Atrial Contractions

nidhi asked:


ARTICLE



In recent years, management strategies for atrial fibrillation (AF) have expanded significantly, and new drugs for ventricular rate control and rhythm conversion have been introduced1. The atrial fibrillation (AF) surgery in India provides you the world class facilities at a very affordable price. Family physicians, handling such cases whether in office practice or in emergencies have the challenge of keeping current with recommendations on heart rate control, anti-arrhythmic drug therapy, cardio version, and antithrombotic therapy.

AF is the most common sustained arrhythmia encountered in the primary care setting. Many people in the general population have permanent or intermittent AF and the prevalence of arrhythmia increases in persons older than 80 years. AF can result in serious complications, including congestive heart failure, myocardial infarction, and thrombo-embolism.

Recognition and acute management of AF in the physician’s office or emergency department are important in preventing adverse consequences.

It is important to note that AF occurring in a background of rheumatic heart disease as is rampant in India is decidedly associated with increased risk of stroke than that without. In the Framingham study2, patients with rheumatic heart disease and AF had a 17-fold increased risk of stroke compared with age matched controls, and the attributable risk was 5 times greater than in those with non-rheumatic AF2.

INTRODUCTION

No arrhythmia is unique to anesthesia practice. Anesthesia may per se potentate the risk of developing arrhythmia in an individual, but more particularly in those susceptible. Cardiac arrhythmias are a relatively frequent occurrence during anesthesia. The possible precipitating factors include: hypoxia, hypercapnia, myocardial infarction, catecholamine, electrolyte abnormalities, acid-base imbalance, drug toxicity and adverse drug reactions. The sudden appearance of any new arrhythmia, regardless of homodynamic consequences, should be of concern and warrants attention. Specific therapy in the form of drugs, cardio version, or pacing will have their efficacy greatly enhanced by prior institution of corrective measures. Frequently, drug or electrical therapy will not be required if aggravating factors are removed. We present this case where the patient had atrial fibrillations in the intraoperative period and no known cause could be attributed to it.

One treatment objective is directed to avoid the negative consequences of the arrhythmia by trying to maintain normal sinus rhythm. Two strategies exist to obtain this result:

1. Chronic treatment with antiarrhythmic drugs (AAD)

2. Catheter ablation of atrial fibrillation

1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.

2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AF episodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.

The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.

ATRIAL FIBRILLATION CAUSES

A variety of conditions can lead to atrial fibrillation. The most common cause of atrial fibrillation is simply aging. Our risk of atrial fibrillation increases as we grow older and areas of scarring or fibrosis develop in our atrial tissue as a result of simple “wear and tear.” Abnormalities of the valves in the heart, most often the mitral valve, can also cause “wear and tear” and lead to atrial fibrillation. Some specific conditions, such as thyroid disease, may be treatable with medications alone. Other conditions may be treatable by our colleagues the cardiologists in the cardiac catheterization laboratory. In a small number of cases, atrial fibrillation appears to be inherited - which is to say that it runs in some families - while in many cases its cause is unknown.

ATRIAL FIBRILLATION RESULTS

Atrial fibrillation results in:

An irregular heartbeat that may be too slow at times, and racing at others. Loss of the atrial contraction that normally contributes to filling of the ventricle (the main pumping chamber of the heart) and improves pump performance –in some ways analogous to an automobile engine supercharger. Abnormal flow of blood through the atrium with areas of stagnation (eddies) which increase the risk of stroke. SURGICAL PROCEDURE

The surgical procedure consists of creating a number of incisions in the atrium that disrupt the re-entrant circuits. Once the incisions are made, they are sewn together again. The atrium can then hold blood on its way to the ventricle and can squeeze or contract to push the blood in to the ventricle, but the electrical impulse cannot cross the incisions. The result is what looks like a children’s maze in which there is only one path that the electrical impulse can take from the SA node to the AV node. The atrium can no longer fibrillate, and sinus rhythm (the normal rhythm of the heart) is restored.

INDICATIONS

The MAZE procedure is not necessary in most patients with atrial fibrillation. Many patients are not bothered by the rhythm or the medications required controlling it. In some cases, cardiologists are able to disrupt the circuits with catheters. Some patients, however, are so troubled by the way they feel when they are in atrial fibrillation or by the medications they must take that a surgical option is appropriate. In addition, individuals in atrial fibrillation who have experienced a stroke are at significant risk for another stroke. The MAZE procedure may be indicated in these individuals as well.

CONCLUCIONS

Atrial fibrillations are common arrhythmias occurring in 0.4-5% of adult population and nearly 5%of these are not associated with cardiac disease. It is important to identify the precipitating factor and eliminate it. Anesthesia may trigger such arrhythmia.

MEDICAL TOURISM INDIA

India is one of the best places for the medical treatment or any other health care in India. Every year thousand of visitors are coming to India from around the world just for the medical check up and other type of surgery related cardiac or others diseases.

India is giving Thailand stiff competition in healthcare services for overseas patients with cost of surgery lower by over 30% and in fact cheapest in entire Southeast Asia. Medical tourism in fast emerging as a big opportunity for India with its low cost advantage, high quality healthcare providers and an English speaking populance. Heart Care Package India, Health Check up India. One of the best options to go for your treatment in India and have a India tour as well. In the same cost you can visit India and you can get your medical treatment done. Medical tourism India brings this choice for you. Go for medical tour in India and treat yourself with the best quality care in India. For more details on atrial fibrillation (AF) in India at an affordable cost feel free to visit us at www.indiancardiacsurgerysite.com or mail your queries at info@indiancardiacsurgerysite.com or talk to us at +91 9579119451.



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Rebecca Brown asked:


Celebrex (or originally Celecoxib) is a controversial drug that is used to treat rheumatoid arthritis, osteoarthritis, acute pain, acute migraine headaches and menstrual pain and discomfort. Also Celebrex is used to reduce the number of intestinal polyps in patients with a rare genetic disorder called familial adenomatous polyposis (FAP), that if untreated develops into colon cancer. This drug is a non-steroidal, anti-inflammatory drug (specifically a “COX-2 inhibitor”) and it is prescribed to relieve pain and swelling. Celebrex is infamous for being associated with increased risk of heart attacks or strokes in patients who have taken the drug for long periods of time. Also the patients who have take the drug for a long time have suffered bleeding ulcers, liver damage, kidney problems leading to kidney failure, and fluid retention. It is manufactured by Pfizer Inc and it was introduced in Canada in 1999. This drug caught attention when a related medical Vioxx was withdrawn from the market in 2004. This event triggered a lot of action against Celebrex, still the drug experienced a short raise in sales. During the Vioxx trial it was claimed that Celebrex carries the similar chemicals and can cause similar problems, and that triggered a drop of Celebrex sales. Only in 2006 the situation became stable and Pfitzer continued the advertising of Celebrex again. The advertisements caused protests form the consumer advocacy groups, but at the moment Celebrex is allowed by the governmental Food and Drugs Act. In 2008 Pfitzer settled most of the Celebrex and Bextra (a similar drug, recalled in April 2005) lawsuits. While strongly linked to already banned Vioxx and Bextra there available research do not support the conclusion that Celebrex increases the risk of heart attack and stroke.

In Canada Celebrex also has a strong opposition that resulted in a class action lawsuit in 2005 in British Columbia. The lawsuit was filled by Poyner Baxter laws firm, the same that conducted a lawsuit against Vioxx. The removal of Vioxx from the market caused enough ground to file a similar lawsuit against a similar drug – Celebrex. The law firm stated that the drug increases the risk of serious adverse cardiovascular complications like heart attack, stroke, angina pectoris, atrial fibrillation, bradycardia, hematoma, irregular heartbeat, palpitation, premature ventricular contraction, tachycardia, venous insufficiency, cerebrovascular accident, congestive heart failure, deep venous thrombosis, pulmonary embolism, transient ischemic attack, unstable angina, and occlusion. As in many lawsuits related to dangerous products the Poyner Baxter claims that Pfitzer knew about the negative effects of the drug, but continued to sell and market it. The current status of the lawsuit is still unclear, still Celebrex continues to be sold but with stronger warnings.

Today if you or your relatives are suffering from the effects of taking Celebrex you can always file a lawsuit and you will be backed by numerous anti-Celebrex organizations. The most important things for this lawsuit will be gathering medical data that proves that the person has taken Celebrex and that the person has the effects caused by this drug and finding a good lawyer of course.



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Juliet Cohen asked:


Cardiac arrhythmia is a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. Cardiac arrhythmias comprise any abnormality or pertubation in the normal activation sequence of the myocardium. Arrhythmias stem from several causes. The heart’s natural timekeeper—a small mass of special cells called the sinus node—can malfunction and develop an abnormal electrical impulse rate. CPR can prolong the survival of the brain in the lack of a normal pulse, but defibrillation is the intervention which is most likely to restore a more healthy heart rhythm. A slow rhythm, known as bradycardia (less than 60 beats/min), is usually not life threatening, but may cause symptoms. When it causes symptoms implantation of a permanent pacemaker may be needed. Either dysrhythmia requires medical attention to evaluate the risks associated with the arrhythmia. The signs and symptoms of cardiac arrhythmias can range from completely asymptomatic to loss of consciousness or sudden cardiac death.

Complaints such as lightheadedness, dizziness, quivering, shortness of breath, chest discomfort, heart fluttering or pounding, and forceful or painful extra beats are commonly reported with a variety of arrhythmias. Beats are generated by electrical impulses in the atria (top chambers of the heart) and are then conducted to the ventricles, where they produce the powerful muscle contraction that pumps blood. People may have allergies or idiosyncratic reactions to many other foods and beverages that cause transitory arrhythmias. Long-term nicotine exposure and any cocaine exposure can cause much more serious arrhythmias. Oxidative stress is a common feature of ischemic-reperfusion injuries, which occur when the heart is temporarily deprived of oxygenated blood (a state known as ischemia), followed by the reintroduction of oxygenated blood (reperfusion). The development of arrhythmias include congenital heart defects, coronary artery disease, high blood pressure (hypertension).

Advances in medicine and technology have created new treatment options for cardiac arrhythmia (commonly known as heart rhythm disturbances). Cardioversion is the application of electrical current across the chest wall to the heart and it is used for treatment of supraventricular or pulsed ventricular tachycardia. Defibrillation differs in that it is used for ventricular fibrillation and pulseless ventricular tachycardia, and more electricity is delivered with defibrillation than with cardioversion. Arrhythmias may involve medications (anti-arrhythmic therapy), catheter ablations, and implantation of pacemakers or implantable cardioverter defibrillators (ICD). Cardiac resynchronization therapy (CRT) or CRT-D (CRT with defibrillator therapy) is an innovative therapeutic option for patients with refractory HF. Defibrillation differs in that it is used for ventricular fibrillation and more electricity is delivered with defibrillation than with cardioversion. Antiarrhythmic medications help to change the electrical signals within the heart to suppress or prevent the arrhythmia.

Treatment for Cardiac Arrhythmias Tips

1. Using a small, battery-powered generator to deliver timed, electrical impulses to the heart muscle through tiny wire leads.

2. The treatment for some patients is a technique called cardiac ablation.

3. Magnetic Guidance in the Heart While transcatheter ablation is very effective, it can be difficult.

4. Stereotaxis Niobe Magnetic Navigation System uses two superconductive magnets, a magnetic-tipped guide wire and advanced computer imaging techniques.

5. Atrial fibrillation can also be treated through a procedure, e.g. pulmonary vein isolation.

6. Fibrillation differs in that it is used for ventricular fibrillation and pulseless ventricular tachycardia.



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Ronald Dyson asked:


The Maze Procedure is an open-heart procedure which is used to cure the condition known as Atrial Fibrillation. Before we look at this and answer the question, we need to know how the heart works and what it is made up of so all will be clear to you.

The heart is a complicated organ both in how it is composed and how it actually works; you can understand this given the job it has to do and how vital it is to our everyday lives - if something does not work properly, it frequently results in a huge loss of quality of life and is the cause of death for many, many people.

Picture two sets of two chambers stacked on top of each other - the larger, upper pair of chambers are known as the atria (singular is atrium) and their job is to gather in blood after it has passed through the lungs and which is full of oxygen to be distributed around the body. Once they are filled, they contract and this forces the blood into the smaller, lower pair of chambers which are called ventricles. The ventricles then contract and this forces the blood around the body under pressure - it is the twin set of contractions by the upper atria and followed by the lower ventricles which gives us the double-beat signature of a healthy heart and is known to doctors as the Sinus Rhythm.

This double-beat process must be coordinated so the atrium knows when to contract and force the blood into the smaller ventricle - if it misses the beat, less blood is pushed into the ventricle which may not be ready to receive the blood in the first place. The trigger for the atrium to contract is an electrical signal sent from what is known as the Sinoatrial Node (or SV Node). This signal travels across the atrium and terminates at the Atrioventricular Node (or AV Node) - note that the ventricles will contract no matter what the signal does, they don’t need this particular impulse to contract.

Now imagine that the signal is somehow getting disrupted and the atrium is not contracting when it is supposed to - the atrium is trying to pump blood into the ventricle but the ventricle is not ready. This is known as atrial fibrillation and is caused by the electrical impulse taking a short cut which bypasses the atrium. While the condition may be so mild that the patient is unaware of it or can live quite happily without any intervention, other cases require medication or the use of catheters to regulate and control the situation. In serious cases, open heart surgery is required and the particular operation is the Maze Procedure.

The surgeon makes a series of incisions around the atrium which are then sewn back up - the result looks like a child’s maze (hence the name). After the operation, the atrium is able to hold blood and contract normally but the electrical signal cannot cross the barriers created by the incisions - it must follow the path which has been created by the Maze Procedure. This stops the signal from bypassing the atrium and ensures a healthy sinus rhythm is established again but in some cases a pacemaker must be inserted because the SV Node has been damaged as a result of the disease.



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peterhutch asked:


 

Arrhythmias are disorders of the regular rhythmic beating of the heart. They’re common — about 2.2 million Americans are living with atrial fibrillation (one type of rhythm problem). Arrhythmias can occur in a healthy heart and be of minimal consequence. They also may indicate a serious problem and lead to heart disease, stroke or sudden cardiac death. The goal of this site is to help the public and healthcare professionals learn more about arrhythmias, and ultimately reduce disability and death from heart disease and stroke.

An irregular heartbeat is an arrhythmia (also called dysrhythmia). Heart rates can also be irregular. A normal heart rate is 50 to 100 beats per minute. Arrhythmias and abnormal heart rates don’t necessarily occur together. Arrhythmias can occur with a normal heart rate, or with heart rates that are slow (called bradyarrhythmias — less than 60 beats per minute). arrhythmias can also occur with rapid heart rates (called tachyarrhythmias — faster than 100 beats per minute).

Most arrhythmias are harmless, but some can be serious or even life threatening. When the heart rate is too slow, too fast, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.

Causes

The heart has 4 compartments, or chambers. The walls of the heart squeeze together (contract) to push blood through the chambers. The contractions are controlled by an electrical signal that begins in the heart’s natural “pacemaker” (called the sinoatrial node). The rate of the contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia.

There are several causes of arrhythmia, such as the sinoatrial node (SAN) firing more quickly or slowly (sometimes both) or another part of the heart taking over the job of the SAN. Sometimes there may be no known cause for an arrhythmia.

Symptoms

Arrhythmias may not cause any signs or symptoms. In fact, your doctor might detect them before you do, during a routine examination. Noticeable signs and symptoms don’t always indicate a serious problem. Some people who feel arrhythmias don’t have a serious problem, while others who have life-threatening arrhythmias have no symptoms at all.

Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are:

* Palpitations (a feeling that your heart has skipped a beat or is beating too hard)

* A slow heartbeat

* An irregular heartbeat

* Feeling of pauses between heartbeats

Treatment

Treatment of arrhythmia depend on the type of arrhythmia, the patients age, physical condition and age. Methods are available for prevention of arrhythmia. These methods include relaxation techniques to reduce stress, limit intake of caffeine, nicotine, alcohol and stimulant drugs. Many arrhythmias require no treatment, they are naturally controlled by the body’s immune system. However if it is necessary that arrhythmias must be controlled, they can be controlled by drugs, Cardioversion, Automatic implantable defibrillators or an Artificial pacemaker. Arrhythmias are very serious.

Because arrhythmias are such a heterogeneous group of conditions, treatment needs to be carefully selected by a patient with their physician. Some arrhythmias require no treatment at all. Others require immediate emergency treatment if death is to be avoided. Treatments include physical maneuvers, antiarrhythmic drugs, other drugs, electricity, and electro or cryo cautery.



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Abhishek Agarwal asked:


One of the manifestations of chronic bronchitis is a productive cough accompanied by phlegm, which obstructs the free flow of air in the bronchial tubes. Chronic bronchitis is a long-term disorder that can last as long as two years. It is the fourth largest killer in the United States of America, and around ten million people fall victim to this disorder every year. About 40,000 deaths due to chronic bronchitis have been recorded annually. It is considered to be the most comman chronic obstructive pulmonary illnesses (CODP).

Causes of Chronic Bronchitis

Certain lifestyle habits such as cigarette smoking is mainly responsible for chronic bronchitis. People who live in highly polluted atmospheres also fall prey to this disorder. The above-mentioned factors weaken the lungs and the body’s immune system to such as extent that the person is easily infected by bacteria and viruses that attack the respiratory system.

Studies reveal that more than 90 percent of the people who contract chronic bronchitis comprise smokers. About 15 percent of the cigarette smokers are ultimately diagnosed with respiratory disorders charaterized by obstruction of the airways. Biopsies of bronchial samples of people who have quit smoking thirteen years ago still reveal persistent marks of bronchial inflammation.

Tests conducted on patients suffering from chronic bronchitis reveal yet another disturbing factor–the presence of three varieties of bacteria: Moxarella catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae.

Methods of Managing Chronic Bronchitis

Two methods of managing chronic bronchitis are in vogue at present–inhalation of ipratropium bromide and treatment through sympathomimetic agents. Theophyllinne is also an important therapy, but its uses are limited to a certain cases of the disorder. Patients who exhibit a remarkable improvement in airflow are not given any steriods. Antibiotics have a crucial part to play in the battle against acute infections. Supplemental oxygen is given to those patients who experience difficulties in breathing. Patients are also strongly advised to quit smoking for good, take plenty of nutritional supplements and fluids, and perform exercises to strengthen their respiratory muscles.

Tests to Determine Chronic Bronchitis

A series of tests are necessary to determine a variety of factors. Needless to say, testing is also essential to make a correct diagnosis of the condition. The results of tests also confirm the extent to which the air passages are obstructed. Some of the tests include pulmonary function testing, blood tests, chest radiograph, electrocardiogram, biopsies, and sputum cultures.

The ratio between the measured forced expiratory volume (FEVI) and the forced vital capacity (FVC) defines the severity of chronic bronchitis. One of the signs of severe and long-term chronic bronchitis is progressive decline of FEVI rates. Factors such as age affect the elasticity of the lungs due to which the pulmonary testing of most adults over middle age show a 30ml decline in FEVI. In addition, the blocking of the bronchi due to an increase in the production of sputum does not always indicate chronic bronchitis. Pulmonary testing documents the reversible characteristics of air passage obstruction, and this helps physicians properly diagnose this disorder.

A sample of arterial blood is taken in order to do a blood test, which can determine conditions such as mild polychthemia.

Chest radiographs reveal conditions such as blebs, diaphragmatic flattening, peribronchial markings, hyperinflation, and bullae. However, the test results cannot be taken as final proof of the existence of chronic bronchitis.

Electrocardiograms pinpoint distrubances, such as arterial fibrillation or flutter and atrial tachycardia having “P” pulmonale, in the supraventricular rhythm.

Airway biopsies can reveal submucosal and mucosal inflammation, hyperplasia of goblet cells, and abnormal smoothness of the muscles on the small noncartilaginous air passage.

Sputum culture is done in case of patients who have not been hopitalized but display acute exacerbations of chronic bronchitis. It is one of the methods used to determine the requirement for antibiotic therapy. Protected-tip sputum cultures are done in case of patients who are in hospitals especially if atypical organisms are suspected to cause the excarberation.

Mortality rate after the diagnosis of chronic bronchitis is fifty percent. The terminal event of chronic bronchitis is respiratory failure. Respiratory failure is due to bacterial infections characterized by purulent sputum, fever, and poor ventilation symptoms. The other factors responsible for respiratory failure are seasonal changes, infections of the upper respiratory system, medications, and prolonged exposure to polluting and irrtating agents.

An understanding of the factors responsible for inflammation in chronic bronchitis makes it easier to manage, control, and treat this disorder.



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