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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
Fetal arrhythmias are the leading cause of cardiac disorders associated with NIH (40%) [8]. Most of them are secondary to tachyarrhythmias and another fraction is the result of heart block. The most frequent tachyarrhythmia is supraventricular tachycardia, followed by atrial flutter and atrial fibrillation. Etiopathogenic disturbances induced by arrhythmias include reduction of the stroke volume, end-diastolic overload, and systemic venous congestion. Sustained fetal tachycardia results in elevated ventricular end-diastolic pressure, which may lead to increased central venous pressure and decreased cardiac output, resulting in NIH, which occurs in about half of these cases, leading to fetal demise in 9% of untreated cases [9]. These conditions are susceptible to in utero treatment with antiarrhythmic drugs administered to the mother or the fetus, improving survival. Historically, the first-line drug has been digoxin. Alternatives are flecainide, sotalol, amiodarone, verapamil, and adenosine. Maternal administration of these drugs is frequently hampered by difficulties associated with an enlarged placenta [10]. Therefore, direct administration to the fetus has been suggested as an alternative, particularly in cases where there is no fetal response to maternal oral administration of medications.
Effects of Stress on Physiological Conditions in the Oral Cavity
Published in Eli Ilana, Oral Psychophysiology, 2020
Psychological stress has been reported to be a risk factor in sudden cardiac death in individuals without underlying structural heart disease. Brodsky et al.132 identified 6 patients (out of a group of 80) who experienced life-threatening tachyarrhythmia without underlying structural heart disease. Of these patients, 5 experienced marked psychological stress. Cases have been described in which sudden and rapid death were attributed to psychological stress (e.g., loss of status or self-esteem, situations which present real or symbolic personal danger, etc.).133
Thromboembolism and Amniotic Fluid Embolism
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Oddly enough, significant hypoxemia was a rare finding in PE, with many patients with oxygenation >95% [7]. Cardiac arrhythmias are present in approximately 10% of patients diagnosed with a PE, usually a tachyarrhythmia. Although sinus tachycardia is the most common tachyarrhythmia, others can present with atrial fibrillation, atrial flutter, and multifocal atrial tachycardia [8].
Recurrent syncope in patients with a pacemaker and bradyarrhythmia
Published in Scandinavian Cardiovascular Journal, 2023
Julie Majormoen Davidsen, Regitze Skals, Frederik Dalgaard, Bhupendar Tayal, Christian Torp-Pedersen, Peter Søgaard, Christina Ji-Young Lee
We found cerebrovascular disease a significant risk factor of recurrent syncope, which could be explained by mediation of post-stroke sequelae, such as orthostatic hypotension, new-onset arrhythmias, and seizures [17–19]. Furthermore, AF was associated with a decreased risk of recurrent syncope, and while the exact mechanism is unknown, we can speculate that in patients with both bradyarrhythmia and AF, pacing could allow for better treatment of tachyarrhythmia. Alternatively, the increased competing risk of mortality in patients with AF observed in this study could in part explain the lower risk. Confirming previous studies investigating history of prior syncope episodes in risk of syncope, our study found an increasing number of syncopes a significant risk factor [3,4,16]. When comparing devices, no associated differences were found for recurrent syncope supported by another study [3]. While knowledge of pacemaker implantation and pacing mode due to arrhythmias has improved in recent years, specifically, studies of the trajectory of syncope with or without cardiac pacing are warranted.
Updates in the management of congenital heart disease in adult patients
Published in Expert Review of Cardiovascular Therapy, 2022
Danielle Massarella, Rafael Alonso-Gonzalez
Arrhythmias are more common in patients with congenital heart disease than in the general population, and the prevalence increases with age [1]. It is estimated that approximately 50% of young adults with congenital heart disease will suffer from tachyarrhythmia during their lifetime [2]. Whereas tachyarrhythmias are more prevalent in this population, bradyarrhythmias often coexist or even represent the first presentation in some patients. Predisposing factors include genetics, anatomic features (both pre- and post-operative), deleterious cell–cell coupling, and/or electromechanical dyssynchrony. In addition to age, risk factors for arrhythmia include smoking, hypertension, heart failure, and diabetes mellitus, among others [11]. Arrhythmia represents the most common reason for presentation to the emergency department and hospital admission in patients with congenital heart disease, speaking to the high degree of morbidity this complication confers [1]. Some key determinants of risk of arrhythmia in adulthood include age at repair, cyanosis, residual ventricular volume and pressure overload and comorbid sinus node dysfunction. In practice, the relationship between recognized risk factors and the development of arrhythmia is nuanced and non-linear.
Clinical electrophysiology of the aging heart
Published in Expert Review of Cardiovascular Therapy, 2022
Kyle Murray, Muizz Wahid, Kannayiram Alagiakrishnan, Janek Senaratne
Palpitations are a heightened or uncomfortable awareness of heartbeat and are a common reason for elderly patients to present to a clinic or hospital [34]. Palpitations are divided into cardiac and noncardiac causes. Noncardiac causes are further subclassified into psychosomatic, medical illness, and pharmacologic mediated. Cardiac causes are secondary to arrhythmias (e.g. tachyarrhythmia, bradyarrhythmia, and extrasystoles) and structural heart disease (e.g. valvular disease, heart failure, and hypertrophic cardiomyopathy). In adults presenting to emergency with palpitations, 47% of cases are a cardiac cause [35]. Patients who are elderly, male, have irregular palpitations, palpitations lasting >5 minutes, and history of coronary artery disease (CAD) have a high likelihood of a cardiac cause [24].