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Complications of Equine Anesthesia
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Treatment of atrial fibrillation includes: Lidocaine: 2 mg/kg IV bolus, 50 µg/kg/min CRI.Quinidine: 1 mg/kg slow IV (over 10 minutes) repeated up to a total of 4 mg/kg.Electrocardioconversion; more likely to be successful if patient has not been in atrial fibrillation for a long period of time.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
An 80-year-old man with no previous medical history develops breathlessness 2 days after open Hartmann's procedure for a perforated sigmoid diverticulum. His oxygen saturations are 96% on 2 litres oxygen, respiratory rate is 22 per minute, heart rate is 160 per minute and his blood pressure is stable 110/50 mmHg. An ECG demonstrates atrial fibrillation (AF).What is AF?
Risks and Rates
Published in Peter Cummings, Analysis of Incidence Rates, 2019
Peter Cummings, Peter Cummings
In a closed population we can often estimate both risks and rates. Sometimes risks may have clearer or more useful interpretations. Atrial fibrillation is an irregular heart rhythm which is often fast and uncomfortable. Five hypothetical patients come to your emergency department with new atrial fibrillation and to fix this you administer Drug A intravenously for up to 30 minutes (Figure 2.5). All patients reverted to normal rhythm within 30 minutes, an incidence proportion of 1. The rate of conversion to normal rhythm for Drug A was 60 × 5/(22 + 27 + 21 + 24 + 25) = 2.5 conversion events per person-hour. For the next five patients who present with this problem you decide to use newer Drug B. The rate for Drug B was superior, 60 × 3/(3 + 4 + 2 + 30 + 30) = 2.6 conversions to normal rhythm per person-hour, but the incidence proportion for conversion was only .6. If Drug B works, it does so quickly, but Drug A yielded a greater overall proportion with normal rhythm after 30 minutes. For the average patient, all other things being equal (cost, side effects) Drug A produced a better result. In this example, a comparison based upon risks (incidence proportion), rather than rates, may be preferred.
Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study
Published in Acta Cardiologica, 2021
Michiel Delesie, Lien Desteghe, Marianne Bertels, Noor Gerets, Florence Van Belleghem, Jasper Meyvis, Ivan Elegeert, Paul Dendale, Hein Heidbuchel
Recent data showed that lifestyle and cardiovascular risk factor management is becoming an increasingly important aspect to optimise outcomes in atrial fibrillation (AF) patients and especially in obese AF patients [1]. It is shown that an increased body mass index (BMI) is independently associated with the progression from paroxysmal to permanent AF [2]. Risk factor management, weight reduction and more exercise can improve AF burden, symptoms, success rates of rhythm restoring procedures and the quality of life in these patients [3–5]. A recent meta-analysis in AF patients with overweight or obesity, evidenced that already modest (≥10%) weight loss is associated with less recurrent AF, improvement in AF burden and lower AF symptom severity [6]. Despite this evidence, it is very hard in daily practice to convince and motivate overweight/obese AF patients to take care of their weight and to improve their cardiorespiratory fitness. Although some hospitals offer rehabilitation programs for these patients, only a minority of the AF patients is included in these programs. Moreover, in many countries, reimbursement for rehabilitation of AF patients is non-existent, or as in Belgium, is restricted to patients who underwent an invasive cardiac procedure or who were recently admitted to the hospital with heart failure.
Reducing treatment toxicity in Waldenström macroglobulinemia
Published in Expert Opinion on Drug Safety, 2021
Shayna Sarosiek, Steven P. Treon, Jorge J. Castillo
Atrial fibrillation, one of the most concerning side effects with ibrutinib, has a time to onset that ranges from a few months to more than a year. Although atrial fibrillation risk persists throughout treatment, the variation in time of onset is likely related to the individual patient’s preexisting cardiac conditions [46,47]. As previously reported, the median time of onset was 4 months in patients with a history of atrial fibrillation but 33 months in those with no history of atrial fibrillation [47]. If atrial fibrillation develops, the patient’s stroke risk should be determined. If anticoagulation is required, a thorough assessment of bleeding risk should be completed before starting anticoagulation due to the increased risk of bleeding associated with BTK inhibitors. If it is deemed safe to initiate anticoagulation or if the patient is already on anticoagulation at the time of ibrutinib initiation, direct oral anticoagulants should be preferentially chosen. Concurrent use of vitamin K antagonists was an exclusion criterion in prior trials, so safety data are not available. Despite the paucity of evidence, warfarin may potentially be used in combination with ibrutinib if other treatment options do not exist, a discussion of risks and benefits is performed, and the patient is very closely monitored. Although new atrial fibrillation does not necessitate cessation of therapy, a dose reduction or temporary hold in therapy may occur, while initial treatment of the arrhythmia is facilitated. If clinically indicated, cardiac amyloidosis should be exonerated.
Use of NOACS in high-risk patients with atrial fibrillation in Saudi Arabia: Perspectives on improving patient care
Published in Expert Review of Cardiovascular Therapy, 2021
N AlShoaibi, M Al Harbi, H Modaimegh, A Al Qubbany, S Al Saif, DL Connolly, S Kharabsheh, M Fathy, Y Hegazy, N Tarcha, A Al Fagih
AF mostly occurs concurrently with other cardiovascular diseases like hypertension and valvular diseases [6]. In Saudi, Cardiometabolic diseases like diabetes mellitus (DM), HTN, and IHD are becoming more prevalent. Hence, a significant proportion of the population are prone to developing AF. In a Saudi prospective observational study at a tertiary hospital, hypertension and diabetes mellitus commonly occurred concomitant with AF. Highlighting the need for optimizing anticoagulation based on individualized thromboembolic risk assessment approach [7]. In another retrospective study assessing the clinical characteristics of patients with atrial fibrillation at a tertiary care hospital, the most common clinical findings were heart failure (26.2%), acute embolic complications (7.9%) and respiratory problems (chest infection, bronchial asthma and pulmonary embolism) (29%). Furthermore, 10.1% of all patients presented with acute myocardial infarction. The study also revealed that the most prevalent causes of AF were diabetes mellitus (DM) 68.8%, hypertension (HTN) 59.3%, chronic lung diseases 31.8%, valvular and ischemic heart 23.6% diseases 23.1% [8]. A recent retrospective study of AF risk factors and comorbidities found that AF was more common in females. In addition, most common risk factors for AF in this study were HTN, valvular heart disease, and T2DM. It also found that Hypertension, Coronary Artery Disease, and Chronic Kidney Disease were the most common predisposing factors to HF in AF patients [9].