heart block and few or no impulses from the SA node reach the
Abnormalities that are being examined includes some arrhythmias, such as premature ventricular contraction or atrial fibrillation.
Up to our knowledge, there are no randomized clinical trials that compared Pitavastatin with Atorvastatin with the same endpoints that we set for this trial. We believe that establishing a clinical evidence to support the use of Pitavastatin as an alternative to the most commonly used statin in a clinical setting is of great importance. Moreover, there is no evidence that Pitavastatin can reduce both cardiovascular and cerebrovascular events and related deaths, which this study is going to test.
My patient who is a 57 year old male who has a past history of Hypertension, takes Accupril to help with his high blood pressure. Is complaining of chest and lest arm pain. He has a blood pressure of 140bpm a high heart rate, and on the ECG showing significant ST elevation and Sinus Tachycardia.
Approximately one million Americans suffer a heart attack annually. Four hundred thousand of these victims die as a result. Many of the heart attack deaths are due to ventricular fibrillation of the heart that occurs before the victim can reach any medical assistance or the emergency room. These electrical disturbances of the heart can be treated with medications once the patient reaches the hospital. Therefore, 90% to 95% of heart attack victims who make it to the hospital survive. The 5% to 10% who later die are those who have suffered major heart muscle damage.
Atrioventricular node (AV) “serves as a gate that slows the electrical current before the signal is permitted to pass down through the ventricle” (Medicine Net) that has a BPM of 40-50.
A normal heartbeats at a rate of 60-100 beats per minute. Cardiac dysrhythmia occurs when there is a disturbance in the normal rhythm of the heart. Atrial fibrillation and atrial flutter are two of the most common types of cardiac dysrhythmia. “These atrial arrhythmias may interfere with the heart’s ability to pump blood properly from its upper chambers (atria). The atria may not always empty completely, and blood remaining there too long may stagnate and potentially clot. Such clots may travel to other parts of the body, where they may cause blockages in the blood supply to the limbs, brain or heart. ("Cardiac Arrhythmias." Cardiac Arrhythmias. N.p., n.d. Web. 11 Dec. 2013, retrieved from http://www.hopkinsmedicine.org/) The American Heart Association reports that 383,000 emergency out-of-hospital treated cardiac arrests occur in the United States. A number of factors can cause cardiac dysrhythmia; smoking, heavy alcohol use, drugs (ie; cocaine or amphetamines), some prescription or over-the-counter medicines, or even too much caffeine or nicotine. Emo...
More research should be done on new oral anticoagulants with different study population and similar patients that are seen in everyday clinical practice as well as attempt to define the best pharmacodynamic monitoring tools. Research should be conducted to outline monitoring protocol including timing relative to dosing and frequency as well as therapeutic targets. Using these strategies, future trials could enhance further the efficacy and safety of these new agents and could extend their use to new indications.
It is now well established that OSA is a cardiovascular risk factor, and that ADMA has the potential to exacerbate cardiovascular disease. But does OSA influence ADMA levels? Many studies show increases in ADMA levels in OSA patients; Barcelo et al measured plasma ADMA in 23 OSA patients and found it significantly higher (1.17 μmol/L) compared to control (0.87 μmol/L, P<0.01) (55). Ozkan et al also found that ADMA levels were higher in OSA patients but levels did not reach statistical significance (56). When treated with CPAP for 4 weeks, patients with OSA had lower ADMA levels and improved forearm mediated dilation (FMD) (57). It is unclear how OSA increases ADMA levels but apparently CPAP treatment can decrease its levels.
Cardiac dysrhythmias come in different degrees of severity. There are heart conditions that you are able to live with and manage on a daily basis, and those that require immediate attention. Atrial fibrillation is one of the more frequently seen types of dysrhythmias (NIH, 2011). The best way to diagnose a heart condition is by reading a cardiac strip (Ignatavicius &Workman, 2013). Cardiac strips play a major role in the nursing world, allowing the nurse and other trained medical professionals to interpret what the heart is doing.
These causes will change the heart significantly. The pathophysiology of heart failure is described differently as: (1) an oedematous disorder, by means of which the deviations in renal hemodynamics and excretory ability lead to salt and water holding; (2) a hemodynamic disorder, considered by peripheral vasoconstriction and decreased cardiac output; (3) a neurohormonal disorder, mainly by stimulation of the renin-angiotensin-aldosterone system and adrenergic nervous system; (4) an inflammatory syndrome, related with amplified local and circulation pro-inflammatory cytokines; (5) a myocardial disease, started with an damage to the heart trailed by pathological ventricular transformation. In heart failure, the heart sustains either a sudden or longstanding structural injury. When damage occurs, sequences of firstly compensatory but consequently maladaptive mechanisms follow (Henry & Abraham, ).
Parwani, A.S., Boldt, L, Huemer, M, et al. (2013). Atrial fibrillation – induced cardiac troponin I release. International Journal of Cardiology. 2013;168(3):2734-7. DOI:10.1016/j.ijcard.2013.03.087.
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
...ockers and arrhythmic drug may be prescribed as well (Mayo Clinic). If neither lifestyle changes or medication work and PVCs or PACs still persists Radiofrequency catheter ablation may be required. According to Mayo Clinic this procedure requires, “use[ing] radiofrequency energy to destroy the area of heart tissue that is causing your irregular contractions”.
When a heart attack becomes a full cardiac arrest, the heart most often goes into uncoordinated electrical activity called fibrillation. The heart twitches ineffectively and can't pump blood. The AED delivers electric current to the heart muscle, momentarily stunning the heart, stopping all activity. This gives the heart an opportunity to resume beating effectively.