Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
Paroxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2ts by his general practitioner (GP) with a 2-moiith history of intermittent palpitations. He was taking ramipril for hypertension and had no other relevant medical history, lie drank 30 units of alcohol per week and was a lifelong non smoker. There was no significant family history.He described four Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 recent episodes of self-terminating palpitations. They were of sudden onset, occurring both at rest and during mild exertion, and had each lasted IwtEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
wcen IS and 60 minutes. The first episode had occurred after he had returned from a parly, having consumed a significant amount of alcohol. The othersParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 dizzy and breathless. Clinical examination revealed a regular pulse of 75 beats per minute I'bpm) with a blood pressure IBP) of 145/80 mmHg. He had normal heart sounds with no signs of cardiac failure.His 12-lead ekvlHJcanliogram (ECG) confirmed a normal sinus rhythm with a normal electrical axis. Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2Transthoracic echocardiography (TTE) confirmed a normal cardiac structure and function with a mildly dilated left atrial size of 40 mm (normal 27-38 mEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
m). Exercise stress testing did not induce any arrhythmias and was negative for ischaemia. Routine blood tests, including thyroid function, were normaParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2diagnosis, treatment was not commenced. He was advised Io reduce his alcohol ami caffeine inlake and an oulpalient 7-day event recorder was requested with subsctpienl follow-up arranged.By the time of his 6 week follow up. he had had a further two symptomatic epi sodes. Neither of these had occurred Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 during his 7 day event recorder which had not documented any arrhythmias. Fortunately, the patient had attended Accident & Emergency (A&E) with a symEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
ptomatic episode. Drspile spontaneously reverting Io sinus rhythm, an initial ECG had captured fast AR hl view of his history, the A&E specialist had Paroxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2tment options were discussed at his outpatient review. Although his paroxysms were fairly infrequent, the patient was highly symptomatic from (hem. With no evidence of structural heart abnormalities or ischaemic heart disease, a class I AAD in the form of flecainide 30(1 mg was initiated as a pill-i Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2n-the-pocket strategy. The CHADS, criteria (Table 16.1) were used to stratify the patient’s thromboembolic risk which duly scored the patient al ‘1’.Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
This gave (he patient a 'moderate risk' of thromboembolism and the patient was commenced on aspirin 75 mg once daily.© Expert commentTreatment with anParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2ecording, it may be reasonable to Iry .1 Ix'l.j-bkx kcr0 Expert commentIl IS a gocxl xks> I<1 grw the pillirni a letter requesting A&.E to do an ECG as soon as the patient turns up < txnplairnng of an arrhythmia A&E can then be asked to give a copy to the patient and fax a copy Io lhe [ihy-.K ian If Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 involving thr tip you should first check that they Ivrvr an I CXi rnarhirx- arxl again give tlx- pilx-ni a truer for llx-CiP practice.© Expert commenEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
tWith a CHADS , sccre of 1. current guidelines allow (hr ikwtor/fxiticni to choose aspirin or warfarin However, the evidence base for aspirin is relatParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2to take the medication themselves in the community.166o Clinical tip Diagnosis of arrhythmias with regard to temporal relationA thorough history and clinical evaluation ĨS essential in diagnosing arrhythmias, but tools such as ambulatory ECG monitors can be invaluable. In those with frequent (daily) Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 symptoms, a Holter monitor can continuously record and save data for up to AS hours Patients are encouraged to keep an event diary, allowing tlte corEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
relation of syTri|Xanr> with ỄCG recordings Patients with infrequent symptoms require loop event recorders that can continuously record data, with infParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2 data Compared to Holter monitors, event roc Older*, can beuuri fix Icxigcr ỊXTicxh, have* a Tnglxt yield in diagnosing arrhythmias, and havelxxri ptcrveri Io he nxxe cost effective and efficacious for the evaluation of palpitations [1Ị if prolonged exte-ial ambulatory event monitors fa to document Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2an arrhythinu. an implantable loop recorder (e.g. Re.eal*' device) ran lie Iisrxl Illi*, rlr*VIC I* I*.irrựilanlerl snlxutaixxiiidy and fas a batteryEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
fife of up to two years. It rontiniKxidy scans icx arrhythmias arxl autrirrvilK ally Uriri’. tachycardia or bradycardia events for future analysis in Paroxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2t Aetiology ol atrial librillalionAh b a complex te entrant arr Irythmia bayed on the coexistence OÍ multiple wavelets of electrical activity within the atria. I Ik* exact aetiology remains unclear, but multiple rrteclianisms have been implicated tn the genesis of Ar These include ectopic activity t Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2n the form of pulmonary and non-pulrnonaty vein uiggets, susceptible atrial substrates (eg. atrial tissue that perpetuates Al- secondary to stmcturalEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
or electoral remodelling, fthrosrs or gap junction mutations), and areas 'With excessive autonomic activny Of these the pulmonary vein foci, which repParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatient Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2to the tnggermg of Ar PlTable 16.1 Adapted CHADS, scheme lor the assessment of stroke risk in patients with (non-valvuiar) AT Ị3ỊCHADS, risk laclorPointsCongestive heart failure1Hypertension (systolic >160 rnrriHg)1Age ■> 7~, years1Diabetes1Prior stroke or HA2Total CHADS, scoreRisk of strokeAnnual s Ebook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2troke rate (%) Antithrombotic therapy indicated0Low1.9Aspirin1Moderate28Warfann or aspinn44963High4 0-182Warfarino Learning point I low to reduce theEbook Challenging concepts in cardiovascular medicine - A case based approach with expert commentary: Part 2
risk of stroke in atrial fibrillationParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatientParoxysmal atrial fibrillationShouvik HaidarG Expert commentary Professor John CammCase historyA SS-year-okl man was referred to cardiology outpatientGọi ngay
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