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 ageing popul... ... middle of paper ... ...rombin time is necessary. This inconvenience and the significant drug-drug interactions implied with warfarin meant the development of new anticoagulant therapy such as dabigatran and rivaroxaban. Dabigatran is a direct thrombin inhibitor. In a random controlled trial conducted in 2009, Connolly et al (2009) reported similar rates of stroke and systemic embolism when comparing warfarin to dabigatran at a 110mg dose, but with lower rates of major haemorrhage. They also compared warfarin to dabigatran at a 150mg dose and reported significantly lower rates of stroke and systemic embolism in the dabigatran group but similar rates of haemorrhage14. Rivaroxaban is a factor Xa inhibitor. In a study carried out by Patel et al (2011), it was reported that in the treatment of AF, rivaroxaban was non-inferior to warfarin in the prevention of stroke or systemic embolism15.
Ischemic Stroke is caused due to a blood clot in an area of the brain, leading to loss of neural function if last for more than 24 hours. In the United States, ischemic stroke affects 2.7% of men and 2.5% of women of age range 18 years and older. In addition, it has reported that annually about 610,000 and 185,000 of new strokes and recurrent strokes cases occur in US1. Moreover, it has reported that patients who have suffered from a stroke have more chances of recurrent stroke, Myocardial infarction, and death from vascular causes2. One of the risk factor of ischemic stroke is formation of plaque in the blood vessels causing blood clot3. Several randomized trials have also reported that antiplatelet medications are efficient in preventing recurrences of stroke in patients who had an incident of ischemic stroke. Antiplatelet medications for preventing recurrences of stroke are aspirin, combination of aspirin and extended-release dipyridamole, and clopidogrel alone4. It ha...
(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.
Dabigatran is a direct reversible thrombin inhibitor that has been approved for treatment of nonvalvular atrial fibrillation (AF) based on results of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study, but its use for other indications remains untested. It works by inhibiting both free and clot-bound thrombin, which enables the conversion of fibrinogen into fibrin. Dabigatran is eliminated primarily by the kidneys and it’s dosed orally.5
There are various treatments for acute coronary syndrome to prevent the occurrence of an acute myocardial infarction. The purpose of this essay is to discuss the current research of the pharmacological treatments of this condition and to evaluate the relevance of this research in relation to the practise of paramedics.
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, ).
As mentioned earlier, Atrial Fibrillation is one of the most common cardiac dysrhythmias in the world. It is easily treatment and managed as long as the patient follows the advice of medical professionals. The exact cause and triggers of atrial fibrillation are unknown and are still being researched today. Through patient education, medication regimen, healthy diet, understanding your condition, and being conscious of your emotional health are crucial when it comes to the management of atrial fibrillation.
Those living with AFib are capable of living a healthy and normal life with early diagnosis and the use of specialized treatments that most effectively reduce risk of stroke and AFib episodes. AFib is the most common heart arrhythmia that affects Americans today so knowing the signs and symptoms can only increase early detection and the likelihood of sustaining a healthy life. While the symptoms of AF are similar to other heart conditions, the disease has specific affects that have risks of their own. With simple lifestyle changes, AF can be prevented or maintained with minimal effort.
“If you’re at high risk for ischemic stroke, your doctor may prescribe drugs that reduce clots by interfering with the aggregation (clumping together) of blood cells called platelets” (Prevention of a Stroke 4). Your doctor would prescribe a specific type of medication called antiplatelet drugs. Anticoagulants (blood thinners), like antiplatelets, interfere with the formation of blood clots, but they work at a different stage in the clotting process- preventing the formation of fibrin, a protein that plays a role in blood clotting. “Statin medications lower blood cholesterol levels by blocking the activity of an enzyme crucial for the production of cholesterol by the liver. These medications also help stabilize plaques- the fatty deposits in arteries that can rupture and trigger the formation of a blood clot that can lead to a stroke” (Prevention of a Stroke 18). Statins are used to lower blood cholesterol levels and reduce inflammation in the artery walls. The medications your physician prescribes will depend on how great your risk of a stroke is as well as your risk of side effects from these
“Extreme high heart rate, ‘cold’ sweat, and dizziness,” is what Kevin Olinger, a person living with atrial fibrillation (afib), experiences during an afib episode (1). Atrial fibrillation, a very serious heart arrhythmia, is found in over two million people living in the United States (2 What is 1). According to Gary Riddle, doctor at Memorial Hospital Health Care Center, he cares for roughly 40 patients diagnosed with afib each year in Ferdinand, Indiana (Riddle 1). People the age of 40 and over have a one in four chance of getting atrial fibrillation (2 What is). Knowing the risk factors, causes, symptoms, and treatment options for atrial fibrillation may help save one’s life in the future.
They can keep a clot from growing or breaking off, and from they prevent new clots from forming. But they can’t thin your blood, despite their name or dissolve and existing clot. There are several medications or blood thinners you can take to for thrombosis. In the hospital, your doctor may give you heparin at first by needle into your vein or as a shot. You may also take warfarin (Coumadin) by pill once a day starting while you’re still on heparin, and then usually for 3-6 months or more. Newer anti-clotting medicines known as Xa inhibitors, work as well as warfarin for most people.
AF develops for many different reasons, including left ventricular dys-function with hemodynamic impairment (Kobayashi et al., 1992), atrial is-chemia or infarction (particularly in patients with early onset atrial fibrilla-tion in the course of acute myocardial infarction), right ventricular infarction (Rechavia et al., 1992), pericarditis, excessive release of catecholamines. Atrial fibrillation is usually abrupt in onset and can cause rapid hemody-namic instability through one of three mechanisms: loss of the atrial com-ponent of the cardiac output, increased ventricular response rate with de-creased diastolic filling time, or irregular ventricular filling (Cristal et al., 1976).
I completely agree with Courtney about performing pulmonary vein ablation on this patient. Radiofrequency catheter ablation for AF has become a common used second-line therapy after failure of at least one antiarrhythmic drug (Bunch & Cutler, 2015). The authors stated that multiple clinical trials report arrhythmia free survival of 50-75% at 1-year post ablation in contrast to only 10-30% with antiarrhythmic drugs. Hence, there is a chance that in near future, pulmonary vein ablation should become a first-line therapy for atrial fibrillation (AF).
One must understand that patients who are prescribed warfarin are at a high risk of bleeding. According to Sanderson et al. (2009) “many patients were unable to link known risk factors as contributing” to DVT to their therapist (p. 25). Although patients are admitted for major lower extremity surgeries, some of these patients also have chronic diseases, such as cerebral vascular accident (CVA), coronary artery disease, diabetes, cardiac, renal disease, and obesity and might take a complex medication regimen. Therefore, these patients require a major understanding of detailed discharge education of medication regimen, side effects, and interactions to prevent them from suffering complications. Furthermore, Campbell and Selton (2010) claimed that patients mostly misunderstand the interactions of some foods that are rich in vitamin K with warfarin (p. 373). Most are unaware of the consciousness and complications foods that are high in vitamin K brings to their current health status. Clinents also lack the knowledge of the need to adjust their warfarin dosing and monitoring of the International Normalization Ratio (INR) level. Although nurses do give a quick verbal instruction such as, informing patients to immediately report to provider if they observe bruises on skin, excessive gum bleeding or blood in urine, patients fail to fully understand the danger of taking anticoagulants medications.
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.
Coumadin, whose generic name is Warfarin, and is manufactured by Bristol-Myers Squibb Company, is an anticoagulant medication. It is more commonly known as a “blood thinner”; however it does not actually thin the blood. An anticoagulant helps your body control how fast your blood clots and it prevents clots from forming during certain medical conditions. Medications such as Coumadin may prevent an already present clot from getting any larger and may also prevent a piece of the clot from breaking off and traveling to your heart, brain or lungs. Anticoagulants do not dissolve blood clots but with time, clots may dissolve on their own. (Cleveland Clinic, 2014)