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Management of Atrial Fibrillation in Patients with Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Panagiotis Korantzopoulos, Aris Bechlioulis
Cardioversion has been associated with an increased risk of embolic stroke in patients not on anticoagulation therapy. All patients planned for immediate cardioversion should receive immediate anticoagulation. Patients who have been in AF for longer than 48 h should start anticoagulation therapy for at least three weeks before cardioversion, whereas, in the case of an urgent cardioversion in a patient with AF lasting >48 hours, a transesophageal echocardiogram is recommended to reduce the possibility of left atrial thrombi before cardioversion.1
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Cardioversion appears to be safe for the fetus (Clark et al., 1994). Digoxin and propranolol may also be used (Box 3.6). Recently adenosine, 6-mg dose given as a rapid intravenous bolus, was recommended for treatment of supraventricular tachycardia. As previously noted limited information regarding the safety of this agent during pregnancy. However, there are several reports regarding its efficacy in pregnant women are published (Afridi et al., 1992; Hagley and Cole, 1994; Mason et al., 1992). Electrical cardioversion should be reserved for patients with cardiac decompensation in whom medical therapy has failed.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Additional treatments are based on the cause of pulmonary edema. If there is rapid atrial fibrillation, cardioversion is done. Intravenous beta-blockers, digoxin, or careful use of calcium channel blockers can slow the ventricular rate. Intravenous vasodilators are used for severe hypertension. For acute MI or another acute coronary syndrome, treatments include thrombolysis or direct percutaneous coronary angioplasty, with or without stenting. The fluid status is usually normal before pulmonary edema develops. Therefore, diuretics may be not useful when patients have acute decompensation of chronic HF, and can precipitate hypotension. When systolic BP is lower than 100 mg Hg or there is shock, IV dobutamine and counterpulsation with an intra-aortic balloon pump may be needed. Direct-current cardioversion is used for ventricular or supraventricular tachycardia. Newer drugs are available but do not improve outcomes greatly, and can even be implicated in the death of the patient. These include intravenous BNP (nesiritide), ibopamine, levosimendan, pimobendane, and vesnarinone. Once the patient is stabilized, long-term treatment for HF is started.
Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India
Published in Acta Cardiologica, 2021
Sharad Chandra, Abhishek Gupta, Gaurav Chaudhary, VS Narain, SK Dwivedi, Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Akhil Sharma, Monika Bhandari, Salvatore Cassese
Between January 2018 and November 2018, all patients admitted at our institution with severe MV stenosis were screened for possible enrolment in this study. Out of a total of 250 admitted patients, 98 (39.2%) patients were selected in this study, to assess safety and feasibility of SDD. Among those treated with PBMV, a total of 94 (96%) were discharged on the same day. Four patients could not be discharged as 3 (3.1%) patients developed severe MV regurgitation and 1 (1.0%) patient developed pericardial tamponade requiring pericardiocentesis. Among those individuals with severe MV regurgitation after PBMV, 1 patient had anterior mitral leaflet tear and required urgent surgery for MV replacement due to rapid hemodynamic deterioration. The remaining 2 patients had commissural severe MV regurgitation, but remained hemodynamically stable and were managed conservatively. These latter patients presented with NYHA class II at 30-day clinical examination. One patient had ventricular tachycardia during procedure requiring electrical cardioversion. Overall, no patient died during hospital stay or at 30-day follow-up and patients who experienced periprocedural complications recovered completely at 30-day follow-up.
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
For more stable patients, pharmacologic cardioversion can be attempted. However, control of rapid ventricular rate response should take priority over cardioversion, as rapid ventricular rates shorten diastolic filling times which may adversely affect fetal perfusion; prompt rate control of AF can be accomplished using digoxin, beta-blockers or non-dihydropyridine calcium channel blockers (CCBs) in pregnant women30. Between the two CCBs, verapamil and diltiazem, verapamil may be the preferred agent due to more extensive experience with its use during pregnancy34. However, IV administration of verapamil carries a risk of precipitating maternal hypotension and secondary hypoperfusion causing fetal bradycardia, high-degree AV block, and hypotension35.
Inotersen therapy of transthyretin amyloid cardiomyopathy
Published in Amyloid, 2020
Noel R. Dasgupta, Stacy M. Rissing, Jessica Smith, Jeesun Jung, Merrill D. Benson
Supportive treatments of the consequences of ATTR cardiomyopathy are in 2 main categories which certainly prolong life beyond the recognised 2.5 to 4.5 year mean survival after diagnosis of ATTR cardiomyopathy [3,4]. (1) Maintenance of a normal or controlled ventricular rate and rhythm to allow optimal diastolic filling of the left ventricle favours maintaining cardiac output and therefore tissue perfusion. Cardioversion for atrial fibrillation is usually effective in the early stages of ATTR cardiomyopathy but often fails with advanced atrial enlargement. Ventricular pacemakers may be needed for conduction system failure but mechanical defibrillators are usually not optimally effective in cardiac amyloidosis. (2) Medical control of the systemic manifestations of cardiovascular amyloidosis is imperative in the care of patients with ATTR congestive heart failure. Retention of electrolytes and water as a response to the failing heart usually reaches a point where cardiac function suffers more than it is helped. Any medication given to ease the load on the heart may lead to fluid retention and decline in effective tissue perfusion. Diuretic medications to reverse the negative response of the kidney are the mainstay of alleviating the effects of congestive heart failure. While life can certainly be prolonged by these non-specific therapeutic measures they do not affect the progressive ingravescent course of transthyretin cardiomyopathy. Therapy to slow or stop the progression of cardiac amyloid burden is needed and may be achievable.